XD‐684型电解质分析仪在血锂测定中的应用

目的评价 XD‐684型电解质分析仪检测血锂浓度的可信度与实用性.方法对36例服用碳酸锂治疗的情感性精神障碍患者分别于治疗第1、3、5周末采用 XD‐684型电解质分析仪检测其血锂浓度,观察碳酸锂服药剂量与血锂浓度的关系;用3种不同锂离子浓度的质控液随每批标本检测,衡量该仪器检测结果的准确性和精密性.结果该仪器变异系数均在其允许范围内(≤3.0%),说明检测结果准确性高、重复性好,口服碳酸锂剂量与检测血锂浓度呈显著正相关(r=0.928,P<0.01).结论该仪器检测血锂浓度快速、准确,建议临床实验室推广使用.     

MI-921E型临床电解质分析仪在血锂测定中的应用

目的评价MI-921E型临床电解质分析仪检测血清锂的可靠性与实用性。方法对30例服用碳酸锂治疗的情感障碍患者分别于治疗第1、3、5、7w末采用MI-921E型临床电解质分析仪检测其血清锂浓度,观察碳酸锂服药剂量与血锂浓度的关系;用两种不同锂浓度的质控液随每批标本检测,衡量该仪器检测结果的准确性和重复性。结果该仪器的检测结果准确性高,重复性好,口服碳酸锂剂量与检测血锂浓度呈显著正相关（r=0．928,P〈0．01）。结论该仪器检测血清锂浓度快速、准确、安全。     

读者来信

编辑同志:你刊1985:3(3):122《血浆碳酸锂火焰光度法测定》一文的小结中“锂盐治疗剂量与血浆锂的浓度成正比例关系(见图),剂量越大,血锂浓度越高,但有个体     

血浆碳酸锂火焰光度法测定

碳酸锂用于抗精神病治疗,锂盐血浓度测定是必须的一种监护手段.用国产6400型火焰光度计测定血浆锂盐,适用于一般医院检验科.一、仪器:国产6400型火焰光度计锂滤光片:波长670.7μm,67002型     

床边检测设备与全自动生化仪测定血电解质及代谢物的比较

目的 研究利用床边血气分析仪与检验科大型全自动生化分析仪测定血钾、血钠、乳酸和血糖浓度的相关性与偏倚,并探讨其差异.方法 分别用GEM Premier3000血气分析仪与OLYMPUS AU2700生化分析议对34例呼吸内科ICU患者的动脉和静脉血样进行血钾、血钠、乳酸和血糖浓度的检测,对检测结果 进行Pearson相关分析、Bland and Ahman偏倚分析和配对t检验.结果 2种仪器测定血钾、血钠、乳酸和血糖浓度均有显著相关性(P<0.01),2种仪器测定血钾、血钠的结果 无显著性差异(P>0.05),GEM Premier3000测定乳酸的结果 显著高于OLYMPUS AU2700的乳酸测定值(P<0.05).结论 GEM Premier3000床边血气分析仪能替代传统生化分析仪测定血电解质,但其测定的乳酸浓度比传统生化仅的测定值高.     

38例脑脊液标本氯化物浓度检测结果分析

脑脊液氯化物浓度检测是脑脊液常规化学检测项目之一,是中枢神经系统疾病诊断、鉴别诊断和疗效观察的常用指标.其正常成人参考范围一般文献和教材上都定为120～130mmol/L[1,2].我们用上海迅达医疗器械公司生产的XD684钾/钠/氯/锂电解质分析仪ISE法对我院神经内科部分住院的非结核性和非化脓性脑膜炎,且其血清氯化物浓度正常的38例脑膜炎标本进行了氯化物浓度测定,结果如下.     

三种电解质分析仪测定血清锂的比较

锂盐的测定方法主要有火焰光度法、原子吸收法、等离子发射光谱法和离子选择电极法。不同方法各有特点,离子选择电极法特异性强,可以同时测定多种离子浓度,并且操作简单,无明显危害而被广泛使用。现用电解质分析仪测定服用碳酸锂的躁狂症患者中,出现服用后测定结果为0．00mmol／L的情况,对此采用3种均为电极法而型号不同的电解质分析仪进行比较分析。     

38例脑脊液标本氯化物浓度检测结果分析

脑脊液氯化物浓度检测是脑脊液常规化学检测项目之一,是中枢神经系统疾病诊断、鉴别诊断和疗效观察的常用指标.其正常成人参考范围一般文献和教材上都定为120～130mmol/L .我们用上海迅达医疗器械公司生产的XD684钾/钠/氯/锂电解质分析仪ISE法对我院神经内科部分住院的非结核性和非化脓性脑膜炎,且其血清氯化物浓度正常的38例脑膜炎标本进行了氯化物浓度测定,结果如下.     

