西地那非联合高频振荡通气治疗足月新生儿肺动脉高压的效果观察

目的 观察西地那非联合高频振荡通气(HFOV)治疗足月新生儿肺动脉高压(PPHN)的临床效果.方法 回顾性分析2008年1月至2014年12月本院新生儿重症监护病房收治的PPHN患儿临床资料,根据不同时间段治疗措施不同分为HFOV组、常频机械通气(CMV)+西地那非组、HFOV+西地那非组.分析各组患儿治疗前、治疗3、6、12 h后的P/F比值、氧合指数(OI)、肺动脉压力,以及机械通气时间、氧疗时间、住院时间、转归.结果 治疗3、6、12 h后HFOV+西地那非组P/F、OI、肺动脉压力均优于CMV+西地那非组和HFOV组,CMV+西地那非组优于HFOV组,差异有统计学意义(P＜0.05).HFOV+西地那非组机械通气时间、氧疗时间、住院时间均短于CMV+西地那非组和HFOV组,CMV+西地那非组短于HFOV组,差异有统计学意义(P＜0.05);各组患儿病死率比较差异无统计学意义(P＞0.05).结论 早期西地那非联合HFOV治疗PPHN疗效显著,能迅速改善肺动脉高压患儿的氧合情况,显著缩短患儿的上机时间、氧疗时间及住院时间,但对患儿病死率没有影响.     

高频震荡通气联合注射用牛肺表面活性剂治疗重症胎粪吸入综合征临床研究

目的：探讨重症胎粪吸入综合征（MAS）的有效治疗方法。方法：选取2004年9月至2014年12月我院新生儿科治疗的重症MAS患儿64例,按治疗方案分为高频振荡通气（HFOV）+肺表面活性物质（PS）组、常频机械通气（CMV）+PS组、HFOV组、CMV组四组各16例,四组辅助处理措施相同。PS为注射用牛肺表面活性剂（Calsurf）,在气管插管后以100 mg/kg气管内给药,患儿依次取平卧位、左侧卧位、右侧卧位、平卧位,每个体位均注入总剂量的1/4,为防止药物黏滞导致气道阻塞,注药时采用复苏囊加压通气,注药完毕后继续接呼吸机辅助通气。观察记录四组患儿治疗前后不同时间点的血气分析、PaO2/FiO2、氧合指数（OI）及机械通气时间、住院时间、转归情况。结果：HFOV+PS组死亡2例,CMV+PS组死亡3例,HFOV组死亡3例,CMV组死亡4例,其他患儿均治愈出院,四组患儿的转归情况比较差异无统计学意义（P>0.05）。四组患儿治疗前（0 h）pH、PaO2、PaCO2、PaO2/FiO2、OI比较差异无统计学意义（P>0.05）,均随着治疗时间的延长而逐渐改善,其中HFOV+PS组改善最为显著,其在治疗2、12、24、48 h时与另三组比较差异均有统计学意义（P均<0.05）。HFOV+PS组的平均机械通气时间是（93.6±41.2）h,平均住院时间是（15.8±5.1）d,均短于另三组（P均<0.05）。结论：HFOV联合PS治疗重症MAS,可迅速改善通气和氧合功能,缩短机械通气时间和住院时间,值得临床推广应用。     

高频振荡通气联合珂立苏治疗新生儿重症胎粪吸入综合征临床分析

目的探讨高频振荡通气(HFOV)联合珂立苏治疗新生儿重症胎粪吸入综合征(MAS)的疗效及并发症。方法本院43例MAS患儿随机分成控制性机械通气(CMV)组23例和HFOV组20例。HFOV组应用高频振荡通气,CMV组常规机械通气,两组均联合应用肺表面活性物质珂立苏治疗。监测两组通气治疗0、2、12、24、48h后反映肺氧合功能的指标吸入氧浓度(FiO2)、氧合指数(OI)、动脉血氧分压/动脉肺泡氧分压(a/ApO2)的变化,比较两组患儿的呼吸机使用情况、住院时间、并发症及临床转归的差异。结果两组患儿联合珂立苏通气治疗后反映肺氧合功能的各参数在不同时间点具有统计学差异(P<0.05),但HFOV组在时限和程度上要比CMV组显著;HFOV组上机时间、氧疗时间及住院时间均比CMV组短,两组比较差异具有统计学意义(P<0.05);HFOV组肺气漏与呼吸机相关性肺炎并发症的发生率低于CMV组(P<0.05),而病死率与Ⅲ度以上颅内出血的发生率两组比较差异无统计学意义(P>0.05)。结论早期高频振荡通气联合珂立苏治疗重症MAS,肺氧合功能改善快,上机时间、氧疗时间和住院时间缩短,并发症减少,可作为一种更安全有效的抢救性措施。     

