Comparison of the acute cardiopulmonary effects of oral albuterol, metaproterenol, and terbutaline in asthmatics

The acute cardiopulmonary effects of oral albuterol, 4 mg, metaproterenol sulfate, 20 mg, and terbutaline sulfate, 5 mg, were compared over eight hours in 20 moderate to severe asthmatics. The magnitude and time course of bronchodilation following albuterol and terbutaline were comparable. Albuterol and terbutaline had a duration of action of at least eight hours and produced significantly greater bronchodilation than metaproterenol from six to eight hours. Metaproterenol produced a greater degree of bronchodilation than albuterol and terbutaline 30 minutes after drug dosing. Significantly fewer patients receiving albuterol experienced one or more central nervous system or musculoskeletal side effects than patients receiving terbutaline. These findings imply possible therapeutic advantages of oral albuterol and terbutaline with respect to dosing frequency, while the more rapid onset of oral metaproterenol suggests that it may have an advantage when used on an as-needed basis.     

Aptiganel hydrochloride in acute ischemic stroke: a randomized controlled trial.

CONTEXT: Tissue plasminogen activator is the only thrombolytic agent approved in the United States for treatment of acute ischemic stroke, and has limitations. Aptiganel hydrochloride is a novel and selective ligand for the ion-channel site of the N-methyl-D-aspartate receptor-channel complex and a promising neuroprotective agent in animal models of focal brain ischemia. OBJECTIVE: To determine whether aptiganel improves the clinical outcome for acute ischemic stroke patients. DESIGN: Nested phase 2/phase 3 randomized controlled trial conducted between July 1996 and September 1997. SETTING: One hundred fifty-six medical centers in the United States, Canada, Australia, South Africa, England, and Scotland. PARTICIPANTS: A total of 628 patients with hemispheric ischemic stroke (50.3% male; mean age, 71.5 years). INTERVENTIONS: Patients were randomly assigned within 6 hours of stroke to receive 1 of 3 treatment regimens: high-dose aptiganel (5-mg bolus followed by 0.75 mg/h for 12 hours; n = 214); low-dose aptiganel (3-mg bolus followed by 0.5 mg/h for 12 hours; n = 200); or placebo (n = 214). MAIN OUTCOME MEASURES: The primary efficacy end point was the Modified Rankin Scale score at 90 days after stroke onset. Secondary end points included mortality and change in National Institutes of Health (NIH) Stroke Scale score at 7 days after stroke. RESULTS: The trial was suspended by the sponsor and the independent data and safety monitoring board because of both a lack of efficacy and a potential imbalance in mortality. There was no improvement in outcome for either aptiganel (low-dose or high-dose) group compared with the placebo group at 90 days (median Modified Rankin Scale score for all 3 treatment groups = 3; P =.31). At 7 days, placebo-treated patients exhibited slightly greater neurological improvement on the NIH Stroke Scale than high-dose aptiganel patients (mean improvement for placebo group, -0.8 points vs for high-dose aptiganel, 0.9 points; P =.04). The mortality rate at 120 days in patients treated with high-dose aptiganel was higher than that in patients who received placebo (26.3% vs 19.2%; P =.06). Mortality in the low-dose aptiganel group was 22.5% (P =.39 vs placebo). CONCLUSIONS: Aptiganel was not efficacious in patients with acute ischemic stroke at either of the tested doses, and m ay be harmful. The larger proportion of patients with favorable outcomes and lower mortality rate in the placebo group suggest that glutamate blockade with aptiganel may have detrimental effects in an undifferentiated population of stroke patients.     

Codeine and propoxyphene in postepisiotomy pain. A two-dose evaluation.

In a double-blind control study, oral doses of placebo, propoxyphene napsylate (50 or 100 mg), or codeine sulfate (30 or 60 mg) were administered to 46 postepisiotomy patients, grouped by severity of pain reported at first-dose drug administration. Eight hourly observations by a trained observer provided estimates of analgesia. The analgesia scores for placebo treatments were significantly lower than for the lesser doses of either drug (P less than .05) as well as for the greater doses (P less than .01). At both dose levels, the analgesia scores for both drugs were almost identical. Analgesia with the higher doses was greater than with the lower, but not to a statistically significant extent. The difference in patient responses increased following the second dose. No serious adverse reactions occurred; the elicited and volunteered reports of minor side effects were similar for all five treatments.     

