钙镁合剂联合维生素B_6防治奥沙利铂神经毒性的临床观察

目的:观察钙镁合剂联合维生素B6防治奥沙利铂神经毒性的临床疗效.方法:128例接受FOLFOX4方案化疗的胃癌根治术后患者随机分3组,A组单用维生素B6,B组单用钙镁合剂,C组联用钙镁合剂和维生素B6防治神经毒性.神经症状采用奥沙利铂Levi专用感觉神经毒性分级标准评定.结果:化疗4～6个周期后3组不同药物干预下奥沙利铂神经毒性总发生率分别为A组25/41(60.97%).B组23/37(62.16%),C组17/50(34.00%),C组防治奥沙利铂神经毒性总发生率明显低于其他两组(P＜0.012 5).结论:钙镁合剂联合维生素B6能有效降低奥沙利铂神经毒性的发生率.     

还原型谷胱甘肽预防奥沙利铂神经毒性疗效观察

目的观察还原型谷胱甘肽预防奥沙利铂神经毒性的疗效。方法对87例应用奥沙利铂全身化疗的癌症患者随机分为二组,治疗组44例,对照组43例。治疗组奥沙利铂全身化疗前2d开始使用还原型谷胱甘肽1800mg加入5%葡萄糖注射液250ml中静脉滴注,每日一次,连用7d。对照组不用还原型谷胱甘肽,其它用药与治疗组相同。观察神经系统不良反应。结果治疗组奥沙利铂神经毒性发生率11.36%（5/44）,对照组为51.16%（22/43）,治疗组与对照组比较,差异有统计意义（χ2=16.09,P〈0.05）。结论用还原型谷胱甘肽预防奥沙利铂神经毒性疗效确切。     

钠钾镁钙葡萄糖注射液联合还原型谷胱甘肽预防奥沙利铂迟发性周围神经毒性

目的研究分析钠钾镁钙葡萄糖注射液联合还原型谷胱甘肽用于预防奥沙利铂迟发性周围神经毒性的临床价值。方法将2012年1月至2013年12月收治的肠癌根治术后64例行辅助化疗患者随机分为实验组32例和对照组32例。两组化疗方案均为mFOLFOX6。实验组患者给予mFOLFOX6(奥沙利铂,亚叶酸钙,氟尿嘧啶)辅助化疗,化疗期间采用钠钾镁钙葡萄糖注射液联合还原型谷胱甘肽治疗方案;对照组患者仅予以mFOLFOX6辅助化疗。两组均14 d为1个周期,共治疗6周期。观察治疗后两组患者迟发性周围神经毒性的发生率。结果经过6周期mFOLFOX6化疗后,实验组患者出现迟发性周围神经毒性的总发生率(18.75%),明显低于对照组患者的总发生率(53.12%),差异有统计学意义(P<0.01)。结论钠钾镁钙葡萄糖注射液联合还原型谷胱甘肽的治疗方法可用于降低奥沙利铂迟发性周围神经毒性的发生率。     

两种铂类化疗方案对胃肠癌患者奥沙利铂神经毒性的预防效果

[目的]探讨两种铂类化疗方案对胃肠癌患者奥沙利铂神经毒性的预防效果.[方法]选取于本院接受改良FOLFOX6方案化疗的胃肠癌患者98例为研究对象,随机分为观察组与对照组,每组各49例.观察组给予单唾液四己糖神经节苷脂预防神毒性,对照组给予钙镁合剂,观察两组患者神经毒性发生率及不良反应发生情况等.[结果]观察组神经毒性发生率8.16%显著低于对照组的26.53%,差异具有统计学意义(P<0.05),两组患者的神经毒性症状均集中在四肢感觉迟钝、疼痛或麻木;两组患者恶心呕吐、贫血、腹泻不良反应发生率比较,差异无统计学意义(P>0.05).[结论]单唾液四己糖神经节苷脂对预防奥沙利铂化疗胃肠癌患者的神经毒性效果显著,且不增加治疗相关不良反应,值得临床推广应用.     