高频振荡通气叠加常频通气治疗新生儿持续肺动脉高压的疗效分析

目的探讨高频振荡通气(HFOV)叠加常频通气(CMV)治疗新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)的疗效。方法选取我院新生儿持续肺动脉高压患儿82例,随机分为研究组和对照组,研究组采用HFOV叠加CMV治疗新生儿持续肺动脉高压;对照组采用HFOV治疗,比较两组患儿治疗后6、12、24、36h后氧合指数、住院时间、机械通气时间、氧暴露时间。结果HFOV叠加CMV组氧合指数(OI)在治疗后6、12、24、36h均低于HFOV组;研究组的住院时间、机械通气时间、氧暴露时间较对照组明显缩短(P0.05)。结论高频振荡叠加常频通气治疗新生儿持续肺动脉高压较单纯高频振荡通气疗效显著。     

HFOV和CMV对新生儿胎粪吸入综合征血流动力学的效果对比

目的:探讨高频振荡机械通气(HFOV)和常频机械通气(CMV)在新生儿胎粪吸入综合征治疗中的临床效果。方法:将某院收治的60例新生儿胎粪吸入综合征患者随机分为两组,30例予以CMV治疗(对照组),30例予以HFOV治疗(研究组),比较两组患者氧分压(PaO2)、二氧化碳分压(PaCO2)、PH值、氧合指数(OI)、每搏量(SV)、射血分数(EF)、血氧饱和度(SpO2)、血压、心率。结果:研究组PaO2、PaCO2、OI改善程度均优于对照组(P0.05),SpO2、SV、EF、PI比较无显著差异(P0.05)。结论:在新生儿胎粪吸入综合征患者治疗中选择HFOV治疗可显著改善患者血气指标,安全有效。     

高频振荡通气联合多巴胺治疗PPHN的效果及对氧合指数、D-D水平的影响

目的:探讨高频振荡通气(HFOV)联合多巴胺治疗新生儿持续性肺动脉高压(PPHN)的效果及对氧合指数(OI)、D-二聚体(D-D)水平的影响。方法:选取2018年2月～2019年2月某院收治的90例PPHN患儿为对象,按照随机数字法分为对照组(n=45)和观察组(n=45),对照组给予HFOV治疗,观察组给补高频振荡通气联合多多巴胺治疗,比较两组临床疗效,血氧饱和度(SpO_2)、OI、血清C反应蛋白(CRP)、脑钠肽(BNP)、D-D水平的变化。结果:治疗后观察组总有效率为93.33%显著高于对照组的71.11%(P0.05);治疗后观察组OI低于对照组,SpO_2高于对照组(P0.05);治疗后观察组血清CRP、BNP及D-D水平均显著低于对照组(P0.05)。结论:HFOV联合多巴胺治疗PPHN的效果显著,能够改善机体缺氧状态,降低炎性因子。     

俯卧位机械通气对呼吸衰竭新生儿氧合指数的影响

目的:研究俯卧位机械通气对新生儿呼吸功能的改善以及对新生儿呼吸衰竭氧合指数(OI)的影响。方法:研究对象为2011年1月至2012年2月徐州市中心医院和宿州市立医院新生儿重症监护室收治给予机械通气治疗的呼吸衰竭新生儿51例,随机分为仰卧位组26例和俯卧位组25例,分别对两组1 h、6 h时呼吸机参数、氧合指标、肺力学参数以及撤机时间、撤机后1 h动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)进行对比分析。结果:俯卧位组1 h PaO2为(66.37±8.54)mm Hg,6 hPaO2为(68.42±10.43)mm Hg,分别较仰卧位组1 h PaO2的(61.22±9.43)mm Hg和6 h PaO2的(62.60±11.36)mm Hg明显增高,差异有统计学意义(P<0.05);俯卧位组1 h OI(OI=PaO2/FiO2)为(167.88±26.97)mm Hg,6 h OI为(170.84±19.82)mm Hg,分别高于仰卧位组的1 h OI(151.66±21.04)mm Hg和6 h OI(156.94±23.51)mm Hg,两组比较差异有统计学意义(P<0.05);仰卧位组与俯卧位组撤机时间以及撤机后1 h PaCO2、PaO2变化相似,两组比较差异无统计学意义(P>0.05)。结论:俯卧位机械通气治疗新生儿呼吸衰竭与传统仰卧位相比,能更好地改善患儿呼吸衰竭症状,提高氧合指数。     

