酮咯酸氨丁三醇联合曲马多超前镇痛预防小儿全麻苏醒期躁动的临床观察

目的探讨酮咯酸氨丁三醇联合曲马多超前镇痛预防小儿全麻苏醒期躁动的作用。方法选择40例择期在全麻下行骨折闭合复位的患儿,随机分为联合用药组和对照组,每组20例。对照组在全麻诱导前静注曲马多0.8 mg/kg,联合用药组在全麻诱导前静注酮咯酸氨丁三醇0.5 mg/kg和曲马多0.8 mg/kg。术中监测血压、心率、血氧饱和度、呼吸末气体浓度,记录手术时间、麻醉时间、拔管时间及术后躁动情况。结果两组患儿手术时间、麻醉时间、拔管时间、术后低氧血症、恶心呕吐发生率的差异均无统计学意义(P>0.05),联合用药组术后躁动发生情况优于对照组(P<0.05)。结论酮咯酸氨丁三醇联合曲马多预防小儿全麻苏醒期躁动的疗效优于单用曲马多,值得临床借鉴。     

酮咯酸氨丁三醇与曲马多对小儿七氟醚全麻术后躁动的影响

目的观察酮咯酸氨丁三醇与曲马多对小儿七氟醚全麻术后躁动的影响。方法选择全麻下行扁桃体和腺样体切除术的患儿80例,年龄2⁷岁、ASAⅠ7岁、ASAⅠ^Ⅱ级。根据手术结束前静脉注入的药物分为4组,每组20例,曲马多组(T组,手术结束前30 min静注曲马多1 mg/kg),酮咯酸氨丁三醇组(K组,手术结束前30 min静注酮咯酸氨丁三醇0.5 mg/kg),曲马多+酮咯酸氨丁三醇组(T+K组,手术结束前30 min静注曲马多1mg/kg和酮咯酸氨丁三醇0.5 mg/kg),对照组(C组,手术结束前30 min静注盐水5 mL)。记录各组手术时间、术后拔管时间,拔管后5 min(T5)、10 min(T10)的躁动评分,入PACU后记录疼痛和镇静评分,以及术后恶心呕吐的情况。结果各组间患儿手术时间、拔管时间比较差异无统计学意义(P>0.05);T5和T10 2个时点的躁动发生率排序:C组>T组>T+K组,C组>K组>T+K组,差异有统计学意义(P<0.05)。K组躁动发生率高于T组,但差异无统计学意义(P>0.05);入PACU后患儿疼痛评分排序:C组>T组>T+K组,C组>K组>T+K组,差异有统计学意义(P<0.05)。K组疼痛评分高于T组,但差异无统计学意义(P>0.05);术后恶心呕吐发生率T组和T+K组明显高于C组和K组(P<0.05)。结论酮咯酸氨丁三醇和曲马多可减轻术后疼痛,减少小儿七氟醚麻醉后躁动的发生。两种药物联合应用降低术后躁动的效果更显著。     

术前静滴酮咯酸氨丁三醇预防小儿全麻苏醒期躁动的临床观察

目的观察预先静脉滴注酮咯酸氨丁三醇对小儿全麻苏醒期躁动的影响。方法选择60例择期静吸复合全麻下行骨折内固定物取出术患儿,随机分为试验组和对照组,每组30例。全麻诱导前10 min试验组静脉滴注酮咯酸氨丁三醇0.5 mg/kg,对照组静脉滴注相同容量的生理盐水。记录两组患儿手术时间、麻醉时间、拔除喉罩时间、苏醒室停留时间,患者在入室及拔除喉罩时(T1)、到达苏醒室后5 min(T2)、15 min(T3)、30 min(T4)各时点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)值以及T1～T4的疼痛、躁动和镇静评分(分别为FLACC评分、PAED评分和Ramsay评分),并观察恶心呕吐、低氧血症、呼吸抑制、反流误吸、瘙痒等不良反应发生情况。结果试验组在T1、T2、T3时点HR低于对照组,在T1、T2时点MAP低于对照组;试验组的疼痛评分在T1、T2、T3时点均低于对照组,躁动评分在4个时点均低于对照组,镇静评分在T1、T2、T3时点均高于对照组,差异有统计学意义(P<0.05)。结论在骨折内固定物取出术患儿全麻诱导前预先静脉滴注酮咯酸氨丁三醇0.5 mg/kg,可获得良好的镇痛效果,减少苏醒期躁动,无明显不良反应的发生。     

