腹腔镜手术对结肠癌患者Th1/Th2状态的影响研究

目的研究及探讨腹腔镜手术对结肠癌患者Th1/Th2状态的影响情况。方法选取2012年7月至2014年8月于本院进行开腹手术治疗的34例结肠癌患者为对照组,并以同时期同龄且采用腹腔镜手术治疗的34例结肠癌患者为观察组,然后将两组患者术前1 d及术后3、7 d的血清Th1/Th2指标进行分别检测及比较。结果两组患者术前1 d的血清Th1/Th2指标间均无显著性差异,P均>0.05,而观察组术后3 d及7 d的血清IL-2水平高于对照组,其他血清检测指标则均低于对照组,P均<0.05,两组术后3 d及7 d的检测水平间均有显著性差异。结论腹腔镜手术对结肠癌患者Th1/Th2状态的不良影响相对小于开腹手术,更有助于患者术后的尽快康复。     

更昔洛韦治疗前后带状疱疹患者免疫状态变化的研究

目的探讨更昔洛韦治疗前后带状疱疹患者免疫状态变化规律。方法选取2010年6月至2012年6月于本院采用更昔洛韦进行治疗的45例带状疱疹患者为观察组,同期采用阿昔洛韦进行治疗的45例患者为对照组,后将两组患者治疗前和治疗后3d、7d的外周血T淋巴细胞亚群水平进行比较。结果治疗后3d、7d观察组的CD3+、CD4+及CD4/CD8均高于对照组,而CD8+则低于对照组,且治疗后7d的改善幅度大于治疗后3d,P均<0.05,有显著性差异。结论更昔洛韦治疗前后带状疱疹患者免疫状态呈现持续改善的状态。     

进行性肌阵挛癫痫患者口服苯妥英钠致非惊厥性癫痫持续状态

1例16岁女性进行性肌阵挛癫痫患者,口服苯妥英钠0.15 g、1次/12 h治疗1周后出现非惊厥性癫痫持续状态,脑电图呈全导持续性棘慢波节律。7周后入我院,立即将苯妥英钠减量至0.05 g,2次/d,2 d后停用,同时给予患者丙戊酸钠0.3 g,1次/8 h;氯硝西泮1 mg,1次/12 h;左乙拉西坦0.25 g,1次/12 h。治疗第3天患者肌阵挛发作消失,治疗第6天脑电图示散在棘慢波、慢波,住院12 d,病情平稳出院。     

帕罗西汀致低钠血症

1例44岁男性患者因癫痫长期给予丙戊酸钠片0.2 g口服、2次/d联合卡马西平0.1 g口服、2次/d;因十二指肠球部溃疡长期口服雷贝拉唑钠肠溶片10 mg、1次/d。因疗效不佳抗癫痫药调整为丙戊酸钠缓释片0.5 g口服、2次/d联合左乙拉西坦0.25 g口服、2次/d, 同时因抑郁状态给予帕罗西汀20 mg口服、1次/d。用药约3个月后, 患者反复出现肢体抽搐, 实验室检查示血钠128 mmol/L。给予口服及静脉补钠治疗16 d, 但血钠水平始终低于130 mmol/L, 考虑患者的低钠血症可能为药物引起。停用帕罗西汀, 2 d后患者血钠140 mmol/L。     

氯氮平撤药致谵妄2例

2例双相障碍患者长期应用氯氮平(分别为100 mg/d,150 mg/d)维持治疗,在骤停氯氮平1天后出现谵妄状态,复用氯氮平后症状迅速缓解。     

克拉霉素致喹硫平血药浓度升高

1例29岁男性患者因双相情感障碍服用富马酸喹硫平（维持剂量：0.2 g、2次/d）与丙戊酸镁缓释片（维持剂量：0.5 g、2次/d）治疗。9 d后,患者精神症状好转,未发生不良反应,喹硫平血药浓度为379 μg/L。因并发化脓性中耳炎,加用克拉霉素（0.25 g口服、2次/d）。次日晨患者出现昏睡状态,喹硫平血药浓度升...     