Comparison of two chamber devices in patients using a metered-dose inhaler with satisfactory technique.

A randomized clinical crossover trial was carried out to compare the use in the home, during 1-week periods, of two commercially available chamber devices (the Aerochamber and the Spacer) and a standard metered-dose inhaler (MDI) in 24 patients with reversible bronchospasm and satisfactory inhaler technique. Measurements of peak flow, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), ratio of FEV1 to FVC and forced midexpiratory flow rate were made immediately before and 15 minutes after inhalation of terbutaline sulfate. No difference was noted in results of spirometry, peak flow readings or side effects between the devices. The results of spirometry were better during the trial than immediately before it (p less than 0.01). The mean score for inhaler technique was significantly lower at follow-up than during the trial (p less than 0.001). The results suggest that in this population there is no advantage to using either a chamber device rather than an MDI or one chamber device rather than the other.     

盐酸纳美芬改善老年病人胃癌术后苏醒和镇痛的效果观察

目的:探讨盐酸纳美芬改善老年病人胃癌手术后苏醒和镇痛的效果。方法:选择拟行手术治疗的老年胃癌病人90例,随机分为对照组、纳美芬低剂量组和纳美芬高剂量组,各30例。对照组手术结束时静脉注入0.9%氯化钠注射液2 mL,出手术室时连接PCIA镇痛泵（酒石酸布托啡诺0.2 mg/kg）;低、高剂量组分别于手术结束时静脉注入0.25、0.50 μg/kg盐酸纳美芬,出手术室时连接PCIA镇痛泵（酒石酸布托啡诺0.2 mg/kg+盐酸纳美芬2 μg/kg）。比较3组病人术后自主呼吸恢复时间、睁眼时间、拔管时间、苏醒期不同时间点Narcotrend值、拔管后精神状态（意识障碍、躁动、谵妄）,并比较3组病人术后1、2、6、12、24、48 h的疼痛视觉模拟（VAS）评分、Ramsay镇静评分和恶心呕吐（PONV）评分。结果:高剂量组病人自主呼吸恢复时间、睁眼时间和拔管时间均明显少于低剂量组和对照组（P<0.01）,低剂量组亦均明显少于对照组（P<0.01）。3组病人给药时Narcotrend值差异无统计学意义（P>0.05）;给药后5、10、15 min,高剂量组Narcotrend值均明显高于低剂量组和对照组（P<0.01）;给药后20 min,高、低剂量组Narcotrend值均明显高于对照组（P<0.01）。3组意识障碍和躁动/谵妄情况间差异均无统计学意义（P>0.05）。术后1 h和48 h,高剂量组VAS评分均明显低于对照组（P<0.01）;术后1~48 h,高剂量组Ramsay镇静评分和PONV评分均明显低于对照组（P<0.01）。结论:纳美芬可有效改善老年胃癌病人术后麻醉苏醒效果,维持良好的术后镇痛,并可减轻阿片类药物不良反应,值得临床推广。     

柴胡皂苷d在小鼠体内的类雌激素样作用

目的：探讨柴胡皂苷d在小鼠体内是否具有类雌激素样作用。方法：40只雌性BALB/c小鼠随机分为假手术组、模型组、雌二醇组和大剂量（50mg/kg）、小剂量（5mg/kg）柴胡皂苷d组,每组8只。除假手术组外,各组小鼠行双侧卵巢切除术造模。卵巢切除术后第10天,予相应药物腹腔注射治疗2周,观察小鼠阴道涂片细胞角化情况和体质量变化;末次给药12h后眼眶取血,放射免疫法检测小鼠血清雌二醇水平;剥离子宫、肾上腺,称取质量,计算子宫和肾上腺指数。结果：大、小剂量柴胡皂苷d组上皮细胞角化率高于模型组（P〈0.05）,低于雌二醇组（P〈0.05）;大、小剂量柴胡皂苷d组血清雌二醇水平高于模型组（P〈0.05）,小剂量柴胡皂苷d组低于雌二醇组（P〈0.05）;大、小剂量柴胡皂苷d组子宫指数和肾上腺指数高于模型组（P〈0.05）,低于雌二醇组（P〈0.05）;大剂量柴胡皂苷d组和雌二醇组体质量低于模型组（P〈0.05）。结论：柴胡皂苷d在体内具有弱雌激素样作用,可能是一种潜在的植物雌激素。     

