抑郁症患者的治疗用药分析

目的了解该院住院抑郁症患者精神药物的临床使用情况。方法使用一日法对该院2012年抑郁症住院患者的精神药物处方进行调查。结果药物治疗抑郁症的方案有13种,联用抗抑郁药、抗精神病药和心境稳定剂88例（72.73%）;使用的抗抑郁药均为新型抗抑郁药,其中舍曲林使用频率最高（29.75%）;使用抗精神病药94例（77.69%）,其中奥氮平使用频率最高（27.27%）;抗焦虑药以苯二氮卓艹卓为主,阿普唑仑与劳拉西泮共占59.50%（72/121）。结论该院抗抑郁药的使用能够做到个体化用药,治疗抑郁症方案合理、有效。     

老年抑郁症用药和不良反应调查及护理对策

目的:了解老年抑郁症患者抗抑郁药物使用情况及不良反应,并提出相应的护理措施。方法:调查了183例老年抑郁症患者的病历资料,对采用的抗抑郁药物种类、药物不良反应及护理措施进行分析。结果:老年抑郁症患者单一用药者175例,占95.63%,合并用药有8例,占4.37%;在单一用药的175例中使用第一代抗抑郁药的8例,占4.57%,使用第二代抗抑郁药167例,占95.43%。用药后的不良反应主要有:震颤(17例,占9.29%)、镇静、嗜睡(18例,占9.84%)、焦虑(17例,占9.29%)、口干(29例,占15.85%)、视物模糊(17例,占9.29%)、头晕(21例,占11.48%)、心动过速(19例,占10.38%)、心电图QT间期异常(24例,占13.11%)、食欲减少(24例,占13.11%)、恶心(49例,占26.78%)、肝功损害(谷丙转氨酶ALT>40U.L-1,41例,占22.40%)等。第一代抗抑郁药导致的抗胆碱不良反应多于第二代抗抑郁药(P<0.05)。采用了预防性护理、针对性护理、心理护理相结合的方法,减少了患者对抗抑郁药的不良反应。结论:老年抑郁症患者多单一用药,绝大多数采用第二代抗抑郁药;但仍有较多的不良反应。对于老年抑郁症用药不良反应宜采用综合护理措施。     

老年精神障碍患者精神药物临床使用分析

目的:了解老年精神障碍患者精神药物临床使用情况。方法:收集肇庆市第三人民医院2008年1月1日-2008年12月31日出院,年龄60a或以上老年住院精神障碍患者的病历175份,采用限定日剂量(DDD)和药物利用指数(DUI)对精神药物的使用进行回顾性分析。结果:非典型抗精神病药利培酮的使用频率居首位,其次为奋乃静;抗抑郁药中舍曲林居首位,其次为帕罗西汀;在联合用药方面,抗精神病药与苯二氮艹卓类药物、抗抑郁药与苯二氮卓艹类药物和情感稳定剂、抗精神病药与抗抑郁药联用较多。在使用的33种精神药物中除舒必利、丙戊酸钠、阿普唑仑、三唑仑外,其余药物的DUI均≤1.0。结论:我院对老年精神障碍患者精神药物的使用基本合理。非典型抗精神病药、新型抗抑郁药的使用越来越多。     

首发抑郁症患者药物使用分析

收集厦门精神卫生中心2010年1月～2011年3月出院,首发住院抑郁症患者病历138份,采用限定日剂量(DDD)和药物利用指数(DUI)对精神药物的使用进行回顾性分析.结果抗抑郁药中西酞普兰使用居首位,其次为舍曲林、度洛西汀、氟西汀和文拉法辛;在联合用药方面,抗抑郁药与苯二氮艹卓类药物和小剂量抗精神病药物联用较多,占60%.在使用的药物中,DUI均≤1.0.     

我院门诊老年糖尿病患者用药依从性差相关因素的调查分析

目的:为提升门诊老年糖尿病患者的用药依从性提供参考。方法:随机选取我院门诊120例60岁以上的老年糖尿病患者,采用自拟问卷进行调查,借助Logistic回归分析方法探讨导致老年糖尿病患者用药依从性差的相关因素。结果:调查问卷的克朗巴赫系数为0.89。共发放问卷120份,回收有效问卷113份,有效回收率为94.17%。113例受访患者中用药依从性差者64例(占56.64%)。其中,未按照疗程服药的59例(占92.19%);未严格按照剂量服药的54例(占84.38%);服药时间错误的43例(占67.19%);随意调换药物的37例(占57.81%);重复用药的18例(占28.13%)。年龄因素、学历因素、药品因素、经济因素、不良反应因素、医务人员因素和治疗方案因素均对受访患者用药依从性具有显著影响(P<0.05)。结论:门诊老年糖尿病患者用药依从性差是临床中的普遍现象,其表现形式呈多元化,受多方面因素的影响,应引起医师和药师等的重视,给予相应的干预。     

