奥曲肽与生长抑素治疗肝硬化上消化道出血的对比观察

目的对比分析奥曲肽与生长抑素治疗肝硬化上消化道出血的临床疗效。方法选取2016年1月至2018年2月本院收治的152例肝硬化上消化道出血患者作为研究对象,根据随机数字表法将152例患者分到观察组(n=76例)和对照组(n=76例),对照组患者采用生长抑素治疗,观察组患者采用奥曲肽治疗,对比分析两组患者的止血时间、临床疗效及不良反应发生率。结果观察组的止血时间明显短于对照组,临床疗效明显高于对照组,不良反应发生率明显低于对照组,均有P <0.05。结论相较于生长抑素,在肝硬化上消化道出血患者中施以奥曲肽治疗,可有效缩短时间,并能有效提高临床疗效,减少不良反应的发生。     

兰索拉唑联合奥曲肽治疗肝硬化上消化道出血的临床疗效分析

目的探究兰索拉唑联合奥曲肽治疗肝硬化上消化道出血的临床疗效。方法我院在2016年10月至2018年9月收治的肝硬化上消化道出血的患者,并选取100例患者作为研究的对象。以随机分成两组每组各50例,对照组的患者采用兰索拉唑进行治疗,实验组的患者采用兰索拉唑联合奥曲肽进行治疗。观察两组患者的临床治疗效果、输血量、止血所用时间以及不良反应发生等情况,探讨兰索拉唑联合奥曲肽治疗肝硬化上消化道出血的临床疗效。结果经过对100例患者的治疗效果以及治疗前后的各种反应情况对比观察可以得出:采用兰索拉唑联合奥曲肽治疗的实验组有效率为96%,远远优于采用兰索拉唑治疗的对照组的84%;实验组的不良反应发生率为6%,低于对照组的19%;实验组的输血量以及止血所用时间也低于对照组。结论治疗肝硬化上消化道出血,兰索拉唑联合奥曲肽治疗可以有效的降低患者治疗过程中的出血量以及止血时间,而且可以减少患者的不良发应发生率。     

奥曲肽治疗肝硬化并发上消化道出血临床分析

目的:观察奥曲肽治疗肝硬化并发上消化道出血的疗效.方法:将81例肝硬化并发上消化道出血患者分为对照组(凝血酶与奥美拉唑等治疗,35例)和观察组(在此基础治疗上加用奥曲肽,46例),比较两组输血量、再出血发生率(48h)、病死率、住院时间、不良反应发生率等.结果:观察组再出血发生率显著低于对照组,住院时间显著少于对照组,两组输血量、不良反应发生率及病死率差异无显著性.结论:奥曲肽治疗肝硬化上消化道出血,能有效预防消化道再出血发生率并缩短住院时间.     

研究分析肝硬化合并上消化道出血患者采用奥曲肽联合奥美拉唑治疗的临床效果

目的分析应用奥美拉唑联合奥曲肽治疗肝硬化合并上消化道出血患者的临床疗效。方法选取2016年11月至2017年11月我院接收的128例肝硬化合并上消化道出血患者,将其随机分为观察组与对照组,各组64例,观察组应用奥曲肽联合奥美拉唑治疗,对照组应用奥曲肽治疗,将两组患者的治疗效果进行比较。结果观察组治疗总有效率高于对照组,止血时间、住院时间以及不良反应发生率低于对照组(P <0.05)。结论应用奥曲肽联合奥美拉唑联合奥曲肽治疗肝硬化合并上消化道出血患者临床疗效较好,其引起不良反应事件较少,值得进一步推广应用。     

奥曲肽治疗肝硬化上消化道出血的疗效观察

目的探讨奥曲肽治疗肝硬化上消化道出血的疗效及安全性。方法将肝硬化上消化道出血患者60例随机分为观察组和对照组各30例。对照组予以止血、补液、输血、防治休克等对症治疗,并持续静脉滴注垂体后叶素和硝酸甘油;观察组在对照组治疗基础上,将垂体后叶素改为奥曲肽0.1mg加至生理盐水20ml中,首次缓慢静脉注射,后以25μg/h静脉滴注。比较2组的临床疗效及不良反应。结果观察组总有效率高于对照组,不良反应发生率低于对照组,差异均有统计学意义(P<0.05)。结论奥曲肽治疗肝硬化上消化道出血疗效显著,不良反应少,值得临床推广应用。     