肺癌患者化疗后应用甲地孕酮致深静脉血栓治疗的分析与探讨

1例38岁女性患者, 因肺腺癌晚期食欲欠佳及恶液质状态, 口服甲地孕酮分散片(宜利治)160 mg·d^-1治疗。1周后, 患者出现左下肢深静脉血栓, 停药并启动低分子肝素、华法林抗凝治疗。14 d后, 患者患肢肿胀、疼痛减轻, 下肢深静脉血管部分再通, 予出院后口服华法林3.75 mg·d^-1继续抗凝治疗并定期监测PT-INR。     

乌司他丁对高龄全髋关节置换术患者血小板活化指标的影响研究

目的研究乌司他丁对高龄全髋关节置换术患者血小板活化指标的影响。方法选取2011年4月至2013年10月的42例高龄去俺髋关节置换术患者为研究对象,将42例高龄患者随机分为对照组(常规治疗组)21例和观察组(常规治疗加乌司他丁治疗组)21例,然后将两组患者用药前及用药后1 d及3 d时的CD62p、PAC-1、GMP-140及GPⅡb/Ⅲa水平进行比较。结果观察组用药后1 d及3 d时的CD62p、PAC-1、GMP-140及GPⅡb/Ⅲa水平均低于对照组同时间段的检测水平,并且观察组用药后1 d及3 d的检测水平均低于本组用药前的检测水平,P均<0.05,检测水平间均有显著性差异。结论乌司他丁对高龄全髋关节置换术患者血小板活化指标的影响较大,可有效改善患者的微循环状态。     

左甲状腺素钠致低钾血症

1例85岁男性患者因缺血性脑卒中合并甲状腺功能减退接受左甲状腺素钠(LT4)50 μg口服、1次/d替代治疗。次日实验室检查示血钾3.0 mmol/L, 予氯化钾缓释片1 g口服、3次/d。6 d后, 患者诉轻微活动后心跳加快, 实验室检查示血钾3.3 mmol/L, 予门冬氨酸钾镁片1片口服、3次/d。补钾治疗8 d后, 患者血钾3.5 mmol/L, 血压163/90 mmHg(1 mmHg= 0.133 kPa)。予氯沙坦钾片50 mg口服、1次/d降压治疗。临床药师问诊得知患者在遵医嘱服用LT4的同时, 继续服用自备的LT4 75 μg、1次/d。嘱患者立即停服自备药, 并将LT4剂量调整至75 μg、1次/d。13 d后, 患者血钾恢复至4.0 mmol/L, 未再诉活动后不适。     

1例甲状腺功能减退患者出现瑞格列奈相关非典型低血糖

1例66岁甲状腺功能减退症的女性患者3年来一直口服左甲状腺素钠50μg,1次/d。患者近期诊断为2型糖尿病,加用瑞格列奈1mg,2次/d降糖治疗。服药1周后患者出现意识不清。实验室检查血糖2.3mmol/L,诊断为低血糖症。遂停用瑞格列奈,给予葡萄糖注射液后患者血糖水平升至3.9、5.1和8.7mmol/L,意识逐渐恢复。改用那格列奈120mg,3次/d治疗,患者未再发生低血糖。     

Pyloric obstruction caused by aspirin: case report.

A case of pyloric obstruction caused by ingestion of enteric-coated aspirin tablets is presented. The patient was predisposed by previous pyloric stenosis. A barium meal study was diagnostic. The patient later had a massive gastro-intestinal haemorrhage requiring surgical repair. The hazards of aspirin ingestion in such a patient are discussed.     

枸橼酸铋钾、克拉霉素和替硝唑治疗消化性溃疡的药物经济学评价

目的 :比较 4个不同三联药物治疗消化性溃疡方案的成本效果分析。方法 :3 1 1例消化性溃疡病人 ,分 5组 ,运用药物经济学的最小成本法、成本效果分析法进行推算每例诊疗成本和评价。结果 :(1 )A ,B ,C ,D 4种三联治疗方案的幽门螺杆菌(Hp)根除率分别为 84% ,88% ,87% ,80 % ,各组间疗效相比P >0 .0 5 ;(2 )门诊诊疗总成本分别为5 86元 ,81 7元 ,648.2 7元 ,889.5 0元 ;(3 )应用枸橼酸铋钾 +克拉霉素 +替硝唑 (BCT)三联治疗 1wk溃疡愈合 1例的药费 3 0 3 .95元 ;Hp根除 1例的药费 2 75 .0 0元 ;(4 )BCT三联包装比单独包装 3种药物 ,每例病例可节约药费 47.3 7元。结论 :4种方案的成本效果分析和边际成本分析表明BCT三联治疗 1wk的门诊诊疗成本最低 ,为根除Hp的优选方案。     

Patient controlled analgesia: evaluation of pain management and patient outcome

A study was conducted to evaluate patient response to patient controlled analgesia (PCA) devices. All patients were interviewed for this concurrent study. A survey was also taken with the nursing staff for their assessments regarding PCA therapy and comparison of outcomes between morphine and meperidine use. Our goal was to see what improvements could be made in pain management and patient therapy wherever possible.     

