原发性青光眼合并白内障手术方式临床评价

目的探讨原发性青光眼合并白内障手术方式临床效果。方法本组53例63眼,根据房角粘连情况将38例48眼闭角青光眼合并白内障患者分为：房角粘连关闭≤180°12眼,采用超乳联合房角分离术;180°〈房角粘连关闭≤270°20眼,采用超乳联合房角分离、虹膜周边切除术;房角粘连关闭〉270°16眼,采用超乳、房角分离联合小梁切除术（简称三联）,15例开角型青光眼合并白内障,视力低于0.4者,行超乳联合小梁切除术,随访3个月-5年,对比术前、术后的视力、眼压、前房深度及前房角变化。结果 29眼急性闭角型青光眼和19眼慢性闭角型青光眼术后眼压控制在正常范围,视力恢复良好;6只慢性闭角型青光眼房角粘连〉2/3,术后近期眼压控制好,术后1.8-2.0年眼压再次增高,药物效果好,眼压控制在正常范围。15例开角型青光眼合并白内障者,术后视力均提高,术后眼压12眼控制正常范围,3眼术后近期眼压控制好,1.0-1.5年眼压再次增高,药物控制眼压良好。结论对于原发性闭角型青光眼合并白内障患者,根据房角关闭情况：行超乳联合房角分离术、虹膜周边切除术超乳联合小梁切除术（三联术）,开角性青光眼合并白内障患者,超乳联合小梁切除术可有效控制眼压,但仍需长期随访。     

超声乳化联合小梁切除术在慢性闭角型青光眼眼压控制的效果

目的探讨白内障超声乳化摘除联合小梁切除术对慢性闭角型青光眼眼压的控制效果。方法慢性闭角型青光眼伴有白内障患者54例(54只眼),随机分为两组:A组,28例,行超声乳化白内障摘除联合小梁切除术;B组,26例,行单纯超声乳化白内障摘除术。观察两组术前、术后1、3、6、9、12、15、18、21和24个月的眼内压、使用降眼压药物的种数以及术后并发症。结果与B组比较,A组术后的眼压控制效果好,使用降眼压药物的种数少。结论超声乳化联合小梁切除术能够更有效地控制慢性闭角型青光眼眼压。     

白内障超声乳化摘除联合小梁切除术在慢性闭角型青光眼中的应用效果

目的探讨白内障超声乳化摘除联合小梁切除术在慢性闭角型青光眼中的应用效果。方法选择本院收治的慢性闭角型青光眼合并白内障患者50例（50眼）随机分为研究组和对照组,研究组患者采用白内障超声乳化摘除联合小梁切除术治疗,对照组患者给予单纯白内障超声乳化摘除术治疗,观察两组术前术后眼内压改变情况及并发症情况。结果两组术前眼压比较,差异无统计学意义;术后随访显示研究组患者眼压明显低于对照组,两组比较,差异无统计学意义;两组术后并发症比较差异无统计学意义。结论白内障超声乳化摘除联合小梁切除术治疗慢性闭角型青光眼可有效控制眼压,且并发症无明显增多,安全有效,值得应用。     

原发性闭角型青光眼持续高眼压状态下的手术治疗

目的探讨原发性闭角型青光眼持续高眼压下施行小梁切除术的手术要点及治疗效果。方法:对21例22眼急性闭角型青光眼持续高眼压状态患者,术前、术中用多种方法使眼压逐渐下降后,进行小梁切除术。结果:术后6～12mo,22眼中有17眼术后不用抗青光眼药物,眼压能控制在21mmHg(1mmHg=0.133kPa)以下,4眼加用降眼压药物眼压控制正常;19眼视力有所提高,无严重并发症。结论:对于应用药物治疗不能有效控制眼压的青光眼患者,应当机立断进行手术治疗。只要完善术前准备,术中精心操作,术后精心护理,高眼压下小梁切除术是必要、安全、有效的。     

持续高眼压状态下原发性闭角型青光眼的临床治疗

目的研究原发性闭角型青光眼持续高眼压下施行小梁切除术的手术治疗效果。方法对32例36眼急性闭角型青光眼,术前用多种方法不能使眼压降至正常患者,在高眼压下进行小梁切除术。结果术后6-12个月,36眼中有32眼术后不用抗青光眼药物,眼压能控制在21mmHg（1mmHg=0．133kPa）1．21T,4眼加用降眼压药物,眼压控制正常;31眼视力有所提高,无严重并发症。结论原发性急性闭角型青光眼持续高眼压状态下的小梁切除术是安全有效的,对持续高眼压状态下的病例应积极采用手术治疗,以避免视功能的进一步损害。     