某电解质分析仪检测注意事项及常见故障与处理

目的 探讨某电解质分析仪检测注意事项及常见故障与处理.方法 阐述IMS-972 Plus电解质分析仪的工作原理,指出了样本检测过程中应注意的主要事项,并探讨了IMS-972 Plus电解质分析仪在使用过程中的常见故障与处理方法.结果 当仪器在运行过程中出现故障后,要仔细查明原因,对于任何一个配件,特别是电极出现漂移或电极值下降,尽量通过维护保养使其恢复到正常检测状态.结论 电解质分析仪性能是否稳定直接影响检测结果的准确性,这就决定了实验室工作人员必须具有快速、准确判断仪器故障和排除故障的能力,使仪器始终保持在最佳状态.     

锂盐治疗双相障碍Ⅰ型躁狂或混合发作患者的血清锂浓度与疗效关系研究

[目的]探讨碳酸锂治疗双相障碍Ⅰ型躁狂或混合发作患者的血清碳酸锂浓度与疗效关系。[方法]选取北京、上海、南京等7家医院70例符合DSM—VI双相障碍Ⅰ型的临床诊断，且当前表现为急性躁狂或混合发作的患者，空腹抽取血液3ml，用原子吸收分光光度法测定血锂浓度，用临床疗效总评量表-双相障碍版病情严重程度项（CGI—BP严重度）作为评价疗效的主要指标，用Young氏躁狂量表（Y—MRS）、简明精神病量表（BPRS）等作为评价疗效的次要指标。[结果]锂盐治疗双相障碍I型躁狂或混合发作患者，通过调节服用锂盐的剂量，到第二周末，血锂浓度就维持在一个相对稳定的水平；第三周、第四周未GGI—BP、Y—MRS、BPRS得分均较基线有明显下降，病人的临床症状得到有效的控制，差异有显著性（P〈0．05）。[结论]双相障碍Ⅰ型躁狂或混合发作患者的治疗效果与血清碳酸锂浓度有一定的相关性；但存在个体差异，不断探索和掌握其中的规律，并在临床上加以科学合理地应用，有利于提高临床疗效和保证临床用药的安全性，避免药物中毒等不良事件的发生。     

碳酸锂联合利培酮口服液治疗躁狂发作临床研究

目的评价碳酸锂联合利培酮口服液治疗狂躁发作患者的疗效和安全性。方法将71例躁狂发作患者随机分为两组,碳酸锂联合利培酮口服液组36例和联合氯氮平组35例,进行为期6周的对照研究,采用Bech-Rafaelsen躁狂量表(BRMS)、临床疗效总评量表(CGI)和不良反应症状量表(TESS)评定疗效及安全性。结果联合利培酮口服液组与联合氯氮平组疗效相当(P0.05),而联合利培酮口服液组药物不良反应明显低于氯氮平组。结论碳酸锂联合利培酮口服液治疗躁狂发作疗效好而不良反应少。     

Effect of acute alcohol consumption on lithium kinetics

Lithium carbonate is used in several psychiatric disorders in the context of alcohol abuse. In a randomized, double-blind, crossover study the single-dose kinetics of lithium were followed after alcohol or placebo. Lithium carbonate capsules were taken by mouth by 10 healthy young men with alcohol on one occasion and with placebo on a separate occasion (at least 7 days apart). Lithium concentrations were determined in serum and urine samples for 24 hours after dosing and served as the basis for kinetic analysis. Acute alcohol had no effect on lithium absorption, elimination, distribution, or clearance. Alcohol did, however, increase the peak serum lithium level in nine of 10 subjects, from a mean of 0.62 mEq/L in the placebo condition to 0.70 mEq/L in the alcohol condition. Our data suggest that alcohol has limited effects on lithium carbonate kinetics. The possibility of elevated serum lithium concentrations when lithium is taken with alcohol is suggested.     

Cluster headache: clinical efficacy of lithium salts in a haemodialysis treated patient

Over the last ten years the efficacy of lithium salts in cluster headache has been well demonstrated. Our patient, who had been suffering from cluster headache for approximately 30 years, had been in haemodialysis treatment for the last ten years for chronic renal failure. Moreover, he was affected by heart failure and peptic ulcer. The patient was currently under therapy with Digitalis, Isorbide dinitrate, and ranitidine and was dialyzed three times a week for a total of five hours each time. Neither prophylactic headache therapy nor high doses of analgesic drugs had proved effective. Although this patient was in haemodialysis, lithium treatment was indicated. The administration of lithium carbonate 300 mg during dialysis days and 150 mg during non-dialysis days improved the attacks. Complete recovery from the attacks was obtained when the serum levels of lithium reached the therapeutic range. No side effects were noted.     

