硝普钠与硝酸甘油治疗急性左心衰竭的疗效观察

目的探讨硝普钠与硝酸甘油治疗急性左心衰竭的临床效果。方法将2008年1月～2010年1月间在我院住院治疗的急性左心衰竭患者70例随机分为观察组和对照组,在综合治疗的基础上对照组给予硝酸甘油治疗,观察组给予硝普钠他汀。结果治疗后两组患者在收缩压、舒张压及心率方面均优于治疗前,两者比较差异具有统计学意义(P<0.05)。治疗后观察组患者在收缩压、舒张压及心率改善方面优于对照组,两组比较差异具有统计学意义(P<0.05)。观察组总有效率为97.14%,对照组为77.14%,两组比较差异具有统计学意义(P<0.05)。两组患者均未见明显的药物不良反应。结论在抢救急性左心衰中硝普钠较硝酸甘油更有优势,值得应用。     

托吡酯和丙戊酸钠预防小儿偏头痛的对比研究

目的探索托吡酯预防小儿偏头痛发作的有效性、安全性和耐受性。方法采用前瞻性的方法,给予小儿偏头痛患者口服托吡酯25~50mg/d,分早晚两次口服,从第1周12.5 mg/d开始,每周递增12.5mg,最大量至50 mg/d;丙戊酸钠则从200mg/d,分早晚两次口服,必要时增至400 mg/d。观察患者治疗前后头痛发作频率、天数和疼痛程度,同时将托吡酯和丙戊酸钠的上述指标进行对比。结果平均每月发作频率均较前减少,托吡酯组和丙戊酸钠组分别从12.38次减至3.52次和14.33次减至6.48次,2组差别无显著性;平均每月头痛天数均较前减少,分别从12.43d减至3.38d和14.58d减至7.19d,2组差别无显著性。头痛程度均较前减轻,分别从7.52分减轻至2.00分和7.24分减轻至3.19分,2组无显著差别。托吡酯的不良反应为记忆力下降、食欲减退、发热、上呼吸道感染、头痛加重。结论托吡酯和丙戊酸钠均能有效预防偏头痛发作,且二者疗效无显著性差异。     

不同麻醉下老年患者静脉输注乳酸钠林格氏液的容量动力学

目的 比较不同麻醉下老年患者静脉输注乳酸钠林格氏液容量动力学的差异.方法 择期行上腹部手术老年患者30例,年龄65～79岁,ASA Ⅰ或Ⅱ级,随机分为2组(n=15):单纯全麻组(GA组)和硬膜外复合全麻组(GE组).GE组经T8.9硬膜外穿刺置管,注入2%利多卡因4 ml使阻滞平面达T4,然后硬膜外给予0.25%布比卡因8～10 ml.2组静脉注射咪达唑仑2 mg、芬太尼3μg/kg、异丙酚1.5 mg,kg和琥珀胆碱1.5 mg/kg麻醉诱导,气管内插管后行机械通气.麻醉诱导后2组经30min静脉输注乳酸钠林格氏液30 ml/kg,随后以0.1 ml·kg-1·min-1的速率继续输注60 min.连续监测心率、平均动脉压、中心静脉压、心脏指数、每搏量指数、胸内血容量指数及血管外肺水容量指数;桡动脉采血测定血红蛋白浓度和红细胞压积;记录试验过程中的尿量;应用容量动力学理论和物质守恒定律,计算中央容量稀释率、血浆容量增加、容量扩张效率、外周容量增加和清除率(K).尿量与Kr进行直线相关分析.结果 GA组和GE组乳酸钠林格氏液分布均符合容量动力学二室模型.与GA组比较,GE组中央容量稀释率、血浆容量增加和容量扩张效率升高,尿量和Kr减少(P<0.05),外周容量增加差异无统计学意义(P>0.05).GA组尿量与Kr呈正相关(r=0.551,P<0.05);GE组尿量与K呈正相关(r=0.531,P<0.05).结论 与单纯全麻比较,老年患者硬膜外复合全麻下静脉输注乳酸钠林格氏液的容量扩张效率增强.     

Inter- and intra-subject variability of nitrendipine and the effects of food

Summary Plasma concentrations of nitrendipine were measured, after single (20 mg) oral doses, in young healthy volunteers.On three occasions the subjects ingested the dose having fasted overnight. Data from these three occasions were used to assess variability in nitrendipine pharmacokinetics and both inter- and intra-subject variability were high.On a fourth occasion, the subjects took the tablet after a standard meal.The effects of food on nitrendipine pharmacokinetics, based on the comparison of data from the first fasting visit and the food visit, were negligible.     

Factors influencing compliance with dietary advice: the Diet And Reinfarction Trial (DART)

Factors influencing compliance with dietary advice were investigated in the Diet and Reinfarcation Trial (DART). In terms of achieved intakes, smokers had a lower mean P/S ratio and fibre intake than non-smokers; manual workers had a lower mean fibre intake than non-manual workers; and obese men had a higher percentage of energy from fat and lower P/S ratio than non-obese men. However the effect of the advice (difference in intakes of those advised and thosen not advised) was similar in smokers and non-smokers and was similar in all social classes. The effect of fat advice was less among obese men than among non-obese men, probably as a result of weight-reducing advice given to all overweight men. Fat advice tended to have a greater effect among those who gave up smoking after their heart attack than among non-smokers and those who continued to smoke but the difference was not statistically significant. This suggests that advice on diet and smoking can be given simultaneously and still be effective.     