改进复合式小梁切除术治疗青光眼260例分析

目的改进抗青光眼复合式小梁切除术,提高青光眼手术的治疗效果。方法将202例（260眼）进行改进的复合式小梁切除术,观察术后手术效果及并发症。结果术后第七天,眼压〈15mmHg者208眼占80%,〈21mmHg者253眼占97%。结论改进的复合式小梁切除术对于急性闭角型青光眼,慢性闭角型青光眼,开角型青光眼有显著疗效。     

复合式小梁切除术治疗原发性急性闭角型青光眼的临床分析

目的评估复合式小梁切除术治疗原发性急性闭角型青光眼的有效性和安全性。方法原发性急性闭角型青光眼42例(48眼)随机分成2组,观察组20例(23眼)采用复合式小梁切除术和对照组22例(25眼)采用传统小梁切除术,进行对照研究,术后1 d、1周、1个月、3个月、6个月进行复诊,检测矫正视力、眼压、前房深度、裂隙灯显微镜检查等指标,同时观察术后并发症。结果两组术后1 d、1周、1个月、3个月、6个月眼压均明显低于术前,差异有统计学意义(P<0.05);观察组术后各时间点眼压均低于对照组,差异有统计学意义(P<0.05);观察组与对照组相比浅前房的发生率明显降低,差异有统计学意义(P<0.05)。结论复合式小梁切除术治疗原发性急性闭角型青光眼效果显著并且安全可靠。     

原发性闭角型青光眼持续高眼压下的手术治疗

目的研究原发性闭角型青光眼（PACG）持续高眼压下复合式小梁切除术的临床效果。方法对43例（46只眼）眼压控制不良的原发性闭角型青光眼进行复合式小梁切除术。结果46只眼手术均顺利,术后3～12个月跟踪随访,39眼眼压控制在8．00～21．00mm Hg,7眼眼压〉21．00mmHg,其中6眼需局部应用降眼压药物控制到正常,1眼二次手术后平稳。手术成功率约84．78％。结论原发性闭角型青光眼持续高眼压下行复合式小梁切除术是安全有效的。     

青光眼滤过术后眼压失控的原因分析

目的探讨小梁切除术后眼压失控的原因,进一步指导临床,争取进一步降低手术失败率。方法回顾性分析了我院2006年5月到2007年5月收治的术后眼压失控的病例;对其第一次抗青光眼手术前后的情况进行分析,归纳。结果首次在我院接受小梁切除术的病例23例,24只眼,急性闭角型青光眼13例,慢性闭角型青光眼6例,恶性青光眼1例,开角型青光眼2例,先天性青光眼婴幼儿型1例;术前眼压14～24mmHg者7例,25～34mmHg者8例,35～60mmHg者9例,平均眼压33.4mmHg;术前闭角型青光眼房角除2例外均窄IV关闭;术后发生浅前房者9例。结论术前高眼压状态,房角功能差,切除的小梁组织范围小,术后浅前房的发生与术后眼压失控关系密切。     

改良小梁切除术联合5-Fu术中应用

为了更好地解决传统小梁切除术后存在的术后早期低眼压、扁平前房、术后滤过泡瘢痕化失败的问题 ,我们于 1997年9月至 2 0 0 0年 9月 ,采用改良小梁切除术联合 5 - Fu术中应用与传统小梁切除术进行比较 ,报告如下。1　临床资料1.1　改良组 :2 4例 32眼 ,男 10例 13眼 ,女 14例 19眼 ;年龄 2 1～ 72岁 ,平均 4 9岁。急性闭角型青光眼 11眼 ,慢性闭角型青光眼 16眼 ,慢性开角型青光眼 5眼 ,其中近绝对期 8眼。1.2　传统组 :19例 2 6眼 ,男 9例 12眼 ,女 10例 14眼 ;年龄 32～ 74岁 ,平均 5 3岁。急性闭角型青光眼 9眼 ,慢性闭角型青光眼 17眼…     

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.