高压氧治疗在神经外科疾病中的应用

神经外科很多疾病致死率和致残率都很高,有些疾病通过手术治疗效果缓解不明显,甚至出现新的症状.仅仅依靠手术治疗神经外科疾病已远远不能满足临床需要,神经外科医生应该掌握以手术为主的综合治疗手段.本文介绍了高压氧在几类常见神经外科疾病中的应用和最新进展,早期高压氧治疗可以明显提高颅脑损伤、脑出血、脑肿瘤、脑血管病的治疗效果,改善患者的生存质量.     

Pharmacogenomics: personalizing drug therapy

Pharmacogenomics is a rapidly growing field of research into the ways in which genetic variation affects drug response. Its objective is to develop precisely targeted, optimal drug therapy. One area of pharmacogenomics focuses on identifying genetic markers for differences in the way people metabolize drugs; another concentrates on developing genetic tests that predict how specific patients will respond to agents such as statins or cancer therapies. Nurses are now called upon to interpret such information or services in order to provide appropriate patient teaching regarding drug selection.     

Antihypertensive drug therapy: adverse effects and drug interactions

The number of classes of antihypertensive drugs has been growing. The options of choice of the drugs now are so great that it seems not to be difficult to reduce blood pressure effectively. Newly developed classes have been shown to provide beneficial effects in variety of hypertension-related processes. However, each drug shows significant differences in adverse effects, incidental properties and interactions with non-antihypertensive drugs. To improve quality of life, compliance with medication, and beneficial effects on pathophysiological and cardiovascular risk conditions of patients, we should be well acquainted with adverse effects and possible disadvantages produced by antihypertensive drugs in particular situations.     

Intrathecal drug therapy: general considerations

Intrathecal drug-delivery systems have been used increasingly for management of pain and spasticity. The indications, efficacy, and cost-effectiveness of intrathecal therapy have not been established with certainty in randomized, controlled trials, but most available data indicate that intrathecal therapy can be a remarkably useful treatment of otherwise intractable pain and spasticity. Outcomes will undoubtedly improve further as we gain a better understanding of (and strict adherence to) patient selection criteria and mechanisms governing intrathecal drug actions while continuing to emphasize thoughtful patient and family education regarding therapeutic goals and their responsibility in helping to make the therapy successful.     

Obesity: principles of drug therapy

Obesity is a major global public health problem. In many instances, a combination of diet modification, increased physical activity and behavior therapy fail or are insufficient for sustained weight loss. In these situations, drug therapy may be helpful. However, drug treatment of obesity resulted in unexpected devastating events in recent years. In the late sixties, aminorex caused an epidemic of pulmonary hypertension with high mortality rates. Dexfenfluramine and phentermine were also associated with the development of pulmonary hypertension and with alarming reports of cardiac valvular abnormalities. Therefore, these drugs were withdrawn from the market. Newer drugs, like sibutramine, a serotonin and norepinephrine reuptake inhibitor, and orlistat, a specific lipase inhibitor, reduce body weight significantly compared to placebo. In combination with a hypocaloric diet, weight loss of three to ten kilos can be achieved. Pharmacotherapy is limited to patients with a body mass index greater than 30 kg/m2, if non-pharmacological treatment programs have failed. The drugs should be prescribed under strict medical surveillance only.     

Antiepileptic drug therapy: Clinical laboratory significance

When evaluating a patient who is taking an antiepileptic medication, it is important for the emergency physician to correlate the clinical presentation with the antiepileptic drug level. Therapeutic ranges have been suggested for most antiepileptic medications, but these must be interpreted in light of clinical efficacy and patient tolerance. When considering the efficacy of antiepileptic medications, it is necessary to consider the patient's unique metabolism, side-effect tolerance, and overall response to therapy. Suggested therapeutic ranges should be the first reference for the emergency physician. The purpose of this report is to discuss the laboratory values of commonly prescribed antiepileptic medications. Therapeutic ranges, side-effects, and common medication interactions are discussed concerning phenytoin, phenobarbital, carbamezapine, and valproic acid.     

Antiviral drug therapy

Major advances in molecular virology have led to the development of new antiviral compounds. These drugs include ribavirin, used in the treatment of severe respiratory syncytial virus infection in children; amantadine, used in the prophylaxis and treatment of influenza A infection; acyclovir, used in a variety of herpesvirus infections, including primary gingivostomatitis, genital herpes and herpes zoster; ganciclovir, used in the treatment of retinitis due to cytomegalovirus, and zidovudine, used in the prophylaxis and treatment of human immunodeficiency virus infection.