哌拉西林/他唑巴坦联合依替米星治疗老年慢性阻塞性肺疾病急性加重期回顾性研究

摘 要 目的:研究哌拉西林/他唑巴坦联合依替米星治疗老年慢性阻塞性肺疾病急性加重期（AECOPD）的疗效。方法：采用回顾性研究方法,80例老年AECOPD患者按治疗方案分为对照组和观察组。对照组采用哌拉西林/他唑巴坦联合左氧氟沙星治疗,观察组采用哌拉西林/他唑巴坦联合依替米星治疗。两组均治疗14 d后,比较两组临床疗效、细菌清除情况及药品不良反应情况。结果：观察组临床总有效率为92.50%,明显高于对照组的77.50%（P＜0.05）。观察组的细菌清除率明显高于对照组（P＜0.05）。观察组药品不良反应发生率也明显低于对照组（P＜0.05）。结论：哌拉西林/他唑巴坦联合依替米星治疗老年AECOPD患者,不良反应发生率低,细菌清除率高,临床疗效良好,值得临床推广应用。     

T> MIC%指导优化的哌拉西林/他唑巴坦抗菌方案对59例铜绿假单胞菌感染患者的临床观察

目的 观察T> MIC%指导优化的哌拉西林/他唑巴坦抗铜绿假单胞菌感染方案的疗效。方法 选择2015年1-4月病原学确诊为铜绿假单胞菌感染且对哌拉西林/他唑巴坦敏感的住院患者59例,治疗前随机分为对照组和试验组。对照组采用哌拉西林/他唑巴坦4.5 g,q6 h的方案;试验组采用哌拉西林/他唑巴坦4.5 g,q12 h的方案。2组均联合阿米卡星15 mg/（kg·d）,qd的方案共同治疗。其他治疗方法相同。结果 2组患者临床治疗有效率和总住院时间相当、细菌清除率和不良反应发生率相似、治疗前后CRP和APACHE Ⅱ评分无差异。结论 依据T> MIC%指导优化的哌拉西林/他唑巴坦抗铜绿假单胞菌感染方案安全、有效、可行。     

氯雷他定联合匹多莫德对反复呼吸道感染患儿的临床疗效及免疫功能的影响

摘 要 目的： 观察氯雷他定联合匹多莫德对儿童反复呼吸道感染的临床疗效及患儿免疫功能的影响。方法: 78例反复呼吸道感染患儿随机分为对照组（n=39）和观察组（n=39）。两组患儿均给予常规对症治疗。对照组加用匹多莫德治疗,观察组在对照组基础上再加用氯雷他定。疗程均为8周。比较两组临床疗效、临床症状和体征改善情况、免疫功能指标水平变化及不良发生情况。结果: 观察组总有效率显著高于对照组（P<0.05）;观察组治疗后肺部啰音消失时间、扁桃体肿大消退时间、咳嗽消失时间、退热时间均显著短于对照组（P<0.05）;治疗后两组IgG、IgM、IgA水平均较治疗前显著降低（P<0.05）,CD3⁺、CD4⁺、CD4⁺/CD8⁺则较治疗前显著增加（P<0.05）;且观察组各项免疫指标水平均明显优于对照组（P<0.05）。两组不良反应发生率比较,差异无统计学意义（P>0.05）。结论: 氯雷他定联合匹多莫德对儿童反复呼吸道感染的临床疗效显著,能迅速改善患儿临床症状和体征,显著提高患儿免疫功能。     

清开灵颗粒联合苯唑西林治疗小儿细菌性急性上呼吸道感染的临床研究

目的 探讨清开灵颗粒联合苯唑西林治疗小儿细菌性急性上呼吸道感染的临床疗效。方法 选取2020年10月—2022年10月连云港市中医院收治的80例细菌性急性上呼吸道感染患儿,随机数字法将患者分对照组（40例）和治疗组（40例）。对照组患儿静脉注射注射用苯唑西林钠,按体质量50 mg/kg,2次/d。治疗组在对照组的基础上口服清开灵颗粒,1袋/次,3次/d。两组连续治疗5 d。观察两组患儿临床疗效,比较治疗前后两组患儿症状缓解时间,血常规指标白细胞计数（WBC）和中性粒细胞计数（N）及血清因子白细胞介素-8（IL-8）、降钙素原（PCT）和C反应蛋白（CRP）水平。结果 治疗后,治疗组总有效率为97.50%,明显高于对照组（77.51%,P＜0.05）。治疗后,治疗组症状缓解时间均明显短于对照组（P＜0.05）。治疗后,两组患儿WBC和N及IL-8、PCT和CRP水平比治疗前明显降低（P＜0.05）,且治疗组明显低于对照组（P＜0.05）。结论 清开灵颗粒联合苯唑西林治疗小儿细菌性急性上呼吸道感染具有良好的临床疗效,能显著缓解临床症状,减轻炎症反应。     

