左旋氨氯地平治疗轻中度高血压疗效及不良反应的临床研究

目的:为评价左旋氨氯地平降压疗效及不良反应,并与氨氯地平相比较。方法:采用随机分组平行对照方法,将120例轻、中度高血压患者分成左旋氨氯地平组(60例),口服2.5～5mg·d~(-1)和氨氯地平组(60例),口服5～10mg·d~(-1)。观察5周。每周一次上午延迟1～4小时用药并测诊室谷值坐位血压、心率、观察不良反应。结果:5周未左旋氨氯地平与氨氯地平组治疗有效反应率分别为86.7％和83.3％,每组治疗前后比较差异非常显著(P<0.01)。组间比无显著性差异(P>0.05)。左旋氨氯地平组不良反应发生率6.7％,氨氯地平组为16.7％(P>0.05),但试验组不良反应程度更轻微。结论:左旋氨氯地平与氨氯地平治疗高血压同样有效,不良反应可能更小。     

Effects of pretreatment with cisatracurium, rocuronium, and d-tubocurarine on succinylcholine-induced fasciculations and myalgia: a comparison with placebo

Study Objective: To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery.

Design: Randomized, prospective, placebo-controlled trial

Setting: Teaching hospital.

Subjects: 80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia.

Intervention: A standardized balanced anesthetic technique was used for all patients.

Measurements and Main Results: Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (IV) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia was assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) in the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative myalgia.

Conclusion: Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery.     

Duration and recovery profile of cisatracurium after succinylcholine during propofol or isoflurane anesthesia

Study Objective: To determine the duration and recovery profile of maintenance doses of cisatracurium besylate following succinylcholine, and during propofol or isoflurane anesthesia.

Design: Randomized, open-label study.

Setting: Operating suite of a university-affiliated medical center.

Patients: Forty ASA physical status I and II adult patients having elective surgery with general anesthesia lasting longer than 90 minutes.

Interventions: Following a standardized induction sequence, a baseline electromyogram (EMG) was obtained. An intubating dose of intravenous (IV) succinylcholine 1.0 mg/kg was administered. Ventilation was maintained with a face mask until the first twitch (T₁) of the evoked train-of-four (TOF) reached 10% of control when tracheal intubation was performed. Spontaneous recovery from neuromuscular blockade was allowed to occur until the first twitch returned to 25% of control. Patients then were randomized to receive cisatracurium as follows. Group 1: 0.025 mg/kg [0.5 × 95% effective dose (ED₉₅)]; Group 2: 0.05 mg/kg (ED₉₅); Group 3: 0.05 mg/kg (ED₉₅); and Group 4: 0.1 mg/kg (2×ED₉₅). Anesthesia for Groups 1 and 2 were maintained with isoflurane 1% to 2%, 66% nitrous oxide (N₂O) in oxygen (O₂), and in Groups 3 and 4, anesthesia was maintained with propofol 80 to 160 μg/kg/min, 66% N₂O in O₂. The TOF-evoked EMG was recorded at 10-second intervals. The time for the evoked EMG to spontaneously return to 25%, 50%, and 75% of the original baseline was recorded.

Measurements and Main Results: There were 10 patients in each of the four groups. The duration of action of cisatracurium 0.05 mg/kg (ED₉₅) after an intubating dose of succinylcholine is 24.5 ± 10 minutes and 21.3 ± 9 minutes during anesthesia maintained with isoflurane and propofol, respectively. Doubling the dose of cisatracurium resulted in approximately twice the duration of action (40.2 ± 7 min) during propofol anesthesia. Following a dose of cisatracurium 0.025 mg/kg (0.5×ED₉₅), the T₁ of the EMG-evoked response did not decrease below 25% in 7 of 10 patients.

Conclusion: Following succinylcholine, the duration of action of a single dose of cisatracurium 0.05 mg/kg is 20 to 25 minutes during anesthesia maintained with propofol or isoflurane. The duration and recovery profile of cisatracurium is dose dependent during propofol and isoflurane anesthetics. Cisatracurium 0.025 mg/kg is an inadequate maintenance dose following recovery from succinylcholine and it fails to provide adequate surgical relaxation.     

电位滴定法测定苯磺酸左旋氨氯地平的含量

目的：建立测定苯磺酸左旋氨氯地平含量的新方法。方法：采用电位滴定法。结果：该法和国家标准规定的HPLC法测定结果一致。结论：所建方法简便，准确，适用于苯磺酸左旋氨氯地平的含量测定。     

阿托伐他汀联合苯磺酸氨氯地平治疗冠心病合并脑梗死的临床效果

目的:研究阿托伐他汀联合苯磺酸氨氯地平治疗冠心痛合并脑梗死的临床疗效.方法:选取我院收治的冠心病合并脑梗死患者76例,随机分为两组,其中对照组36例,予改善循环、抗血小板聚集、扩冠、改善脑供血常规治疗,4周为1个疗程,治疗1个疗程;实验组40例,在常规治疗的基础上加用阿托伐他汀(立普妥)20 mg,每日一次口服,苯磺酸氨氯地平(络活喜)5 mg每日一次口服,4周为1个疗程.治疗结束后,对比治疗前后患者血清乳酸脱氢酶(LDH)、血清肌酸激酶(CK-MB)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及欧洲卒中量表(ESS)评分.结果:(1)治疗后两组患者心肌酶水平改善,且实验组LDH、CK-MB较对照组明显下降,差异有统计学意义(P＜0.05);(2)治疗后两组患者血脂水平改善,且实验组TC、LDL-C较对照组明显下降,差异有统计学意义(P＜0.05);实验组HDL-C较对照组明显上升,差异有统计学意义(P＜0.05);(3)治疗后两组患者神经功能改善,且实验组ESS评分较对照组明显上升,差异有统计学意义(P＜0.05).结论:阿托伐他汀联合苯磺酸氨氯地平能够从根本上治疗冠心病合并脑梗死,确实具有良好的临床疗效,值得临床推广.     

