硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效观察

目的探讨硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效。方法将笔者所在医院2011年3月～2012年3月72例慢性肺源性心脏病患者随机分成对照组和治疗组,对照组患者进行常规的抗感染、保持呼吸道通畅、利尿、扩张血管、纠正电解质平衡等治疗;治疗组在对照组的基础上加用硫酸镁和银杏达莫。观察两组患者治疗前后心功能、肺动脉收缩压的改善情况,并进行临床观察分析。结果治疗组的总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论硫酸镁联合银杏达莫治疗慢性肺源性心脏病疗效显著,临床上建议进一步推广运用。     

异甘草酸镁对慢性肝病实验室指标改善的价值

目的探讨异甘草酸镁(MIG)对慢性肝病患者实验室指标改善的价值。方法 66例应用MIG注射液(150mg/日)和129例应用非甘草酸类(非-MIG)如二氯醋酸二异丙胺注射液(80mg/日)单独或合并应用其他保肝药物治疗,观察治疗1周和2周时患者血常规、血电解质和血生化指标的变化。结果与非-MIG治疗组比,MIG治疗1周时能升高白细胞(P=0.01),ALT、AST、ALP和GGT降低非常明显(P<0.01)。MIG开始治疗时患者ALT、AST、ALP和GGT水平分别是非-MIG治疗组患者的5倍(P<0.01)、2.94倍(P<0.01)、2.41倍(P<0.01)和1.63倍(P<0.01),治疗2周后MIG治疗组这些指标分别下降到非-MIG治疗组的1.53倍(P=0.03)、1.04倍(P=0.79)、1.29倍(P=0.26)和1.1倍(P=0.33);治疗2周后,MIG组和非-MIG治疗组患者TP、ALB、Hb均有所下降,但两组间无统计学差异(P>0.05)。结论 MIG对慢性肝损伤的治疗安全有效,血清酶学恢复迅速,未见明显的副作用。     

MEMBRANE Na &#180 +;-K &#180 +; ATPase MEDIATED CASCADE IN BIPOLAR MOOD DISORDER,MAJOR DEPRESSIVE DISORDER,AND SCHIZOPHRENIA RELATIONSHIP TO HEMISPHERIC DOMINANCE

The isoprenoid pathway produces digoxin, an endogenous membrane Na &#180 +;-K &#180 +; ATPase inhibitor and regulator of neurotransmitter transport. The objective of the study was to relate digoxin status and hemispheric dominance to the pathogenesis of psychiatric disorders--bipolar mood disorder, major depressive disorder, and schizophrenia. The following parameters were assessed in bipolar mood disorder during the manic phase and depressive phase of the illness as well as in major depressive disorder, and schizophrenia: HMG CoA reductase activity, tryptophan and tyrosine catabolic patterns, red blood cell (RBC) Na &#180 +;-K &#180 +; ATPase activity, and serum magnesium. These parameters were compared to individuals of dif fering hemispheric dominance. The levels of serum digoxin and HMG CoA reductase activity were found to be decreased in the depressive phase of bipolar mood disorder and major depressive disorder with a cor responding increase in RBC Na &#180 +;-K &#180 +; ATPase activity and serum magnesium levels. There was increase in tyrosine and tyrosine catabolites, and a reduction in tryptophan and its catabolites, in the serum in the depressive phase of bipolar mood disorder and major depressive disorder. The neurotransmitter patterns and digoxin levels in the depressive phase of bipolar mood disorder/major depressive disorder correlated with those in right-handed/left hemisphere dominant individual. The neuro transmitter patterns and digoxin levels in the manic phase of bipolar mood disorder and schizophrenia correlated with those in left-handed/right hemisphere dominant individuals. Digoxin status and hemispheric domi nance could correlate with the pathogenesis of psychiatric disorders--schizophrenia, major depressive disorder, and bipolar mood disorder.     

SLC41A1 is the only magnesium responsive gene significantly overexpressed in placentas of preeclamptic women

Objective: To examine expression profile of magnesium responsive genes (MRGs) in placentas of normoevolutive and preeclamptic women. Methods: The expression profiles of MRGs were determined in placentas of normoevolutive (N?=?26) and preeclamptic (N?=?25) women by RT-qPCR. Results: Among all tested MRGs (9) only SLC41A1 (encoding for Na⁺/Mg²⁺ exchanger) was significantly overexpressed in ～54.2% of preeclamptic (n?=?24) and in ～9.5% of normoevolutive (n?=?21) specimens. On average, SLC41A1 was overexpressed sixfold in the preeclamptic group. Presence of SLC41A1 in placentas was confirmed by Western blot analysis. Conclusion. SLC41A1 is significantly overexpressed in nearly 55% of preeclamptic placentas. This may indicate a direct contribution of changed Mg homeostasis in the development of preeclampsia.     