高频振荡通气治疗新生儿呼吸窘迫综合征临床疗效观察

目的：探讨高频振荡通气（HFOV）治疗新生儿呼吸窘迫综合征（RDS）的临床效果。方法选择2012年2月~2013年7月本院收治、需机械通气的RDS患儿70例,随机分为HFOV组和常频机械通气（CMV）组,比较两组患儿肺功能、并发症、机械通气时间及住院时间。结果机械通气1 h后,两组患儿吸入氧浓度（FiO2）、氧合指数（OI）、平均气道压（MAP）、动脉血二氧化碳分压（PaCO2）均较0 h有不同程度改善,且在1 h及6 h HFOV组较CMV组改善更明显,差异有统计学意义（P〈0.05）;机械通气24 h后HFOV组的OI、MAP仍较CMV组低,差异有统计学意义（P〈0.05）。HFOV组患儿机械通气时间、住院时间短于CMV组（P〈0.05）;两组气漏、支气管肺发育不良、早产儿视网膜病变等并发症发生率差异无统计学意义（P〉0.05）。结论 HFOV能更好更快的改善RDS患儿的肺氧合功能,缩短病程,同时并不增加并发症的发生率。     

氧合氟碳腹腔通气对兔急性肺损伤的治疗作用

目的:探讨以氟碳(PFC)作为氧载体及腹膜作为气体交换部位的腹腔通气(PV)对急性肺损伤(ALI)动物的治疗作用.方法:将24只成年大耳白兔经油酸生理盐水混悬液中心静脉推注制成ALI模型,随机分为对照组、常规通气(CMV)组、氟碳腹腔通气(PFC-PV)组及CMV+PFC-PV组.各组持续通气120 min,分别于ALI模型建立的0、30、60及120min测定并计算动脉氧分压[p(O2)]、氧合指数PaO2/FiO2及呼吸系统动态顺应性(Cdyn).结果:与对照组比较,ALI模型建立30min后,PFC-PV、CMV、CMV+PFC-PV 3组的动脉p(O2)均明显上升,其作用强度依次为CMV+PFC-PV组>CMV组>PFC-PV组.且PFC-PV、CMV和CMV+PFC-PV 3组治疗后60 min均可改善PaO2/FiO2,尤以CMV+PFC-PV效果最佳.治疗后,CMV组未见Cdyn明显变化,CMV-PV组Cdyn值有所改善.结论:CMV+PFC-PV组可显著改善急性肺损伤兔的气体交换和Cdyn.氧合氟碳腹腔通气可能成为治疗可逆性急性肺损伤严重缺氧的一项新方法.     

Nitric Oxide Therapy in Persistent Pulmonary Hypertension of Newborn

目的:探讨吸入一氧化氮(iNO)联合高频振荡通气(HFOV)治疗新生儿持续性肺动脉高压(PPHN)的有效性和安全性.方法:选取PPHN患儿36例,其中无器质性心脏病30例(Ⅰ组),有先天性心脏病6例(Ⅱ组);对所有患儿进行HFOV和iNO联合治疗.监测NO吸入前、吸入30 min及24h后的氧合指数(OI)、平均压、肺动脉压力(SPAP)、心率、平均气道压(MAP)、动脉导管前后的经皮血氧饱和度(TcSaO2),吸入NO 30 min及24h后测定高铁血红蛋白(MetHb)与NO2浓度.结果:Ⅰ组,与吸入前比较,吸入30 min和24h后,MAP、OI和SPAP均下降,导管前TcSaO2和导管后TcSaO2升高,心率在吸入24h后下降,差异有统计学意义(P＜0.01).Ⅱ组,吸入前后所有的检测指标差异均无统计学意义(P＞0.05).治愈26例,死亡4例,放弃治疗6例.本组治疗期间,MetHb和NO2浓度均在正常范围.结论:肺血管痉挛型PPHN患儿应尽早采用最低有效剂量iNO联合HFOV治疗.特别是≥34周早产PPHN患儿疗效更佳.     

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.