气相色谱法研究赋形剂对苯唑青霉素钠稳定性的影响

采用程序裂解-气相色谱(GC)检测系统,配合红外光谱等手段,研究常用赋形剂如硬脂酸、硬脂酸镁、淀粉、滑石粉和碳酸钙等对苯唑青霉素钠和氨苄青霉素稳定性的影响。实验结果表明,硬脂酸和苯唑青霉素钠有固相反应发生,不宜作苯唑青霉素钠固体制剂的赋形剂,其它赋形剂在相同条件下无此现象。这与差热分析的结果一致。     

差示脉冲极谱法测定硝普钠溶液含量

本文建立了极谱法测定硝普钠含量的方法。采用pH7.2缓冲溶液为支持电解质溶液。以峰高为定量依据。在25～97μg·ml~(-1)浓度范围内,峰高与浓度有良好的线性关系,相关系数为:r=0.9999。方法回收率为99.39%,C.V.(%)=0.54,灵敏度达0.3μg/ml~(-1),以1M高氯酸(内含1mg·ml~(-1)K_4[Fe(CN)_6)为支持电解质,灵敏度可提高到2ng/ml。该分析方法有良好的专一性。     

Calcium Sensitization Induced by Sodium Fluoride in Permeabilized Rat Mesenteric Arteries

It was hypothesized that NaF induces calcium sensitization in Ca²⁺-controlled solution in permeabilized rat mesenteric arteries. Rat mesenteric arteries were permeabilized with β-escin and subjected to tension measurement. NaF potentiated the concentration-response curves to Ca²⁺ (decreased EC₅₀ and increased E_max). Cumulative addition of NaF (4.0, 8.0 and 16 mM) also increased vascular tension in Ca²⁺-controlled solution at pCa 7.0 or pCa 6.5, but not at pCa 8.0. NaF-induced vasocontraction and GTPγS-induced vasocontraction were not additive. NaF-induced vasocontraction at pCa 7.0 was inhibited by pretreatment with Rho kinase inhibitors H1152 or Y27632 but not with a MLCK inhibitor ML-7 or a PKC inhibitor Ro31-8220. NaF induces calcium sensitization in a Ca²⁺-dependent manner in β-escin-permeabilized rat mesenteric arteries. These results suggest that NaF is an activator of the Rho kinase signaling pathway during vascular contraction.     

Mexiletine-responsive erythromelalgia due to a new Nav1.7 mutation showing use-dependent current fall-off

Inherited erythromelalgia (IEM), characterized by episodic burning pain and erythema of the extremities, is produced by gain-of-function mutations in sodium channel Na_v1.7, which is preferentially expressed in nociceptive and sympathetic neurons. Most patients do not respond to pharmacotherapy, although occasional reports document patients as showing partial relief with lidocaine or mexiletine. A 7-year-old girl, with a two-year history of symmetric burning pain and erythema in her hands and feet, was diagnosed with erythromelalgia. Treatment with mexiletine reduced the number and severity of pain episodes. We report here a new IEM Na_v1.7 mutation in this patient, and its response to mexiletine. SCN9A exons from the proband were amplified and sequenced. We identified a single nucleotide substitution (T2616G) in exon 15, not present in 200 ethnically-matched control alleles, which substitutes valine 872 by glycine (V872G) within DII/S5. Whole-cell patch-clamp analysis of wild-type and mutant Na_v1.7 channels in mammalian cells show that V872G shifts activation by − 10 mV, slows deactivation, and generates larger ramp currents. We observed a stronger use-dependent fall-off in current following exposure to mexiletine for V872G compared to wild-type channels. These observations suggest that some patients with IEM may show a favorable response to mexiletine due to a use-dependent effect on mutant Na_v1.7 channels. Continued relief from pain, even after mexiletine was discontinued in this patient, might suggest that early treatment may slow the progression of the disease.     

Renal responses to angiotensin II infusion in early type 1 (insulin-dependent) diabetes.

The renal response to infusion of sub-pressor doses of angiotension II was examined in nine euglycaemic Type 1 (insulin-dependent) diabetic patients with diabetes of short duration and nine non-diabetic control subjects. Plasma concentrations of angiotensin II and of free insulin were similar in both groups at baseline and during angiotensin II infusion. Glomerular filtration rate (Inutest clearance) fell to a similar extent during angiotensin II infusion in both groups (diabetic 116(SE 5) to 102(5) ml min-1 1.73-m-2; control 113(6) to 100(5) ml min-1 1.73-m-2). There was a large dose-dependent fall in effective renal plasma flow (p-aminohippurate clearance) during angiotensin II infusion which was of similar magnitude in both groups (diabetic; 694(46) to 521(21) ml min-1 1.73-m-2; control 665(41) to 498(30) ml min-1 1.73-m-2). The absolute and the fractional rates of urinary excretion of sodium were both lower in the diabetic group throughout the study, but there was a comparable antinatriuretic response to angiotensin II. Thus, the renal haemodynamic response to angiotensin II infusion is normal in early well-controlled Type 1 diabetes. Differences were found in the renal handling of sodium, which could not be related to altered renal tubular responses to angiotensin II or to peripheral hyperinsulinaemia.