Plasma Peroxyl Radical-Trapping Capacity in Severe Preeclampsia is Strongly Related to Uric Acid

The total peroxyl radical-trapping antioxidant parameter (TRAP) of plasma from nine patients suffering from severe preeclampsia was compared with that from nine control patients sharing the same weeks of pregnancy. Measurement of TRAP was by a new chemiluminescent method. The mean TRAP in preeclamptic patients was 1288 ± 110 µmol/l and in control patients 970 ± 153 µmol/l (p<0.001). TRAP was highly correlated with plasma uric acid (r=0.86), and 91% of the increase in TRAP was due to increase in uric acid, which raises a question of the possible antioxidative role of uric acid in preeclampsia.     

Potassium,Magnesium, and Electrolyte Imbalance and Complications in Disease Management

Electrolyte balance is a critical issue in managing comorbid conditions in both diseased and elderly patients. Patients with hypertension and diabetes need careful regulation of their calcium and magnesium levels, whereas in patients with congestive heart failure, sodium and potassium levels also are critical. Herein we report the outcome of a round table discussion at which issues of renal magnesium clearance, magnesium and arrhythmic risk, ion balance in heart failure, diabetes, ischemic stress, oxidative stress in the cardiomyopathy of magnesium deficiency, roles of magnesium and potassium in bone metabolism and the aging population, and the role of electrolyte balance in hypertension have been discussed. In all these issues the maintaining homeostasis of potassium and magnesium is critical and the various therapies that impact on retaining these ions were discussed. Hallmark studies, i.e., Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial and Studies of Left Ventricular Dysfunction, have provided insight into treatment of patients with cardiovascular and progressive heart failure. These studies and the availability of potassium- and magnesium-sparing diuretics for use in these disorders provide relevant perspectives for treatment.     

Atrial fibrillation post-cardiac surgery: changing perspectives

ABSTRACT

Perioperative atrial fibrillation (AF) is one of the most frequent complications of cardiac surgery. Its development is associated with an increased morbidity and mortality, for example from perioperative stroke, as well as ventricular arrhythmias, postoperative myocardial infarction, congestive cardiac failure, renal failure, increased use of inotropic medications and the need for intra-aortic balloon pump. Furthermore, AF after cardiac surgery results in prolonged hospitalization after the procedure, as well as an excess utilization of hospital resources and increased hospital costs. Given the importance of AF for patient outcome, a wide variety of prophylactic pharmacologic strategies have been evaluated.

The risk of post-operative AF should be reduced by the administration of amiodarone, a beta- blocker, sotalol or rate-limiting calcium antagonists. In addition, in patients undergoing cardiac surgery on pre-existing beta-blocker therapy, this treatment should be continued unless contraindications develop (such as post-operative bradycardia or hypotension). Unless contraindicated, a rhythm control strategy is recommended as the initial option for the treatment of post-operative AF following cardiothoracic surgery. More recently, some data regarding magnesium, statins and n-3 olyunsaturated fatty acids in reducing post-op AF are available. Clearly, perspectives are changing in our management of this common arrhythmia.     

硫酸镁注射液治疗婴幼儿喘息性疾病的分析

调查分析我院门诊、急诊患儿硫酸镁注射液的应用情况，为临床合理用药和儿科安全用药提供参考依据。对2017年11月门急诊含硫酸镁电子处方进行回顾性分析，内容包括年龄、用法用量、临床诊断、联合用药，使用天数等。共计204例患儿使用硫酸镁注射液，年龄在6个月至1岁之间的患儿最多，共72例，占比35.29%。67.65%的患儿使用剂量是30~50 mg·kg-1·d-1。临床诊断分别为急性喘息性支气管炎（32.35%）、肺炎（29.41%）、支气管炎（23.53%）等。在治疗方案中，硫酸镁常和糖皮质激素合用，其中有58.82%和醋酸甲泼尼龙合用，55.88%和布地奈德合用。目前硫酸镁在婴幼儿喘息性疾病的应用尚无统一、权威标准，可能存在用药风险。临床用药应加以重视、规范管理，保证用药安全。本研究结果对儿科合理使用硫酸镁注射液有参考价值。     

Association between the use of magnesium sulfate as neuroprotector in prematurity and the neonatal hemodynamic effects

Purpose: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO₄) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO₄ at the imminent premature delivery and neonatal hemodynamic effects.

Materials and methods: A cross-sectional study involving 94 newborns (NB) between 24 and 32?weeks at a Brazilian hospital was performed. Bivariate analysis between the use or the non-use of MgSO₄ and hemodynamic characteristics was performed, using the Chi-square test.

Results: NB were evaluated between those who received MgSO₄ (27.7) and those who did not (72.3%). Normal heart rate was verified in 62.8% of NB, normal respiratory rate in 70.2%, and normal temperature in 22.3%. Oxygen saturation higher or equal than 95% was evidenced in 85.1% of NB, normal hemoglucotest in 74.5%, and hemoglobin greater or equal than 16.4?g/dL in 30.9%. Non-invasive ventilation was performed in 48.9% of NB, while 51.1% were submitted to endotracheal ventilation. There was no significance relation detected between the use of MgSO₄ and the hemodynamic characteristics.

Conclusions: MgSO₄ does not appear to influence hemodynamic factors as a cause of the neuroprotection in premature NB.