文拉法辛联合谷胱甘肽防治奥沙利铂所致神经毒性的观察和随访

目的观察和分析文拉法辛联合谷胱甘肽防治奥沙利铂所致神经毒性的发生和恢复情况。方法应用奥沙利铂辅助治疗肠癌和胃癌患者共90例,随机分为对照组和观察组,每组45例,对照组给予5%葡萄糖联合维生素B6治疗,观察组给予文拉法辛联合谷胱甘肽治疗,观察两组神经毒性的发生情况,应用NTX-12自评量表对患者长期遗留神经毒性进行随访和分析。结果对照组和治疗组在化疗4、8、12周期时神经毒性发生率分别为40.0%、77.8%、83.9%和24.4%、44.4%、46.5%。慢性神经毒性在两组均具有明显的剂量累积性。两组患者NTX-12评分变化在化疗后6个月比较差异有统计学意义(P0.05),化疗后12个月差异未见统计学意义。对照组和观察组患者在化疗后6、12个月遗留神经毒性分别为44.5%、33.3%和35.6%、22.2%,其中3级分别为6.7%、4.4%和2.2%、2.2%。结论文拉法辛联合谷胱甘肽可以减轻奥沙利铂所致神经毒性,并且有助于神经毒性的恢复。     

应用中药泡洗缓解奥沙利铂神经毒性的护理

目的探讨应用中药泡洗缓解奥沙利铂周围神经毒性的护理效果。方法将120例应用奥沙利铂方案化疗的住院患者,随机分为治疗组(化疗加用中药泡洗)和对照组(单用化疗)各60例,观察2组神经毒性的评分。结果 0级~Ⅳ级神经毒性发生率治疗组与对照组比较,差异有统计学意义(P0.05),治疗组周围神经毒性较对照组减轻。结论中药泡洗可有效缓解奥沙利铂化疗所致的神经毒性,值得临床推广。     

围化疗期针刺防治奥沙利铂神经毒性临床观察

目的:观察针刺防治奥沙利铂神经毒性的临床疗效,以及针刺对奥沙利铂化疗患者中医临床证候的影响。方法:将60例符合纳入标准的患者随机分为3组,针刺治疗组20例、西药对照组20例和单纯化疗组20例,所有患者均采用含奥沙利铂方案化疗,采用Levi感觉神经毒性评分评价治疗疗效,并观察中医临床证候变化。结果:针刺治疗组神经毒性发生率为30.00%,西药对照组发生率为36.84%,单纯化疗组发生率为78.95%,针刺治疗组与西药对照组均优于单纯化疗组,针刺治疗组与西药对照组差异比较无统计学意义(P0.0167);三组神经毒性Levi分级比较,针刺治疗组与西药对照组神经毒性分级均低于单纯化疗组,差异具有统计学意义(P0.05),针刺治疗组与西药对照组比较,差异无统计学意义(P0.05);三组中医临床证候变化情况比较,针刺治疗组对奥沙利铂化疗患者的中医临床证候改善,优于西药对照组和单纯化疗组,差异比较具有统计学意义(P0.05),而西药对照组与单纯化疗组比较,差异无统计学意义(P0.05)。结论:针刺治疗可降低奥沙利铂神经毒性的发生及减轻神经毒性的反应程度,并能对化疗患者的中医临床证候有明显改善。     

中医临床护理路径在奥沙利铂化疗病人护理中的应用

[目的]探讨中医临床护理路径在奥沙利铂化疗病人护理中的应用效果。[方法]将120例拟应用奥沙利铂化疗的肿瘤病人随机分为对照组与观察组各60例,对照组采用化疗神经损害常规治疗、护理方法,观察组应用基于德尔菲法拟定的奥沙利铂神经毒性反应防治中医临床护理路径。护理前后比较两组病人神经毒性反应发生率、生活质量评分及护理满意度。[结果]观察组化疗第2个月、第3个月、第4个月Ⅱ～Ⅳ级神经毒性反应发生率分别为0%、15%及22%,对照组分别为5%、28%及75%,两组比较差异有统计学意义(P0.01);两组化疗后生活质量评分(QLQ-C30)及护理满意度比较差异均有统计学意义(P0.01)。[结论]中医临床护理路径的应用有助于减轻奥沙利铂引起的外周神经损害,改善病人的生活质量,提高病人对护理工作的满意度。     

还原型谷胱甘肽预防奥沙利铂所致神经毒性的临床观察

目的探讨用还原型谷胱甘肽(GSH)预防及减轻奥沙利铂(OXL)引起急慢性神经毒性的临床应用价值。方法 106例结肠癌术后使用FOLFOX4方案辅助化疗的患者,随机分为两组,一组在使用OXL化疗前后给予GSH,另一组不给予GSH,观察两组患者急慢性神经毒性的发生率和发生程度,分析两组患者的中位无进展生存时间(PFS)是否有差异。结果急性神经毒性在试验组总的发生率为88.8%,对照组为90.3%(P值=0.801),两组间差异无统计学意义。慢性神经毒性治疗组总发生率为88.9%,显著低于对照组的100%(P<0.05),随着OXL累积剂量的增加,神经毒性的发生率也增加。治疗组与对照组中位随访46.0个月和46.5个月后,中位PFS分别为51.8个月与49.2个月(P值=0.848),差异无统计学意义。结论在OXL治疗前后使用GSH可以减轻慢性神经毒性的发生率和程度,而对急性神经毒性无影响。GSH不影响OXL的治疗疗效,对患者的中位PFS无影响。     