酮咯酸氨丁三醇预防七氟烷麻醉苏醒期躁动的临床观察

目的:观察酮咯酸氨丁三醇预防七氟烷麻醉苏醒期躁动的临床疗效。方法:选择年龄在45～65岁择期行腹腔镜胆囊手术患者100例,ASA I-II级,随机分为两组,每组50例。实验组手术结束前30min静脉滴注酮咯酸氨丁三醇30mg;对照组手术结束前30min静脉滴0.9%氯化钠1ml。观察两组患者自主呼吸恢复时间、苏醒时问、拔管时间。拔管后15min、30min烦躁程度评分及疼痛评分。结果:两组自主呼吸恢复时间、苏醒时间、拔管时间没有明显统计学差异(P>0.05);对照组疼痛评分及烦躁程度评分明显高于实验组(P<0.01)。结论:酮咯酸氨丁三醇可以预防七氟烷麻醉苏醒期躁动。     

酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者血流动力学的影响

目的观察酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者气管拔管期血流动力学的影响及术后的镇痛效果。方法选择择期行双侧扁桃体切除术的全麻患者60例,随机分为2组:观察组(酮咯酸氨丁三醇30 mg),对照组(生理盐水)。手术开始前15 min,观察组静注酮咯酸氨丁三醇30 mg,对照组静注等剂量生理盐水。记录两组患者的一般资料,入室、拔管即刻、拔管后5 min、拔管后10 min患者的收缩压、舒张压、心率、血氧饱和度,苏醒期躁动评分,拔管后5 min、10 min、1 h时的OAA/S评分和拔管后1、4、6、12 h的VAS评分,记录患者的手术时间、麻醉时间、拔管时间及术后不良反应。结果拔管即刻及拔管后5、10 min,观察组的SBP为(124.9±7.7)、(120.3±9.2)、(118.9±9.3)mm Hg,DBP为(73.8±5.9)、(71.8±8.1)、(69.5±8.0)mm Hg;对照组的SBP为(138.0±9.4)、(134.9±11.0)、(132.7±10.8)mm Hg,DBP为(82.3±8.5)、(80.6±9.6)、(79.8±8.5)mm Hg,观察组各时点的血压均低于对照组,差异有统计学意义(P<0.05)。拔管后1、4、6、12 h,观察组的VAS评分为1.0±0.8、1.4±0.7、2.2±1.0、2.8±0.6,对照组为2.7±1.0、3.5±1.1、4.1±1.0、3.2±1.1,观察组评分低于对照组(P<0.05)。结论酮咯酸氨丁三醇30 mg超前镇痛用于成人双侧扁桃体切除术患者气管拔管期血流动力学波动小,镇痛效果良好。     

酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响

目的:观察酮咯酸氨丁三醇联合骶管阻滞超前镇痛对小儿包皮环切术患者术后镇痛效果的影响。方法:选择我院择期拟行包皮环切术的患儿60例,随机分为酮咯酸氨丁三醇组(K组)、骶管阻滞组(D组)、酮咯酸氨丁三醇联合骶管阻滞组(KD组),每组20例。K组和KD组患儿于麻醉诱导前15 min静脉注射酮咯酸氨丁三醇0.5 mg·kg^-1。D组和KD组患儿术前行骶管阻滞麻醉,并于穿刺成功后一次性注入局麻药物0.8%利多卡因+0.25%罗哌卡因混合液1 ml·kg^-1。观察3组患儿术中体动、芬太尼和丙泊酚的使用情况、术后麻醉苏醒和麻醉苏醒后在麻醉后监测治疗室(PACU)的停留时间、术后补救镇痛情况和不良反应发生情况。结果:与K组相比,D组和KD组患儿术中体动发生率和术后布洛芬混悬液的服用率明显降低,术中芬太尼和丙泊酚的总用量明显减少,术后麻醉苏醒以及麻醉苏醒后在PACU的停留时间明显缩短(P<0.05)。D组布洛芬混悬液服用率明显高于KD组(P<0.05)。3组患儿术后均未见呼吸抑制、恶心、呕吐、瘙痒和尿潴留等不良反应的发生。结论:对于小儿包皮环切术患者,酮咯酸氨丁三醇联合骶管阻滞的术后镇痛效果确切且提供了高质量的术后苏醒。     