硫酸镁联合布地奈德、硫酸特布他林雾化吸入治疗毛细支气管炎疗效

［摘要］目的　观察硫酸镁联合布地奈德、硫酸特布他林雾化吸入治疗毛细支气管炎的临床疗效．方法　将60例毛细支气管炎患儿随机分为观察组与对照组,每组各30例,给予对照组患儿常规综合治疗,观察组在对照组基础上加用硫酸镁联合布地奈德、硫酸特布他林雾化吸入治疗．分别从临床症状、血清炎性因子以及总体临床疗效几方面对治疗效果进行评价．结果　观察组患儿的气喘、气促、咳嗽、肺部哮鸣音及湿啰音消失时间均显著短于对照组患儿（P＜0.05）;经过治疗,2组患儿的TNF-ɑ、IL-6、IL-8、TIgE血清水平均显著降低,与治疗前比较差异有统计学意义（P＜0.05）,但治疗后组间比较以观察组患儿的改善效果更为明显,与对照组比较差异有统计学意义（P＜0.05）;观察组患儿的临床总有效率为93.3%,对照组为70.0%,组间比较差异有统计学意义（P＜0.001）．结论　硫酸镁联合布地奈德、硫酸特布他林雾化吸入治疗毛细支气管炎的临床疗效满意,值得在临床推广应用．     

促红细胞生成素治疗大鼠肾脏缺血再灌注损伤最佳剂量及时机的探讨

目的探讨重组人促红细胞生成素（rHuEPO）治疗大鼠肾脏缺血再灌注性损伤的最佳剂量及时机。方法将60只SD大鼠随机分为6组,每组10只,假手术组、模型组、高剂量24（高24）组：造模后腹腔注射rHuEPO 5 000 U/kg,24 h后取肾标本;低剂量24（低24）组：rHuEPO 2 500 U/kg,24 h取肾脏标本;高剂量48（高48）组：rHuEPO 5 000 U/kg,48 h取肾标本;低剂量48（低48）组：rHuEPO 2 500 U/kg,24 h后追加2 500 U/kg,48 h取肾标本。检测血清尿素氮（BUN）、肌酐水平（Scr）、肾组织中磷酸化应激活化蛋白激酶（p-JNK）的表达及肾小管上皮细胞凋亡情况。结果与假手术组相比,其他5组大鼠BUN、Scr明显升高,凋亡加重,p-JNK表达增多;与模型组相比,各rHuEPO治疗组肾功能明显好转,肾功能高24组好于低24组,高48组好于低48组（P〈0.05）。结论及时一次大剂量应用rHuEPO对大鼠肾脏具有更好的保护作用,可能是通过调节p-JNK等因子表达以减少凋亡的发生,而达到改善肾脏病理性损伤。     

氯化镧短期重复剂量染毒对ICR小鼠遗传毒性和氧化损伤的影响

目的：研究氯化镧短期重复染毒对ICR小鼠产生的遗传毒性和氧化损伤;方法：ICR小鼠随机分为对照组、低剂量组和高剂量组,分别给予0 mg/kg、20 mg/kg、200 mg/kg氯化镧,连续灌胃7 d,测定外周血淋巴细胞微核,取脏器分别测定丙二醛（ malondiadehyde,MDA）、谷胱甘肽（ glutathione,GSH）、超氧化物歧化酶（ SuperoXide dismutase,SOD）的含量。结果：高剂量组微核率显著高于对照组（ P〈0.05）;镧元素在心脏、肝脏、脾脏和肾脏的蓄积量,高剂量组与低剂量组和对照组相比差异均有统计学意义（ P〈0.05）;高剂量组小鼠脾脏、肾脏组织中MDA含量高于对照组（ P〈0.05）;高剂量组小鼠脾脏、肾脏中 GSH、T -SOD 含量低于低剂量组和对照组（ P〈0.05）。结论：氯化镧经口染毒剂量在200 mg/kg时可在各脏器中蓄积,且可引起小鼠脏器发生氧化损伤和骨髓微核率的增加,提示200 mg/kg氯化镧对小鼠有一定的遗传毒性,氧化损伤可能是其引起遗传毒性的机制之一。     

