清热涤痰定喘汤联合穴位贴敷治疗支气管哮喘随机平行对照研究

[目的]观察清热涤痰定喘汤联合穴位贴敷治疗支气管哮喘疗效。[方法]使用随机平行对照方法,将78例住院及门诊患者按随机数字表法分为两组。对照组39例氨茶碱,4~6mg/kg,3次/d;沙美特罗替卡松粉吸入剂,50/250ug,1吸/次,2次/d。治疗组39例清热涤痰定喘汤(荆芥、麻黄、黄芩各12g,炙百部、炙冬花、炙金沸草、射干各6g,石膏、法夏各10g,葶苈子、苏子、神曲、山楂、橘红各15g,芦根30g);1剂/d,水煎至300mL,3次/d。痰涎壅盛、苔白腻加复方蛇胆陈皮末;腑气不通加胖大海10g,瓜壳15g;口渴加天花粉15g;舌苔黄腻加滑石15g,木通12g,郁金10g,黄连3g。穴位敷帖:在患者大椎、气海、肺俞等穴位贴敷冬病夏治消喘贴膏,白芥子、细辛各21g,甘遂、元胡各12g,皂角20g,研细末生姜汁调膏敷贴;0.5~2h/次,如皮肤异常,将贴敷时间缩短。每年夏季入伏日期,1次/10d,共贴3次。连续治疗30d为1疗程。观测临床症状、不良反应。治疗1疗程,判定疗效。[结果]治疗组痊愈25例,显效12例,无效2例,总有效率94.87%。对照组痊愈12例,显效16例,无效11例,总有效率71.79%。治疗组疗效优于对照组(P0.05)。[结论]清热涤痰定喘汤联合穴位贴敷治疗支气管哮喘效果显著,值得推广。     

依诺沙星对氨茶碱药代动力学的影响

目的：测定健康人单用氨茶碱及合用依诺沙星后的血清茶碱浓度，并进行药代动力学比较。方法：采用反相高效液相色谱法（RP－HPLC）测定8名健康人单用氨茶碱及合用依诺沙星后茶碱的稳态血药浓度，并对两种情况下茶碱的药代动力学参数进行对比研究。结果：联用依诺沙星后血清茶碱浓度普遍提高，最大血药浓度（Cmax)与单用氨茶碱相比有显性差异（P＜0．05），药时曲线下面积（AUC）显提高（P＜0．05），清除率（Cl)明显降低（P＜0．05），半衰期（T1／2）明显延长（P＜0．05）。结论：依诺沙星可使氨茶碱的血清浓度提高，药时曲线下面积（AUC）和半衰期（T1／2）增大，清除率（Cl)减小。     

心肺复苏早期应用氨茶碱与传统方法的比较研究

目的：探讨心肺复苏（CPR）早期应用氨茶碱的临床意义。方法：将100例心脏骤停（CA）患者，随机分成观察组（肾上腺素＋氨茶碱组）、对照组（肾上腺素组），对照组按照传统CPR方法。静脉注射肾上腺素；观察组在传统方法的基础上早期加用氨茶碱静注。对两组在6h、24h存活率及正常出院方面进行统计学分析。结果：（1）两组在性别、年龄、疾病构成方面无统计学差异（P〉0．05）；（2）两组在肾上腙素剂量、开始使用时间、直流电除颤等方面比较无统计学差异（P〉0.05）；（3）观察组6h存活率与对照组比较有显著性差异（P〈0．05）；两组24h存活率无统计学差异，但在正常出院方面观察组略优于对照组。结论：（1）早期使用氨茶碱可提高6h存活率，正常出院略优于单使用肾上腺索组（对照组）；（2）早期使用氨茶碱可能对最终生存率有益。     

氨茶碱在体外循环中对肺的保护作用

目的探讨氨茶碱对体外循环(CPB)所致肺损伤的保护作用.方法选择心瓣膜置换术患者20例,采用随机化分组表分为氨茶碱组和对照组,每组10例.氨茶碱组于麻醉诱导后缓慢(5分钟)静脉注射氨茶碱(5 mg/kg),其后按0.5mg/kg·h经微量泵持续静脉注射;对照组用等容量平衡盐溶液静脉注射.两组均于CPB前、CPB结束后1、8和24小时测定肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)的血浆水平,同时测量两组患者围术期血流动力学、呼吸指数(RI)、右心房血/左心房血中性粒细胞比值和血浆丙二醛(MDA)含量等.结果CPB结束后1小时和8小时,对照组RI较CPB前和氨茶碱组明显增高(P<0.05),氨茶碱明显抑制了中性粒细胞在肺内的聚集,抑制TNF-α和IL-8的释放,减少MDA产生,促进IL-10的产生.结论氨茶碱能够减轻炎性反应和CPB导致的肺损伤.     