加味黄芪桂枝五物汤防治奥沙利铂急性周围神经毒性观察

目的:观察用加味黄芪桂枝五物汤防治奥沙利铂急性周围神经毒性的临床疗效。方法:将80例患者随机分成2组,试验组40例,化疗同时联用加味黄芪桂枝五物汤。对照组40例单用化疗。化疗方案均采用FOLFOX方案,急性周围神经毒性评定参考Levi及赵国光等关于奥沙利铂外周神经毒性评分标准。结果:可评定疗效病例试验组40例,发生奥沙利铂化疗后急性周围神经毒性患者1级10例,2级4例,3级2例,4级0例,发生率约为40.0%。对照组40例,发生急性周围神经毒性1级12例,2级13例,3级8例,4级2例,发生率约为87.5%。2组具有显著性差异(P0.02)。而发生3、4级急性周围神经毒性患者,治疗组和对照组有显著差异(P0.01)。结论:运用加味黄芪桂枝五物汤可以有效预防奥沙利铂引起的急性外周神经毒性。     

Controlled study of citrate effects and response to i.v. calcium administration during allogeneic peripheral blood progenitor cell donation

BACKGROUND: Leukapheresis procedures are generally performed at citrate anticoagulation rates extrapolated from shorter plateletpheresis procedures. However, neither the metabolic effects nor the management of associated symptoms have been critically evaluated during leukapheresis in healthy donors. STUDY DESIGN AND METHODS: Symptom assessments (n = 315) and laboratory analyses (n = 49) were performed during 244 procedures performed with and 71 without prophylactic calcium (Ca) chloride or Ca gluconate given at a dose linked to the citrate infusion rate (1.0-2.2 mg/kg/min). RESULTS: During leukapheresis of 12 to 25 L processed, ionized Ca and ionized magnesium (Mg) decreased as much as 35 and 56 percent, respectively, each exhibiting a tight negative correlation with marked increases in serum citrate levels. Significant increases in urinary Ca and Mg excretion accompanied the renal excretion of a large citrate load. Serum divalent cation levels remained depressed 24 hours after leukapheresis. Symptoms were more frequent in donors who were women, had low initial total Mg levels, and underwent procedures in which larger volumes were processed at higher citrate infusion rates. Ca infusions reduced clinically significant paresthesias by 96 percent and also attenuated decreases in serum potassium. Ca chloride maintained higher Ca levels than Ca gluconate. CONCLUSIONS: Prophylactic Ca infusions safely attenuate the marked metabolic effects of citrate administration and promote faster, more comfortable, leukapheresis procedures.     

还原型谷胱甘肽预防草酸铂慢性神经毒性16例疗效观察

目的:观察还原型谷胱甘肽对草酸铂慢性神经毒性的预防作用.方法:将31例接受FOLFOX4方案(草酸铂、亚叶酸、氟尿嘧啶)化学治疗的胃癌和大肠癌患者,随机分为预防组和对照组.预防组16例,在草酸铂化学治疗前予还原型谷胱甘肽1.5 g/m2静脉注射.对照组15例不使用还原型谷胱甘肽.在治疗的第2周期后(草酸铂累积剂量大于300 mg/m2),第4周期后(草酸铂累积剂量大于600mg/m2).第6周期后(草酸铂累积剂量大于1000 mg/m2)分别评估2组的神经毒性.结果:在完成第2和第4周期治疗后2组的神经毒性无明显差异,完成第6周期后对照组的神经毒性发生率为67%,并且有13%的患者(2例)出现功能障碍,而预防组神经毒性的发生率为31%,无1例出现功能障碍.结论:还原型谷胱甘肽能有效地预防草酸铂引起的慢性神经毒性.     