小剂量纳洛酮联合曲马多用于妇科腹腔镜术后镇痛的临床观察

目的：探讨小剂量纳洛酮联合曲马多用于妇科腹腔镜术后镇痛的效果。方法：选择行腹腔镜手术治疗的患者104例,随机分为曲马多组和联合组,各52例。曲马多组于腹腔镜术后给予曲马多100mg ,静注;联合组给予曲马多100mg ,纳洛酮0．4mg ,静注。结果：联合组在 T0、T1h 、T6h时VAS评分明显低于曲马多组（P＜0．05）。联合组术后T0、T1h 、T6h时MAP、HR均明显低于曲马多组（P＜0．05）。联合组术后24h恶心、呕吐发生率明显低于曲马多组。联合组术后2h寒战发生率明显低于曲马多组（P＜0．05）。结论：小剂量纳洛酮联合曲马多可增强曲马多的镇痛效果,降低其消耗量,对血流动力学影响较轻,不良反应少,安全可靠,对患者术后恢复非常有利。因此,曲马多联合小剂量纳洛酮对术后镇痛效果安全、有效,是腹腔镜术后镇痛较好的方法。     

The effect of terbutaline on cardiac function in patients with stable chronic obstructive lung disease

The effect of 0.25 mg of terbutaline sulfate, a beta 2-adrenergic agent, on the right and left ventricular ejection fractions (RVEF and LVEF, respectively) was studied in 30 patients with severe stable chronic obstructive pulmonary disease (COPD) with a mean forced expiratory volume in 1 s of 0.79 +/- 0.06 L. All bronchodilator therapy was withdrawn 48 hours before the study. The ECG-synchronized gated equilibrium radionuclide ventriculography showed decreased RVEF in 27 patients and LVEF in 16 patients. Both the RVEF and LVEF significantly increased after the terbutaline injection; this increase was noted both in patients with normal and decreased ejection fractions. We conclude that the increase in ejection fractions after terbutaline injection may contribute to the good clinical response to this drug seen in patients with severe stable COPD even though the bronchodilator effect may be minimal.     

Low-dose amiodarone for the prevention of atrial fibrillation after coronary artery bypass grafting in patients older than 70 years

Background Atrial fibrillation （AF） is one of the most common arrhythmia after coronary artery bypass grafting （CABG）, which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly. Methods Two hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone （low-dose amiodarone group, n=100） or placebo （control group, n=110） daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively. Results Postoperative AF occurred in 16 patients （16%） receiving amiodarone and in 36 （37.7%） patients receiving placebo （P=0.006）. AF occurred at （58.13±16.63） hours after CABG in the low-dose amiodarone group and at （45.03±17.40） hours in the control group （P=0.018）. The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group （（121.42±8.91） beats/min） than in the control group （（134.11±30.57） beats/min, P=0.036）. The duration of AF was （10.92±9.56） hours for the low-dose amiodarone group compared with （14.81±10.37） hours for the control group （P=0.002）. The postoperative left ventricular ejection fraction （LVEF） was significantly improved in the low-dose amiodarone group （from （59.9±10.3）% to （63.4±11.4）%, P=0.001）, and significantly higher compared with the control group （（58.5±10.7）%, P=-0.002）. Both groups had a similar incidence of complication other than rhythm disturbances （12.0% vs 16.4%, P=0.368）. The low-dose amiodarone group patients had shorter hospital stays （（11.8±3.2） days vs （13.8±4.7） days, P=-0.001） and lower cost of care （RMB （79 115±16 673） Yuan vs RMB （84 997±21 587） Yuan, P=0.031） than that of control group patients. The in-hospital mortality was not significantly different between the two groups （1.0% vs 0.9%, P=0.946）. Conclusions Perioperative low-dose oral amiodarone appeared to be cost-effective in the prevention and delay of new-onset postoperative AF in aged patients. It significantly reduced ventricular rate and duration of AF after CABG, decreased hospital cost and stay, as well as promoted the amelioration of left ventricular, systolic function. Furthermore, low-dose amiodarone was safe to use and well tolerated with low toxic and side effects, and did not increase the risk of complications and mortality. It is proved to be a first-line therapy and as routine prophylaxis for AF after CABG, especially for elderly patients complicated with left ventricular dysfunction.     