氨茶碱涂膜剂经皮吸收及平喘作用的研究

氨茶碱涂膜剂为一种新颖的骨架型经皮给药系统。采用离体鼠皮进行该涂膜剂的体外渗透试验，并用组胺－乙酰胆碱引喘试验考察其平喘作用。结果表明，涂膜剂中氨茶碱以零级动力学经皮吸收；０～１２ｈ累积渗透量为４０．４％，渗透速率７７．６８μｇ／ｃｍ２·ｈ，本品有显著平喘作用，其作用优于氨茶碱溶液剂。     

常用平喘穴对氨茶碱经皮吸收的影响

目的　比较氨茶碱贴剂在常用平喘给药后 ,家兔皮肤电阻与血浆中氨茶碱浓度的经时变化 ,考察不同穴位对药物经皮吸收的影响 ,验证穴位给药的差异性。方法　采用HPLC UV法测定血浆中氨茶碱的含量 ,电阻测定仪测定皮肤电阻。结果　电阻经时曲线符合二次函数关系 ,肺俞、膻中、膈俞等穴的电阻值与非穴位相比均有极显著差异 (P <0 0 1) ,定喘穴与非穴位相比有显著性差异 (P <0 0 5 ) ,各穴位组之间不存在显著性差异 (P >0 0 5 ) ;血药浓度经时曲线近似符合零级释放 ,肺俞、膻中穴给药后的血药浓度与非穴位相比有极显著差异 (P <0 0 1) ,膈俞穴与非穴位相比有显著性差异 (P <0 0 5 )。结论　各穴位组给药后的血药浓度比较发现 ,肺俞、膻中穴与膈俞穴之间有极显著差异 (P <0 0 1) ,肺俞与膻中存在显著性差异 (P <0 0 5 )。此外 ,各穴位的血药浓度和对应的皮肤电阻之间存在负相关关系     

Anxiolytic effect of carbamazepine in the elevated plus-maze: possible role of adenosine

In order to extend previously reported observations with other animal models of anxiety, the effect of carbamazepine (CBZ) was presently measured in rats placed on the elevated plus-maze. Intraperitoneal injection of CBZ (5–40 mg/kg) increased the percentage of open arm entries as well as the percentage of time spent on the open arms of the maze, without affecting the total number of arm entries. This effect is characteristic of anxiolytic drugs. The inhibitor of adenosine neuronal uptake papaverine (5–40 mg/kg) caused a similar anxiolytic effect, whereas the adenosine receptor antagonist aminophylline (1–4 mg/kg) selectively decreased the percentage of open arm entries, indicative of an anxiogenic effect. Furthermore, the combination of an anxiogenic dose (4 mg/kg) of aminophylline with an anxiolytic dose (40 mg/kg) of CBZ resulted in cancellation of each other effects. Since reported neurochemical evidence shows that CBZ interacts with adenosine receptors, the present results provide preliminary support for a participation of this neurotransmitter in the anxiolytic action of CBZ.     

小剂量氨茶碱治疗缓慢室率性房颤的长期疗效观察

目的研究小剂量氨茶碱对老年缓慢心室率性心房纤颤的长期疗效。方法１５例有症状的老年缓慢心室率性房颤病人口服氨茶碱（１５０ｍｇ／ｄ）。治疗前及治疗后第７天、第１、３、６、９及１２个月行心电图及动态心电图检查。结果以均数±标准差表示，采用秩和检验分析差异显著性。结果治疗后第７天静息心率、２４小时平均心率、最慢心率及最快心率分别增加３８％（Ｐ＜０．０１）、２８％（Ｐ＜０．０１）、２６％（Ｐ＜０．０５）及１６％（Ｐ＜０．０１），２４小时＞２５００ｍｓ的心脏停搏次数减少９４％（Ｐ＜０．０１），室性早搏次数增加６％，但差异不显著。随访１２个月（中位数），各项参数与治疗后第７天的结果相似，临床症状明显减轻或消失。结论小剂量氨茶碱治疗老年缓慢心室率性房颤有效。     