预注顺阿曲库铵与增大其剂量在全麻诱导中的效果比较

目的：通过观察在全麻诱导插管中,预注顺阿曲库铵和增大其剂量两种给药方式对其起效时间、临床有效时间及肌松效果的影响,并进行对比,指导此药的临床应用。方法选择18~55岁,ASAⅠ~Ⅱ级择期行妇科手术的女性患者90例,随机分为3组,每组30例,分别为3ED95组、预注组（预注顺阿曲库铵0.015 mg/kg,4 min后给予0.135 mg/kg）和4ED95组。麻醉诱导使用芬太尼、咪达唑仑、丙泊酚,麻醉维持应用靶控微量泵输注丙泊酚、瑞芬太尼,TOF模式监测肌松情况。记录血压、心率及全身皮肤情况,记录肌松药起效时间、临床有效时间及气管插管条件评级。结果各组麻醉诱导期间血流动力学的变化比较均无统计学意义,各组肌松药起效时间分别是（184±56）s、（141±31）s、（135±45）s,预注组、4ED95组分别与3ED95组之间的比较均有统计学意义（P＜0.05）,但4ED95与预注组相比较无统计学意义（P＞0.05）;各组临床有效时间分别是（41±8）min、（44±6）min、（53±8）min,4ED95组分别与3ED95组、预注组相比较均有统计学意义（P＜0.05）,预注组与3ED95组比较无统计学意义（P＞0.05）。结论预注顺阿曲库铵与增大其剂量均能加快药物的起效时间,但前者比后者维持的临床有效时间更短,更有利于患者的苏醒及快速拔管。     

美托洛尔在高血压临床治疗中的应用效果评价

目的探究美托洛尔在高血压临床治疗中的应用效果。方法选取2018年7月~12月某院收治的150例高血压患者,采用随机分组法将其分为对照组和观察组,每组75例。对照组患者中采用钙拮抗剂苯磺酸氨氯地平治疗,观察组患者采用β受体阻滞剂美托洛尔治疗,比较两组患者治疗有效率、治疗前后平均心率与不良反应发生率,对结果进行分析。结果观察组高血压治疗总有效率(98.67%)显著高于对照组高血压治疗总有效率(78.67%),差异具有统计学意义(P<0.05),而观察组和对照组患者均未出现不良反应。结论高血压患者经美托洛尔治疗后效果显著,可以显著提高治疗效果,有助于恢复患者健康。     

左旋氨氯地平的临床疗效与生物学特性

目的 通过观察手性药物左旋氨氯地平在治疗轻、中度高血压的临床疗效,分析手性药物的生物学特性.方法 入选62例轻、中度高血压患者,随机分为左旋氨氯地平治疗组30例,氨氯地平治疗组32例,观察8周后两组血压变化及不良反应情况.结果 左旋氨氯地平治疗轻、中度高血压的总有效率为86.7％,氨氯地平的总有效率为87.5％,无显著性差异,但不良反应方面,左旋氨氯地平低于氨氯地平.结论 手性药左旋氨氯地平是高效、安全的抗高血压药.氨氯地平的有效活性成分是其左旋异构体.     

用LC-MS法测定人血浆中顺式阿曲库铵的浓度

目的 建立高效液相色谱串联质谱方法（LC-MS）测定人血浆中顺式阿曲库铵的浓度,并应用于临床治疗药物监测。方法 采用盐酸普罗帕酮同位素内标,样品经2%甲酸水和含内标的乙腈溶液沉淀蛋白处理。HPLC色谱柱为Agilent SB-C₁₈,柱温35 ℃,流速0.3 ml/min,流动相为0.1%甲酸水和0.1%甲酸乙腈溶液,梯度洗脱。质谱检测方式为ESI正离子模式,MRM扫描,监测阿曲库铵m/z 464.6~358.4,盐酸普罗帕酮（内标）m/z 342.2~116.2。结果 人血浆中顺式阿曲库铵在该条件下分离良好,在2~500 ng/ml浓度范围内线性关系良好（r=0.996 5）,定量下限为2 ng/ml。方法日内精密度RSD<16.0%;日间精密度RSD<6.0%。平均回收率为97.63%~111.93%;血浆样品室温放置4 h,-80 ℃放置14 d,处理后室温放置24 h,稳定性良好。结论 本方法简便、准确、快速、稳定,适用于顺式阿曲库铵的血药浓度测定。     

肥胖患者应用顺苯磺酸阿曲库铵的肌松效应探讨

目的探讨肥胖患者应用顺苯磺酸阿曲库铵的肌松效应。方法选取该院收治的行全身气管插管静脉麻醉择期手术患者90例作为研究对象,按照患者体质量分为A组(正常体质量组)、B组和C组(肥胖组,C组体质量略高于B组)。3组均给予顺苯磺酸阿曲库铵麻醉诱导并采用肌松监测仪进行拇内收肌肌松监测,T1/Tc不足10%时给予气管插管,A组和B组按照患者实际体质量给药,C组按照理想体质量给药,比较3组患者的恢复指数、起效时间、作用时间以及气管插管条件评级等。结果 B组药物作用时间延长,药物起效时间缩短,C组药物作用时间缩短,药物起效时间延长,差异有统计学意义(P0.05)。结论按实际体质量给肥胖患者应用顺苯磺酸阿曲库铵肌松效果良好,起效时间短,作用时间长,改善患者耐受性,具有积极的临床使用和推广价值。