维生素Ｄ联合维生素Ｄ结合蛋白测定 对慢阻肺预后的预测价值

探讨维生素Ｄ联合维生素Ｄ结合蛋白测定对慢阻肺预后的预测价值。方法　选择患者８０例,观 察组为急性发作期患者,对照组为近１年内未急性发作的慢阻肺患者,比较两组患者第一秒用力肺活量百分比、 血钙和血磷水平,比较两组２５羟维生素Ｄ及血清维生素Ｄ结合蛋白水平,比较治疗后１年内,急性发作次数, 第一秒用力肺活量恢复及死亡比例。结果　观察组第一秒用力肺活量百分比低于对照组（Ｐ＜００５）,血钙水平 低于对照组（Ｐ＜００５）,血磷水平高于对照组（Ｐ＜００５）,２５羟维生素Ｄ及血清维生素Ｄ结合蛋白水平低于对 照组（Ｐ＜００５）,急性发作次数多于对照组（Ｐ＜００５）,第一秒用力肺活量恢复３０％低于对照组（Ｐ＜００５）,死 亡比例显著高于对照组（Ｐ＜００５）。结论　２５羟维生素Ｄ联合维生素Ｄ结合蛋白测定对于判断慢阻肺患者疾 病发作状态,预测患者预后具有一定重要指导价值。     

Prevention of travelers' diarrhea by the tablet formulation of bismuth subsalicylate

Within 48 hours of arrival in Mexico, 182 US students participated in a study to compare the efficacy of two dosages of bismuth subsalicylate (262 mg per tablet) as a prophylactic agent against diarrhea. The students were randomly assigned to receive two tablets (high dose) or one tablet (low dose) of bismuth subsalicylate four times daily or a placebo four times daily during a three-week period. Among these completing the trial, diarrhea (four or more unformed stools in 24 hours or three in eight hours, plus one other symptom) occurred in seven (14%) of 51 receiving the high-dose regimen compared with 15 (24%) of 63 receiving the low-dose regimen and 23 (40%) of 58 in the placebo group. Protection rates were 65% for high-dose and 40% for low-dose bismuth subsalicylate. Diarrhea caused by enterotoxigenic Escherichia coli was found in one student receiving the high-dose regimen, in no students receiving the low-dose regimen, and in seven placebo-treated subjects. Bismuth subsalicylate was well tolerated; the most common side effects were blackening of tongues and stools. Bismuth subsalicylate use in both dosages was associated with tinnitus at a low, clinically insignificant frequency of 1.2 days per 100 days of treatment. The dosage of two tablets of bismuth subsalicylate four times daily (2.1 g/d) appears to be a safe and effective means of reducing the occurrence of travelers' diarrhea among persons at risk for periods up to three weeks.     

Oral aztreonam, a poorly absorbed yet effective therapy for bacterial diarrhea in US travelers to Mexico.