Potassium Repletion Fails to Interfere with Reduction of Serum Lithium by Sodium Polystyrene Sulfonate in Mice

OBJECTIVES: Previous studies have shown that oral sodium polystyrene sulfonate (SPS) lowers serum lithium concentrations after acute and chronic toxic lithium exposures. Because hypokalemia may represent a deterrent to the clinical use of SPS for lithium intoxication, this study was designed to determine whether potassium (K+) repletion interferes with the effect of SPS on serum lithium. METHODS: 168 male, CD-1 mice were given lithium chloride (LiCl) (250 mg/kg) by gavage at time 0. Half of the mice were then given SPS (5 g/kg/dose) and half an equivalent volume of water by gavage at times 20 and 40 minutes. Half of each of these subgroups was then given potassium chloride (KCl) (3 mmol/kg) intraperitoneally and half an equivalent volume of normal saline. The animals were then sacrificed at one, two, four, and eight hours after lithium administration and the sera were analyzed for lithium and K+ by atomic absorption spectrophotometry. The groups were compared with analysis of variance. RESULTS: The SPS lowered both lithium and K+ concentrations (ps < or = 0.0001). The KCl treatment was associated with transiently increased K+ concentrations (p < 0.0001) and with mildly elevated lithium concentrations when compared with the results of the animals not treated with KCl (p = 0.0016). The KCl treatment-associated increase in lithium concentration occurred both in the animals treated with water and in those treated with SPS. CONCLUSIONS: Potassium repletion did not interfere with the ability of SPS to lower serum lithium concentration in animals experimentally poisoned with lithium.     

奎硫平与氯氮平合并碳酸锂治疗躁狂症的临床对照研究

[目的]观察奎硫平联合碳酸锂与氯氮平联合碳酸锂治疗躁狂症的临床疗效和安全性.[方法]选取本院进行治疗的80例躁狂症患者,采用随机对照分组方式,将其分为两组：奎硫平组（40例）和氯氮平组（40例）.两组分别给予奎硫平联合碳酸锂治疗和氯氮平联合碳酸锂治疗,疗程6周.治疗前及治疗2,4,6周对两组患者应用倍克-拉范森躁狂量表（BRMS）进行疗效评定,对用药期间患者进行副反应量表（TESS）评价安全性.[结果]两组患者治疗后BRMS评分与治疗前比较,差异有显著性（P＜0.01）;治疗后两组之间BRMS评分相比较差异均无显著性（P＞0.05）.治疗后氯氮平组TESS评分明显高于奎硫平组,且差异有显著性（P＜0.05）.[结论]奎硫平联合碳酸锂与氯氮平联合碳酸锂治疗躁狂症的临床疗效相当,但奎硫平联合碳酸锂在治疗躁狂症时安全性较高,副作用小,患者依从性好.     

使用添加剂处理标本对离子选择电极法测定血锂浓度的影响

目的　探讨使用肝素钠抗凝剂、促凝剂、分离胶等添加剂处理的标本是否适合锂盐(Li+ )浓度的监测。方法　选择临床服用碳酸锂治疗达稳态的住院患者,使用真空采血系统分别采集普通管血液标本和分别含有肝素钠抗凝剂、促凝剂、分离胶等添加剂的标本,在IMS 972电解质分析仪上测定Li+浓度,比较结果的差异。结果　(1)不同方式处理的标本间Li+浓度差异有显著性(P<0. 001),其中普通血清、肝素钠抗凝血浆、促凝剂处理的血清之间Li+浓度差异均无显著性(P>0. 05),分离胶处理的标本与普通血清、促凝剂和肝素钠处理的标本之间Li+浓度差异均有显著性(P<0. 001); (2)肝素钠抗凝剂和促凝剂处理的标本与普通血清Li+浓度之间呈高度线性相关(r=0. 988~0. 993, P<0. 001),分离胶处理的标本与普通血清、肝素钠抗凝剂、促凝剂处理标本的Li+浓度线性相关均无显著性(r=0. 203~0. 288,P>0. 05); (3)肝素钠抗凝剂、促凝剂、分离胶等添加剂处理标本和普通血液标本,不分离血凝块室温放置8h,Li+浓度较放置前增高(P<0. 05~0. 001)。结论　促凝剂和肝素处理标本适合用于锂盐的快速测定,而分离胶处理的标本不适合用于离子选择电极法测定Li+浓度,也不适于储存和标本运输;使用肝素钠抗凝剂和促凝剂处理的标本,不能及时测定时应分离血浆或血     