复苏早期应用氨茶碱对腺苷及血管活性因子的影响

目的： 观察心搏骤停大鼠复苏早期应用氨茶碱对复苏成功率、血浆去甲肾上腺素(NE)、腺苷、一氧化氮(NO)水平及心肌组织内皮素-1(ET-1)、腺苷水平的影响。方法: 选60只SD大鼠，随机分为3组：手术对照组、肾上腺素治疗组和肾上腺素+氨茶碱治疗组各20只。分别测定治疗组自主循环恢复30 min后及手术对照组的血浆NE、腺苷、NO及心肌组织ET-1、腺苷的水平。结果: 肾上腺素+氨茶碱治疗组自主循环恢复时间明显少于肾上腺素治疗组(P＜0.05)。肾上腺素+氨茶碱治疗组自主循环恢复率为75%，30 min存活率为70%，肾上腺素治疗组分别为60%和55% (P>0.05)。2个治疗组自主循环恢复大鼠的血浆腺苷、NE水平及心肌组织ET-1、腺苷水平均明显高于手术对照组(P<0.05)，肾上腺素治疗组血浆NO水平也显著高于手术对照组(P＜0.01)，肾上腺素+氨茶碱治疗组血浆NO及心肌组织ET-1水平低于肾上腺素治疗组(P＜0.05)。结论: 在复苏早期应用腺苷受体拮抗剂氨茶碱不仅可提高复苏成功率，并且降低血浆NO和心肌组织ET-1水平，有利于减轻复苏后综合征。     

Effect of tolbutamide on aminophylline-, 3,5-AMP-dibutyrate-or glucagon-induced insulin release from pancreatic islets after impairment of pyridine nucleotide metabolism caused by 6-aminonicotinamide (6-AN)

Summary The effect of tolbutamide on pyridine nucleotides and insulin secretion stimulated by aminophylline, 3,5-AMP-dibutyrate or glucagon was studied in pancreatic islets of rats previously treated with 6-aminonicotinamide (6-AN), an inhibitor of pyridine nucleotide synthesis.After being incubated for 60 min in a Krebs-Ringer-Bicarbonate-Buffer in the absence of glucose, pancreatic islets of rats i.p. injected with 35 mg/kg of 6-AN 6 hrs before pancreas removal contained about 30% less NADP and NADPH than did islets of control rats. No changes of NAD or NADH were observed in islets of 6-AN-treated animals. Addition of 16.5 mM glucose led to an increase of NADH, NADPH and a decrease of NADP in islets of both groups of animals; NAD levels remained unchanged. In vitro addition of tolbutamide to islets of control rats did not affect the levels of NADPH or NADP in the presence of 5.5 mM glucose. When 16.5 mM glucose were present, a decrease of NADPH and an increase of NADP was obvious. No effect of tolbutamide on insular NADPH or NADP was observed in islets of rats previously treated with 6-AN be it in the presence of 5.5 or 16.5 mM glucose.In islets of 6-AN-treated rats insulin release in response to aminophylline or 3,5-AMP-dibutyrate in the presence of 5.5 mM glucose was significantly depressed, when compared to islets of untreated controls. Addition of tolbutamide increased insulin release due to aminophylline, 3,5-AMP-dibutyrate or glucagon from islets of controls. Tolbutamide alone was without effect. In islets of 6-AN-treated rats aminophylline, 3,5-AMP-dibutyrate or glucagon stimulated insulin release only when tolbutamide was present.Our data suggest that there is no direct interference of tolbutamide with pyridine nucleotides of pancreatic islets, and that tolbutamide increases the secretory response of the -cell to aminophylline, 3,5-AMP-dibutyrate or glucagon when insulin release due to these agents is inhibited during decrease of insular NADP and NADPH, caused by 6-AN.Supported by the Deutsche Forschungsgemeinschaft.