OBJECTIVE--To evaluate a poorly absorbed antimicrobial with in vitro activity against all major bacterial enteropathogens in oral therapy for bacterial diarrhea. DESIGN--One hundred ninety-one US students with diarrhea acquired in Mexico received 100 mg of aztreonam or matching placebo three times a day for 5 days. Stools were cultured for bacterial enteropathogens before and after therapy. SETTING--We studied US students who acquired diarrhea in Mexico (travelers' diarrhea) in view of the high frequency of bacterial agents in this setting. MAIN OUTCOME MEASURE--We examined time of clinical recovery, treatment failures, adverse experiences, and microbiologic eradication from stool of the etiologic agent in subjects randomized to receive aztreonam or placebo. RESULTS--Aztreonam reduced the average duration of diarrhea compared with the placebo: for all cases, by 40 hours (P much less than .01); for those with enterotoxigenic Escherichia coli diarrhea, by 50 hours (P less than .01); for those with shigellosis, by 90 hours (P, not significant [small sample size]); for all bacterial agents, by 57 hours (P much less than .01). Clinical failures during the 5 days of therapy were seen in six patients (6%) receiving aztreonam and 25 (27%) receiving placebo (P less than .01). Pathogen eradication occurred in 95% of those receiving aztreonam and in 70% of those receiving the placebo (P less than .01). All bacterial enteropathogens were susceptible in vitro to aztreonam. The drug was well tolerated. CONCLUSIONS--Oral aztreonam, which is poorly absorbed, was well tolerated and was an effective therapy for bacterial diarrhea in US adults in Mexico.     

丙泊酚对新生小鼠下丘脑室旁核神经元及下丘脑小胶质细胞的影响

目的 研究丙泊酚对新生小鼠下丘脑区域神经元激活及小胶质细胞活化水平的影响,并探讨与丙泊酚神经毒性的相关性.方法 15只同窝7d龄(postnatal day 7,P7) C57小鼠按随机数字表法分为3组(n=5):对照组、丙泊酚低剂量组、丙泊酚高剂量组.P7时,丙泊酚低、高剂量组小鼠分别接受丙泊酚30、60 mg/kg腹腔注射,对照组注射同等体积的脂肪乳溶剂.24 h后(P8)处死小鼠收取脑标本,采用免疫组织化学方法检测下丘脑C-Fos、精氨酸加压素(arginine vasopressin,AVP)、糖皮质激素受体(glucocorticoid receptor,GR)及小胶质细胞标志物离子钙接头分子蛋白1(ionized calcium binding adapter molecule 1,Iba1)的表达,Western blot测定AVP及GR的表达.结果 与对照组(9.95±1.51)相比,丙泊酚低剂量组(14.75±1.39)、丙泊酚高剂量组(24.00 ±5.25)室旁核C-Fos阳性细胞数量均明显增多(P ＜0.05,P＜0.01),且高剂量组相对低剂量组增多(P＜0.01);对照组(14.94 ±3.39)与低剂量组(19.63 ±3.70)室旁核表达AVP阳性细胞数量无明显差异,而高剂量组(23.38 ±2.29)中AVP阳性细胞数量对比对照组明显增加(P＜0.01),且蛋白表达上调;高剂量组(37.38 ±3.17)下丘脑室旁核GR表达相对对照组(27.38 ±2.17)及低剂量组(31.38 ±2.39)均明显上调(P ＜0.01,P＜0.05),对照组和低剂量组间无差异;与对照组相比,低剂量组、高剂量组下丘脑背内侧区、腹内侧区、外侧区Iba1标记的小胶质细胞数量均明显减少.结论 丙泊酚激活新生小鼠下丘脑室旁核神经元,致下丘脑精氨酸加压素和糖皮质激素受体表达上调,并抑制小胶质细胞活化水平,影响程度与剂量相关.     

雾化吸入治疗胃肠道肿瘤患者术后咽部不适效果观察

目的观察盐酸氨溴索联合硫酸特步他林雾化吸入对治疗胃肠道肿瘤患者手术后咽部不适的效果。方法将60例手术后存在咽部不适的胃肠道肿瘤患者随机分为观察组和对照组各30例。两组均接受抗感染、吸氧、维持水电解质平衡等综合治疗,观察组在综合治疗基础上于手术后第1天使用盐酸氨溴索15mg＋硫酸特布他林0.5mg（4mL）＋生理盐水2mL雾化吸入。比较两组的临床疗效。结果观察组显效27例,显效率90.0%,对照组显效24例,显效率80.0%。观察组显效率明显高于对照组,P〈0.01。观察组有效2例,对照组有效1例。观察组显效率＋有效率96.7%,对照组显效率＋有效率83.3%,观察组显效率＋有效率明显高于对照组,P〈0.05。结论联合应用盐酸氨溴索和硫酸特步他林雾化吸入有利于缓解胃肠道肿瘤手术后患者的咽部不适症状。     