Hypnic headache: report of two cases

Hypnic headache constitutes one rare type of primary short-lasting headache related to sleep. The authors describe two cases of hypnic headache that had a very good response to lithium carbonate. Although these two cases do not fulfill the proposed criteria for hypnic headache, as the pain was not bilateral, and, in case 2, it had a longer duration than previously described, we believe that the very good response to lithium carbonate favors this diagnosis. We believe that it is important to consider a diagnosis of hypnic headache because of the remarkable response to lithium carbonate shown by some patients with this condition.     

Relationship between erythrocyte lithium concentration and renal concentrating capacity

BACKGROUND: Studies investigating possible correlations between plasma lithium concentration, lithium treatment duration, and frequency of lithium administration, and lithium nephrotoxicity have yielded conflicting results. OBJECTIVES: Our main objective was to investigate whether there was any relationship between erythrocyte lithium concentration (ELC) and renal side effects. Another objective of our study was to identify a parameter, which could be estimated inexpensively, for assessing possible renal side-effects of lithium. METHOD: Seventy Iranian inpatients with bipolar disorder entered this case-control study. Medications taken concurrently by the patients were recorded. A direct method of measuring ELC was used in this study. The cases were patients on lithium who had urine specific gravity (SG) of 1.006 or less after 8-10 h water deprivation at night and the controls consisted of patients on lithium with urine SG of 1.011 or more after this period. Blood urea nitrogen, serum creatinine, sodium and potassium and urine SG, sodium, and potassium were measured in all patients during this time. Renal indices were compared by using independent sample t-test at a significance level of a P-value of 0.05 or less. Non-parametric Spearman's rank correlation test was used to investigate the relationship between clinical variables and the indices of renal function. RESULTS: Results revealed that in case group mean serum sodium concentrations were significantly higher (P = 0.008) and mean urine sodium and potassium were significantly lower than those of controls (P = 0.004 and 0.007 respectively). We found no statistically difference in lithium ratios between the two groups. However, ELCs were significantly higher in the cases (P = 0.026). There were no significant correlation between concomitant use of neuroleptics, benzodiazepines or carbamazepine and ELC or lithium renal side-effects. CONCLUSION: This study showed that ELC may reflect lithium renal side-effects better than plasma lithium level.     

情感障碍患者碳酸锂治疗的血清尿酸、尿素水平分析

目的分析情感障碍患者碳酸锂治疗的血清尿酸、尿素水平。方法随机工作日选择情感障碍患者血锂浓度监测样本317例,在日立7020型生化仪上采用酶法测定尿酸、尿素浓度。结果住院、门诊碳酸锂治疗组男女患者尿酸水平分别显著高于健康对照组（P〈0.001）,尿酸水平偏高的比率在男性分别为37.8%、26.1%,在女性分别为25.0%、33.3%;尿素水平分别显著低于健康对照组（P〈0.001）,尿素水平偏低的比率在男性分别为6.8%、4.5%,在女性分别为37.5%、8.0%。结论情感障碍患者碳酸锂治疗的血清尿酸水平显著偏高、尿素水平显著偏低而呈现尿酸、尿素水平分离现象。这一现象可能与锂引发肾毒性损害并产生抗利尿激素抵抗有关。     

血气分析仪与其他仪器部分相同检测项目的比较分析

目的探讨血气分析仪与电解质分析仪以及生化分析仪在不同类别的样本中血钾（K＋）、血钠（Na＋）、血糖（Glu）检测项目的可比性。方法分别用GEM Premier 3000血气分析仪与镇江奥迪康电解质析仪及迈瑞生化分析仪对30例患者的动脉全血和静脉血清样本进行K＋、Na＋、Glu的检测,对检测结果进行相关分析。结果血气分析仪和生化分析仪测定Glu的结果以及血气分析仪和电解质分析仪测定Na＋的结果,二者的差异均无统计学意义（P〉0.05）。血气分析仪测定K＋的结果显著低于镇江奥迪康电解质析仪的测定结果,差异有统计学意义（P〈0.05）。结论 GEM Premier 3000血气分析仪能替代传统电解质分析仪和生化分析仪测定K＋、Na＋、Glu,其中K＋的结果有差异但存在正相关。