哌拉西林/舒巴坦治疗细菌性感染的疗效与药物经济学评价

摘 要 目的： 观察哌拉西林/舒巴坦治疗细菌性感染的临床疗效与安全性,并进行药物经济学评价。方法: 126例手外伤细菌性感染患者随机分为对照组和观察组。对照组予哌拉西林/他唑巴坦2.5 g,ivd,bid;观察组予哌拉西林/舒巴坦1.25 g,ivd,bid。治疗14 d后,观察两组患者的临床疗效、药品不良反应,并进行最小成本比较。结果:观察组总有效率为93.65%,细菌清除率为96.83%;对照组则分别为92.06%,95.24%。两组比较,差异无统计学意义(P>0.05)。两组药品不良反应发生率比较,差异也无统计学意义(P>0.05)。但哌拉西林/舒巴坦成本 效果明显低于对照组(P＜0.05)。结论: 临床手外伤细菌性感染患者采用哌拉西林/舒巴坦治疗,疗效及安全性与哌拉西林/他唑巴坦相当,均有较好的抗菌效果,且不良反应少。但因哌拉西林/舒巴坦具有较好经济效益,值得推广应用。     

阿奇霉素与头孢呋辛治疗儿童呼吸道感染疗效比较

摘 要 目的： 比较阿奇霉素与头孢呋辛治疗儿童呼吸道感染的疗效及对患儿血清前白蛋白（PA）、C反应蛋白（CRP）与降钙素原（PCT）水平的影响。方法: 120例呼吸道感染患儿随机分为两组各60例。观察组采用阿奇霉素（10 mg·kg^-1·d^-1 ivd）治疗,对照组采用头孢呋辛钠(30 mg·kg^-1, ivd,q8h)治疗,疗程均为5d。比较两组患儿治疗前后CRP、PA、PCT水平变化,以及临床症状消失时间和疗效。结果: 治疗后,两组患儿的CRP和PCT均明显降低,PA明显升高(P<0.05),但组间差异无统计学意义(P>0.05)。观察组患儿咳嗽消失、退热、肺啰音消失和气急消失时间均明显短于对照组(P<0.05)。两组疗效和药品不良反应发生率差异无统计学意义(P>0.05)。结论:阿奇霉素治疗儿童呼吸道感染的疗效与头孢呋辛钠相当,但症状消失较快。     

重症患者延长输注碳青霉烯类药和哌拉西林/他唑巴坦给药方案的实施效果

摘 要 目的:探讨延长输注碳青酶烯类抗菌药和哌拉西林/他唑巴坦在重症监护病区中推广应用的可行性。方法：对重症监护病区使用美罗培南、比阿培南和哌拉西林/他唑巴坦（PTZ)的患者应用延长输注时间的给药方案,记录新方案实施的情况。以其为观察组（EI组）,传统输注法为对照组（TI组）,回顾性分析两组的疗效、安全性及经济性。结果：在10个月的临床实践中,77例患者使用微泵延长抗菌药物输注时间,占总用药例数的64.2%。EI组美罗培南治疗有效率为75%,比阿培南为71.88%,均显著高于TI组(P<0.05)。两组不良反应无明显差异。三种药物EI组单位效果的成本低于TI组。结论：延长输注碳青霉烯类药及PTZ具有显著疗效及经济学优势,值得在重症患者中推广应用,但是需要医药护团队密切配合,尤其需要药师的严密监护以保证患者的用药安全有效。     