七氟烷苏芬太尼静吸复合全麻在小儿扁桃体摘除术中的应用

目的 探讨七氟烷苏芬太尼静吸复合全麻在小儿扁桃体摘除术中的应用效果.方法 60例需行扁桃体摘除术患儿随机分为两组,观察组采用七氟烷与苏芬太尼等药物,对照组采用丙泊酚与瑞芬太尼等药物.记录患儿麻醉期间各时点的血流动力学变化,苏醒时间,拔管后5 min、10 min、出PACU时的Ramsay评分与躁动评分.结果 两组在拔管后5 min平均动脉压[(77.87±4.86)mmm Hg比(83.23±3.22)mm Hg]、心率[(107.09±7.59)次/min比(112.29±8.11)次/min]均差异有统计学意义(均P＜0.05);观察组在拔管后5 min、10 min、出PACU的Ramsay评分[(2.63±0.90)分,(2.23±0.57)分,(2.18±0.23)分]均高于对照组的[(1.03±0.125)分,(1.48±0.49)分,(1.17±0.42)分](均P＜0.05),在拔管后5 min、出PACU的躁动评分均低于对照组(均P ＜0.05).结论 七氟烷苏芬太尼静吸复合全麻在小儿扁桃体摘除术应用中具有较好的麻醉恢复质量与安全性,值得在临床上推广应用.     

酮咯酸氨丁三醇对腹部手术患者术后疼痛、躁动及基础体征的改善效果

目的 研究酮咯酸氨丁三醇对腹部手术患者术后疼痛、躁动及基础体征的改善效果.方法 选择2014年6月至2015年6月我院80例腹部手术患者作为研究对象,采用随机数表法分为两组,每组40例.对照组给予常规麻醉,观察组在常规麻醉基础上加用酮咯酸氨丁三醇.比较两种方法对患者术后疼痛、躁动及基础体征的影响.结果 观察组手术结束后2h (T2)、手术结束后12 h(T3)及手术结束后24 h(T4)VAS评分分别为(1.24±0.23)、(1.21±0.17)及(1.19±0.30),均显著低于对照组,差异有统计学意义(P＜ 0.05).观察组术后躁动发生率为42.5％,显著低于对照组的65％,差异有统计学意义(P＜0.05).观察组手术结束时(T1)、T2、T3及T4时血压、心率及血氧饱和度等基础生命体征比较,差异均无统计学意义(P＞0.05).结论 酮咯酸氨丁三醇能显著减轻患者术后疼痛,有利于改善患者术后躁动状态,维持生命体征的稳定.     

酮咯酸氨丁三醇超前镇痛用于妇科腹腔镜手术中的效果观察

目的探讨酮咯酸氨丁三醇超前镇痛用于妇科腹腔镜手术中的效果。方法随机选择妇科腹腔镜手术患者60例,分为治疗组和对照组各30例。治疗组在手术切皮前15 min静脉注射酮咯酸氨丁三醇30 mg,对照组静脉注射同等剂量的0.9%氯化钠注射液。采用视觉模拟评分(VAS)对两组患者术后1、2、4、6、12、24h进行镇痛评分;记录两组不良反应发生情况。结果治疗组术后1、2、4、6、12、24h VAS均低于对照组,差异有统计学意义(P<0.05)。两组均未发生严重不良反应。结论酮咯酸氨丁三醇超前镇痛用于妇科腹腔镜手术有较好的镇痛效果,且不良反应少,值得推广。     

处方前置审核对酮咯酸氨丁三醇临床应用合理性的影响

目的探讨处方前置审核自定义设置审查规则对酮咯酸氨丁三醇临床应用合理性的影响。方法根据建立的酮咯酸氨丁三醇药物利用评价(DUE)标准自定义设置处方前置审核规则,并运用于临床科室。采用回顾性研究,随机抽取亳州市人民医院开展处方前置审核前后使用酮咯酸氨丁三醇的各130例患者归档病历,基于属性层次模型(AHM)法对其合理性进行评价。结果处方前置审核前病历平均得分为(75.70±14.28)分,审核后病历平均得分为(87.48±11.45)分,差异具有统计学意义(P<0.05);审核前酮咯酸氨丁三醇人均费用为(250±414)元;审核后人均费用为(128±148)元,差异具有统计学意义(P<0.05)。审核后适应证、疗程、联合用药及疗效指标的合理数均有明显提升,增长率均超过15%。结论基于DUE标准自定义设置处方前置审核规则可以促进酮咯酸氨丁三醇的合理使用,降低酮咯酸氨丁三醇的人均费用。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.