Effect of terbutaline sulphate in chronic "allergic" cough

The effects of terbutaline sulphate were studied in 30 patients who presented with chronic cough at an allergy clinic. After a three week baseline period terbutaline and its placebo were given for two periods of three weeks each in a randomised, double blind, crossover manner. Patients kept a daily record of day and night cough scores and peak expiratory flow readings. Twenty one patients responded to terbutaline; placebo produced no significant effect. Both day and night cough scores (p less than 0.001) and peak expiratory flow rates were significantly improved (p less than 0.05) by the end of the first week of treatment with terbutaline. This improvement was achieved with only a fairly small change in airway calibre.     

剑麻皂素对大鼠局灶性脑缺血再灌注损伤的保护作用及其机制

目的探讨剑麻皂素对大鼠局灶性脑缺血再灌注损伤的保护作用及其机制。方法采用大脑中动脉闭塞法制备局灶性脑缺血再灌注损伤大鼠模型,模型建立成功后,选取大鼠60只,按随机数字表法分为模型组、三七通舒组,剑麻皂素高、中、低剂量组,每组12只。模型组灌服蒸馏水,三七通舒组灌服三七通舒胶囊,剑麻皂素高、中、低剂量组分别按450、225、113 mg/（kg·d）灌服剑麻皂素。对比各组神经行为学评分、脑梗死体积、脑组织含水量及血清超氧化物歧化酶（SOD）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-Px）、乳酸（LA）水平。结果剑麻皂素高、中剂量组大鼠神经行为学评分明显低于模型组（P〈0.05）,绝对脑梗死体积和相对脑梗死体积明显小于模型组（P〈0.05）,剑麻皂素高剂量组脑含水量明显低于模型组（P〈0.05）。剑麻皂素高剂量组大鼠血清SOD、GSH-Px水平明显高于模型组,MDA、LA水平明显低于模型组（P〈0.05）;剑麻皂素中剂量组大鼠血清SOD水平明显高于模型组（P〈0.05）,MDA水平低于模型组（P〈0.05）。结论剑麻皂素对大鼠局灶性脑缺血再灌注损伤具有明显保护作用,其机制可能与清除自由基、减轻LA性酸中毒程度有关。     

大剂量α-硫辛酸治疗糖尿病周围神经病变的有效性和安全性评价

目的 观察口服较大剂量α-硫辛酸对糖尿病神经病变的治疗作用与安全性.方法 采用随机、双盲、多中心与安慰剂对照方法,共从5个中心入选236例有临床症状的糖尿病神经病变患者,口服α-硫辛酸(117例)1800 mg/d或安慰剂(119例)12周,主要终点指标为总神经症状积分,次要终点指标包括神经传导速度、各神经症状积分、HbA1c和安全性指标,分别在随访前和治疗后2、4、8、12周观察这些指标的变化,统计分析两组间差别.结果 经过α-硫辛酸治疗12周后,73.3%患者神经症状显著改善,对照组为18.3%;总神经症状积分减少2.6±2.3,显著高于对照组的0.7±1.4(P＜0.05);2周随访时,两组症状改变量差异有统计学意义(P＜0.05).α-硫辛酸对疼痛、麻木、烧灼感和其他感觉异常均有较好的疗效,症状积分均较入组前显著减少(P＜0.05);但是神经传导速度在治疗前后无改变.12周观察期间,α-硫辛酸组HbA1c进一步降低;但是副反应发生率较高(25.4%),以咽喉部至胃部灼热感为主,未见严重不良反应.结论 在安全的基础上,口服较大剂量α-硫辛酸对改善糖尿病神经病变的症状疗效显著,在2周内就能使症状显著减轻.