Glutathione in the prevention of cisplatin induced toxicities. A prospectively randomized pilot trial in patients with head and neck cancer and non small cell lung cancer

PURPOSE: Glutathione has been shown to be an effective chemoprotector against cisplatin-induced side effects in patients with ovarian cancer. In view of this fact, we performed a randomized clinical pilot-trial in the management of other solid tumors in order to compare application of Glutathione to intensive hydration in patients undergoing chemotherapy with a regimen including cisplatin. PATIENTS AND METHODS: Twenty patients suffering from advanced non small cell lung cancer (n = 6) or head- and neck cancer (n = 14) were enrolled in the study. All patients received 80 mg/m2 cisplatin along with etoposide or 5-fluorouracil every 4 weeks. Patients randomized to application of Glutathione (n = 11) received 5 g of Glutathione immediately before application of cisplatin followed by 2000 ml of normal saline. Patients in the control group (n = 9) received 2000 ml electrolyte infusion before and 2000 ml of normal saline with forced diuresis after cisplatin. RESULTS: The intensity of hematologic toxicity was significantly less pronounced in patients treated with Glutathione than in the control group (hemoglobin: 10.7 vs 9.5 mg% respectively, p = 0.039; white blood cell count 3.3 vs 2.2 x 103/microliter respectively, p = 0.004; platelets 167 vs 95 x 103/microliter respectively, p = 0.02), whereas in terms of non-hematologic toxicity no difference was observed. Objective remission occurred in 6 out of 11 evaluable patients from the group receiving Glutathione (55%; complete remission: 9%; partial remission: 46%), and in 4 out of 8 evaluable patients from the control group (partial remission: 50%). However, there was no statistical difference in terms of response and overall survival (13.5 months vs. 10.5 months) between the two groups. CONCLUSIONS: Application of Cisplatin and Glutathione seems to be safe and feasible and the antitumoral efficacy of cisplatin is apparently not impaired by the concomitant use of Glutathione in patients with solid tumors.     

不同静脉给药方法治疗破伤风患者的临床效果研究

目的:探讨不同静脉给药方法治疗破伤风患者的临床效果.方法:将30例破伤风患者随机分为治疗组16例和对照组14例,治疗组采用冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注,对照组采用冬眠Ⅰ号合剂静脉输液治疗.观察两组患者的治疗效果及感受.结果:治疗组在静脉推注定时给药后1～5min内抽搐症状得到控制,对照组在静脉输液后5～12min内抽搐症状得到缓解,且治疗组患者家属满意度高于对照组(P<0.05),治疗组护士的支持率明显高于对照组(P<0.05).结论:冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注法效果明显优于静脉输液治疗法.     

Postresuscitation electrolyte changes: role of arrhythmia and resuscitation efforts in their genesis

Hypokalemia frequently occurs after resuscitation from ventricular fibrillation (VF) in man. To test the casual roles of VF and resuscitation variables in this electrolyte change, we studied six groups of dogs: VF with CPR and electrical cardioversion (n = 9), control dogs with no intervention (n = 9), CPR without arrhythmia (n = 5), electrical cardioversion without arrhythmia (n = 5), CPR and cardioversion without arrhythmia (n = 5), and rapid right ventricular pacing (n = 5) (pacing rate 374 +/- 68 beat/min; BP 79/52 mm Hg during pacing). Blood for K, Ca, Mg, and glucose analysis was collected before each intervention (or at baseline in control animals) and sequentially for 3 hr. Mg had a maximum change of 0.3 mEq/L in the VF group 7 min after resuscitation, but did not change in the other groups (p less than .005). Glucose had a maximum change of 79 mg/dl in the VF group 7 min after resuscitation but did not change in the other groups (p less than .005). Ca had a maximum decrease of 0.4 mg/dl in the VF group 15 min after resuscitation but did not decrease in the other groups (p less than .005). K had a maximum decrease of 0.8 mEq/L in the VF group 60 min after resuscitation, whereas decreases were less in the other groups (p less than .005). Thus, VF caused a rapid rise in Mg and glucose followed by a fall in Ca and K. These changes were independent of resuscitation efforts as well as the moderate hypotension induced by rapid right ventricular pacing.(ABSTRACT TRUNCATED AT 250 WORDS)     

2种不输液途径对奥沙利铂化疗患者神经毒性的影响

目的探讨经外周静脉置人的中心静脉导管（PICC）与外周静脉留置针输入奥沙利铂对患者造成神经毒性的差异。方法将58例拟行奥沙利铂化疗方案的消化道恶性肿瘤患者分为PICC组（n=32）和外周组（n=29）,PICC组经PICC输入奥沙利铂,外周组经外周静脉留置针输入奥沙利铂,对比观察2种给药途径引起周围神经毒性反应以及药物引起肢体疼痛情况。结果PICC组出现3例神经毒性反应,均为一级,无一例出现肢体疼痛;外周组18例出现神经毒性反应,其中一级10例,二级8例,有11例出现输注侧肢体局部疼痛。PICC组神经毒性发生率明显低于外周组,差异有统计学意义（P〈0．01）。结论经PICC输入奥沙利铂,神经毒性反应轻,可避免引起肢体疼痛,有利于提高患者化疗依从性。     

Interactions of calcium, magnesium and atropine on exocrine pancreatic secretion in man.