醋酸奥曲肽联合硝酸甘油治疗肝硬化继发上消化道出血疗效观察

目的探讨醋酸奥曲肽与硝酸甘油治疗肝硬化继发上消化道出血患者止血的临床疗效。方法肝硬化上消化道出血患者185例,采用随机抽样法随机分为两组:对照组95例,采用常规止血治疗;观察组90例,在对照组基础上加用醋酸奥曲肽与硝酸甘油治疗。比较两组的治疗效果、止血时间、显效时间以及不良反应。结果观察组总有效率为93.3%明显高于对照组的76.8%(P<0.05);观察组的止血时间和显效时间明显比对照组短(P<0.05);两组不良反应发生率无明显差异(P>0.05)。结论醋酸奥曲肽联合硝酸甘油治疗肝硬化继发上消化道出血患者疗效显著,不良反应发生少,值得临床推广。     

奥曲肽联合奥美拉唑治疗肝硬化上消化道大出血的临床观察

目的 分析研究奥曲肽联合奥美拉唑治疗肝硬化上消化道大出血的临床疗效及安全性.方法 回顾性分析2010年4月至2011年4月期间在我院治疗的58例肝硬化上消化道大出血患者的临床资料.将58例患者随机分为观察组和对照组各29例,观察组患者给予奥曲肽联合奥美拉唑治疗,对照组仅给予奥美拉唑治疗,观察记录两组患者的临床治疗效果和止血情况.结果 观察组的临床疗效明显优于对照组,止血时间明显短于对照组,48 h再出血率明显低于对照组,且并发症的发生率低于对照组,两组比较差异有统计学意义(P<0.05).结论奥曲肽联合奥美拉唑治疗肝硬化上消化道大出血疗效肯定,再出血率低、不良反应少,值得临床上推广应用.     

奥曲肽联合奥美拉唑治疗肝炎后肝硬化并上消化道出血的疗效观察

目的：观察奥曲肽联合奥美拉唑治疗肝炎后肝硬化并上消化道出血的临床疗效。方法将88例肝炎后肝硬化并发上消化道出血患者随机分为观察组46例和对照组42例。观察组给予奥曲肽联合奥美拉唑治疗,对照组给予垂体后叶素治疗,对比2组患者止血效果、住院时间和不良反应发生情况。结果观察组止血效果显著优于对照组,住院时间显著短于对照组,不良反应发生率显著低于对照组,差异均有统计学意义（P ＜0．05）。结论在肝炎后肝硬化并发上消化道出血治疗中,应用奥曲肽联合奥美拉唑可实现快速止血的治疗目的,不良反应发生率低且较轻,安全可靠,值得在临床中推广。     

奥曲肽和生长抑素治疗急性上消化道出血的临床疗效观察

探讨奥曲肽和生长抑素联合泮托拉唑治疗急性上消化道出血的临床疗效及安全性。对我院收治的148例急性上消化道出血患者随机分为奥曲肽联合泮托拉唑组(56例)、生长抑素联合泮托拉唑组(50例)和对照组(42例),观察3组患者的临床疗效及不良反应情况。奥曲肽联合泮托拉唑组与生长抑素联合泮托拉唑组患者总有效率无明显差异,但均明显高于对照组(P<0.05)。奥曲肽联合泮托拉唑组与生长抑素联合泮托拉唑组患者出血明显缓解时间亦无明显差异,但均明显短于对照组(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。对于急性上消化道出血的患者,在泮托拉唑治疗基础上加用奥曲肽和生长抑素进行治疗均能明显提高临床疗效,能缩短止血时间,且并未增加不良反应发生率,值得临床应用。     

奥曲肽治疗乙型肝炎肝硬化并发上消化道出血的临床疗效

目的观察奥曲肽用于治疗乙型肝炎肝硬化合并上消化道出血的临床效果。方法按照治疗方式的区别将65例乙型肝炎肝硬化合并上消化道出血患者分为观察组33例与对照组32例,两组患者均给予相同的常规治疗,在此基础上再对观察组患者进行奥曲肽治疗,对比两组的止血状况与不良反应发生情况。结果观察组的治疗总有效率为90.9%,明显高于对照组的62.5%(P<0.05),观察组的不良反应发生率为6.1%,明显低于对照组的31.25%(P<0.05)。结论奥曲肽用于乙型肝炎肝硬化合并上消化道出血治疗的临床效果显著,不良反应少,止血可靠,值得临床推广。     

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.