哌拉西林他唑巴坦负荷剂量两步输注治疗ICU病房革兰阴性菌致重症医院获得性肺炎的临床研究

目的 探讨哌拉西林他唑巴坦负荷剂量两步输注与传统延长输注治疗重症监护病房革兰阴性菌（GNB）致重症医院获得性肺炎（HAP）的临床疗效。方法 选择2019年5月—2022年11月入住衡水市人民医院重症监护病房（ICU）的多重耐药革兰阴性菌（GNB）致重症医院获得性肺炎患者150例,按照随机数字表分为对照组和治疗组,每组各75例。对照组静脉泵入注射用哌拉西林钠他唑巴坦钠,4.5 g加入生理盐水100 mL,静脉泵持续输注3 h,1次/8 h。治疗组静脉泵入注射用哌拉西林钠他唑巴坦钠,4.5 g加入生理盐水100 mL,前2.25 g采用静脉泵在30 min内输注,后2.25 g采用静脉泵在150 min内持续输注。两组患者均治疗7～14 d。观察两组患者临床疗效,比较治疗前后两组患者细菌清除率,临床感染症状恢复时间,炎性指标降钙素原（PCT）、C反应蛋白（CRP）和白细胞计数（WBC）水平,及住院时间、机械通气时间和治疗总费用。结果 治疗后,治疗组临床总有效率（85.33%）显著高于对照组（70.67%,P＜0.05）。治疗后,治疗组细菌清除率（73.33%）显著高于对照组（56.00%,P＜0.05）。治疗后,治疗组啰音消失时间、咳嗽咳痰消失时间和退热时间均短于对照组（P＜0.05）;治疗后,两组WBC、PCT和CRP均显著下降（P＜0.05）,且治疗组比对照组下降更显著（P＜0.05）。治疗后,治疗组在住院时间、机械通气时间和治疗总费用方面均明显小于对照组（P＜0.05）。结论 哌拉西林他唑巴坦负荷剂量两步输注能显著提高入住ICU病房GNB致重症HAP的临床疗效和细菌清除率,能明显缩短症状改善时间,从而缩短患者住院时间和降低治疗费用。     

脾多肽辅助治疗婴幼儿迁延性慢性腹泻疗效及对Ｔ淋巴细胞亚群变化影响

摘 要 目的：探讨脾多肽辅助治疗迁延性慢性腹泻（PCDD）患儿的疗效,及对患儿T淋巴细胞（简称T细胞）亚群的影响。 方法：60 例PCDD病例随机分为联合治疗组（30例）和常规治疗组（30例）,所有患儿均给予常规口服蒙脱石散、益生菌及补液治疗;联合治疗组同时加用脾多肽静滴辅助治疗。两组疗程均为1周。分别对两组患儿治疗前后外周血T细胞亚群进行检测,以同期体检的20例健康儿童做为健康对照,比较两组患儿治疗前后外周血T细胞亚群变化,评价两组疗效。 结果：治疗前,两组患儿CD3⁺、CD4⁺及CD4⁺/CD8⁺ 等指标均低于健康对照组（P＜0.05）。治疗后,联合治疗组CD3⁺、CD4⁺及CD4⁺/CD8⁺较治疗前及常规治疗组明显升高（P＜0.05）,且恢复至健康水平。常规治疗组治疗前后CD3⁺、CD4⁺及CD4⁺/CD8⁺未见明显变化（P＞0.05）。联合治疗组疗效明显优于常规治疗组（P＜0.05）。 结论：PCDD患儿存在T细胞介导的免疫功能障碍,脾多肽可恢复PCDD患儿T细胞亚群的正常比例,改善患儿的细胞免疫功能。     

匹多莫德对反复呼吸道感染患儿免疫功能及临床疗效的影响

目的 探讨匹多莫得辅助治疗小儿呼吸道反复感染的临床疗效及其对患儿免疫功能的影响。方法 选择广元市妇幼保健院2013年8月—2016年1月收治的呼吸道反复感染患儿150例,随机分为2组,每组75例,对照组患儿接受常规抗生素治疗,治疗组患儿在对照组治疗基础上加用匹多莫得治疗,持续治疗2个月,治疗结束后随访4个月,比较两组患儿治疗期间临床症状以及机体免疫功能的变化,同时比较随访期间两组患儿的临床疗效。结果 治疗后,治疗组患儿咳嗽、发热、扁桃体发炎以及肺部哮鸣音消失的时间显著短于对照组（P＜0.05）。治疗后,两组患儿血清免疫球蛋白水平较治疗前有所升高（P＜0.05）,其中治疗组患儿升高更为明显,与对照组比较具有统计学意义（P＜0.05）;治疗后两组患儿T细胞亚群CD3⁺、CD4⁺、CD8⁺以及NK细胞相对活性都明显升高（P＜0.05）,且CD4+/CD8+相对含量同样升高（P＜0.05）,同时比较两组患儿治疗后各细胞水平,统计结果表明治疗组患儿改善情况更为明显（P＜0.05）。治疗后,治疗组患儿治疗总有效率显著高于对照组（P＜0.05）,且治疗组患儿随访期间感染复发的次数显著少于对照组（P＜0.05）,且复发持续时间明显较短（P＜0.05）。结论 匹多莫得联合抗菌药物治疗小儿呼吸道反复感染效果显著,有效改善机体免疫功能,减少感染复发次数,值得临床推广应用。     

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.