The effects of the intravenous administration of atropine or magnesium on pancreatic secretion which has been stimulated by secretin and induced hypercalcaemia have been studied in man. In the presence of secretin (0.5 CU/kg.h) the infusion of Ca2+ (0.3 mmol/kg.105 min) resulted in an increase in secretion of enzymes by 100-200%, and in that of Ca2+ and Mg2+ by 50-100% without affecting fluid and bicarbonate secretion. The additional injection of atropine (0.5 mg i.v. and 0.5 mg s.c.) were followed by a prompt fall in enzymes but not in Ca2+ and Mg2+ to the secretin-stimulated values. The additional infusion of Mg2+ (0.12 mmol/kg.45 min) to the Ca2+-infusion did not alter the secretion of enzymes, Ca2+ or Mg2+ compared with the calcium infusion alone. It is suggested that the hypercalcaemic stimulus depends on an intact innervation of the acinar cells. In these experiments the secretion of Ca2+ and Mg2+ seem to originate mainly from extracellular fluxes.     

帕金森病大鼠黑质细胞凋亡与左旋多巴剂量的关系

目的研究左旋多巴对黑质细胞的神经毒性作用,探讨左旋多巴治疗帕金森病(PD)的最佳方案。方法选用Wistar大鼠,采用改良的Thomas方法,用6-OHDA行脑立体定向注射术制作大鼠帕金森病(PD)模型100只,随机分为两大组:PD模型组(n=25)、L-dopa治疗组(n=75),采用TUNEL方法观察左旋多巴小、中、大3种不同剂量犤10,50,100mg/(kg·d)犦、不同的作用时间(1,3,5,7d)对帕金森病大鼠黑质细胞的毒性作用,并观察治疗后7d各项指标的变化。结果同一时点PD大鼠黑质细胞凋亡数随着左旋多巴治疗的时间、剂量增加而增加;1～7d小剂量组:从(412±35)个/mm2减少到(403±22)个/mm2,中剂量组从(468±33)个/mm2增加到(605±37)个/mm2,大剂量组从(759±61)个/mm2减少到(486±37)个/mm2;7～14d各时点减少。结论左旋多巴能加速PD大鼠黑质细胞凋亡,小剂量、间隔使用左旋多巴能有效减少其神经毒性作用。     

A Comparison of Computer-Controlled Versus Manual Administration of Vecuronium in Humans

The short elimination half-life of vecuronium suggests it may be delivered more efficiently by continuous infusion than by traditional bolus injections. The objective of this study was to compare manual administration with computer-controlled administration. Anesthesia was induced in 22 patients (American Society of Anesthesiologists [ASA] physical status I and II) with fentanyl and sodium thiopental and maintained with halothane and nitrous oxide in oxygen. Neuromuscular function was assessed at the hypothenar eminence and the adductor pollicis (train-of-four stimulation). A bolus of 0.1 mg/kg of vecuronium was given to obtain 100% twitch depression for tracheal intubation. After twitch height returned to 25% of control, relaxation was maintained by traditional bolus injections (group 1, n = 7), manually controlled continuous infusion (group 2, n = 7), or computer-controlled continuous infusion (group 3, n = 8). In all three groups the desired level of relaxation was 90% twitch depression. Variability of relaxation differed significantly among the three groups (group 1: 10.5%, group 2: 12.4%, group 3: 7.1%). Twitch height was more constant with computer control than with either bolus injections or manual infusion (P < 0.05). There was no statistically significant difference in the drug requirement (group 1: 1.60 μg/kg/min, group 2: 1.51 μg/kg/min, group 3: 1.45 μg/kg/min). Variability in the mechanomyogram (n = 12) was much higher than in the electromyogram (n = 10). Computer-controlled infusion may be a useful adjunct for the anesthesiologist who desires a stable level of patient relaxation when using short-acting, nondepolarizing relaxants.