137例老年精神障碍患者抗精神病药物的用药分析

目的:了解老年精神障碍患者抗精神病药物的使用情况。方法:调查我院137例老年精神障碍患者的临床情况及用药记录。结果:137例老年精神障碍患者中89例(64.96%)伴有各种躯体疾病;单一使用抗精神病药治疗83例(60.58%),联合使用抗精神病药治疗54例(39.42%);使用非典型抗精神病药占78.53%;用药频度前5位的药物依次是奥氮平、利培酮、喹硫平、氯丙嗪、氯氮平;抗精神病药的使用剂量基本都在常用治疗剂量低端;在联合其他精神科药物方面,抗精神病药与抗抑郁药、心境稳定剂、镇静催眠药联用较多。结论:老年精神障碍患者应根据患者的实际躯体情况个体化用药,用药品种宜少,选择疗效高、不良反应小、药物间互相作用少的抗精神病药物,低剂量使用,慎用对心脏毒性大、抗胆碱作用强和锥体外系反应明显的药物。     

2016～2020年中国九城市老年失眠患者镇静催眠类药物使用趋势分析

目的:了解镇静催眠类药物在老年人群中的使用现状,为进一步促进其合理使用提供依据。方法:随机抽取参加《医院处方分析合作项目》的中国九城市119家医院2016～2020年年龄≥60岁患者,诊断为失眠,包含有镇静催眠类药物的处方,分析各类镇静催眠药物各年的使用频次、比例及复合年增长率,不同组合治疗方案的各年频次及比例,各种药物的平均日剂量(PDD),非苯二氮艹卓类苯二氮艹卓受体激动药(non-BZDs)和苯二氮艹卓类药物(BZDs)品种选择的相关因素。结果:老年失眠患者处方中BZDs各年用药频次及构成比均居于首位,构成比呈逐年缓慢下降趋势;治疗方案各年均以单类药物的治疗为主(>90%),联合治疗方案以苯二氮艹卓受体激动药(BZRAs)间的联用(2.81%～3.87%)以及BZRAs与抗抑郁药的联用为主(0.93%～1.09%);处方中70.6%(12/17)的镇静催眠类药物PDD≤限定日剂量(DDD),29.4%(5/17)的药物PDD>DDD;根据多因素分析,一线城市较非一线城市[OR=0.510, 95%CI(0.502,0.518)],男性较女性[OR=0.969, 95%...     

抗抑郁药处方835张分析

目的分析该院抗抑郁药的使用情况。方法采用限定日剂量方法,随机抽取该院835张处方,对其抗抑郁药的使用情况进行统计、分析。结果抑郁症的发病率女性高于男性;抗抑郁药使用频率最高的是5-羟色胺再摄取抑制剂(SSRIs)类,超过60%的处方均联用其他药物,主要联合用药为抗焦虑药、情感稳定剂。结论该院抗抑郁药以SSRIs类最为常用,以单用抗抑郁药为主,联用其他药物可增加疗效。     

我院精神病住院患者抗精神病药应用情况分析

目的:了解我院精神病住院患者抗精神病药的应用情况,为临床合理用药提供参考。方法:对我院2008年7月21日共770例精神病住院患者的用药情况进行调查。结果:有734例患者应用抗精神病药进行治疗,共涉及药物治疗方案30种;单用1种抗精神病药治疗者676例(87.8%),利培酮190例(24.7%)、喹硫平144例(18.7%)、奥氮平123例(16.0%)分列前3位;抗精神病药与抗抑郁药、心境稳定剂、苯二氮类药及非苯二氮类镇静催眠药、降糖药、调血脂药联用比例较高。结论:新型非典型抗精神病药已替代传统抗精神病药,其单一用药占临床治疗主导地位。     

分析用药频度考察抗抑郁药在广东的应用

目的分析广东抗抑郁药的用药频度,考察抗抑郁药的应用情况和发展趋势。方法通过统计广东75家代表性医院2005~2007年抗抑郁药销售数据,采用限定日剂量为指标的分析方法,计算药品的用药频度,了解抗抑郁药的应用情况。结果抗抑郁药的用药频度年均增长率达29%,5-羟色胺再摄取抑制剂(SSRIs)的使用约占50%以上,进口合资药品的使用占据主导地位。结论抗抑郁药应用广泛,抑郁症患者得到较好治疗,SSRIs仍然为最常用的一类抗抑郁药,临床应更注重合理用药,使患者真正受益。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Deoxynivalenol in cereals in Russia

A survey of the occurrence of deoxynivalenol (DON) and zearalenone (ZEN) in wheat, rye, barley and maize harvested in 1989-2001 in several regions of Russia has been conducted. A total of 5652 samples of cereals were analysed for DON and ZEN by using TLC and normal-phase HPLC with UV-detector. DON was detected in 69% of 2166 samples from Krasnodar region which is considered to be the major Fusarium endemic region of Russia. The contamination levels ranged from 0.1 till 8.6 ppm, MTEL was exceeded in 37% of these samples. The positive correlation between DON concentration and a percentage of Fusaria-damaged wheat kernels has been shown. DON occurrence and contamination levels were much lower that for wheat. Based on the results of monitoring and the data of average actual consumption of wheat products in Russia, the estimated daily intake of DON per 1 kg of body weight (EDI)was calculated. EDI varied from 0.07 ug in 1990-1991 till 1.40 ug in 1992. Although average EDI were lower than adopted tolerable daily intake (TDI, 3 ug/kg body weight) EDIs for the North-Caucasian region in some cases exceeded TDI.