1例粘多糖病ⅣA型儿童GALNS基因突变分析

目的 研究1例粘多糖病ⅣA型（mucopolysaccharidosis ⅣA,Morquio A,MPS ⅣA）患者的临床特点及N-乙酰半乳糖胺-6-硫酸酯酶（GALNS）基因的突变.方法 研究对象为1例散发粘多糖病ⅣA型患儿及50例正常儿童.分别取其外周血5 mL,提取DNA,应用聚合酶链式反应（PCR）扩增GALNS基因的全部14个外显子,应用正反引物对PCR产物进行基因序列直接测序.结果 该患儿未发现GALNS基因致病突变.但是检测出2个GALNS基因多态性1431A＞G、1569＋36A＞G.结论 GALNS基因突变不是本研究中1例散发MPS ⅣA患儿的主要致病原因.     

全口义齿修复少汗型外胚叶发育不全综合征追踪观察

目的：探讨全口义齿在修复少汗型外胚层发育不全（HED）患者中的临床应用及修复要点。方法：1例HED导致全口牙列缺失,进食困难、自觉容貌苍老的儿童患者,常规完成全口义齿,3年内追踪观察、更换义齿。结果：全口义齿修复后咬合关系良好,恢复部分咀嚼功能,至两年半时出现下颌前伸,义齿呈反牙合形式,重新全口义齿修复。结论：少汗型外胚叶发育不全患者应早期全口义齿修复治疗。有助于改善外貌、发音和咀嚼功能,同时应根据儿童生长发育特点加强随访。     

Aluminum load in chronic intermittent plasma exchange

Aluminum (Al) loading due to administration of human albumin (HA) solutions was studied in 2 patients with stable renal function who underwent plasma exchange once (patient A) and twice (patient B) per week for treatment of hyperviscosity syndrome. Al was determined by Zeeman-AAS in plasma before, during and after treatment, also in bone of one patient and in various preparations of HA from different manufacturers. In addition, the net Al uptake (difference between total Al influx and efflux) and the 24th urinary excretion between 2 exchanges were determined. The electrolyte solution used for dilution had no detectable Al, while HA contained between 15 and 1900 micrograms Al/l. Increase of Al in plasma after treatment was clearly related to Al content of the HA used. When the patients received substitution solutions based on inadvertently highly Al contaminated 20% HA (1419 micrograms/l), the average net uptake was 2265 in patient A and 2049 micrograms in patient B and plasma Al rose from 8.4 respectively 18.0 before to 69.2 and 86.5 micrograms/l after treatment. By using medium Al contaminated HA (574 micrograms/l), the net uptake was 742 (pat. A) and 819 micrograms (pat.B), and there was an elevation of plasma Al from 5.1 respectively 18.2 to 34.2 and 39.8 micrograms/l. Following a net uptake of 870 micrograms patient A excreted 668 micrograms Al until the next treatment (23% positive balance). Treating patient A with a low Al HA (47 micrograms/l), there was a slight increase of plasma Al from 10.8 to 16.2 micrograms/l, the net Al uptake was negligible (less than 10 micrograms), and the weekly Al balance was negative. After 10 months of plasma exchange therapy (patient A) there was no increase of Al in bone (6.4 micrograms/g). We conclude, that the use of HA with a low Al contamination is recommended for all patients receiving this therapy during chronic intermittent plasma exchange or for other indications, especially in cases with impaired renal function.     

用药不当致呼吸心跳骤停1例

1例60岁男性患者,因颅脑磁共振检查需要给予10%水合氯醛溶液20mL口服,镇静效果不明显,再次给予地西泮10mg缓慢静脉注射后,患者出现呼吸及心跳停止,立即给予地塞米松、尼可刹米、洛贝林和肾上腺素,经抢救患者逐渐恢复自主心律及自主呼吸。     

Very long half-life of paroxetine following intoxication in an extensive cytochrome P4502D6 metabolizer

A very long half-life of paroxetine (195 h instead of the usual value of around 16 h) was measured after an overdose with 2 g paroxetine and 1 g clorazepate in a patient who was an extensive cytochrome P4502D6 metabolizer. The patient recovered well without any clinically significant complications. A consequence of the close monitoring of paroxetine levels in this patient was that it was decided not to reintroduce any other antidepressant despite her suicide attempt, until normal levels of paroxetine had been reached, which took over 1 month.     

对1例原发性肾病综合征患者的药学监护

1例34a男性患者,因原发性肾病综合征、轻度系膜增生性肾小球肾炎采用足量激素治疗8周后临床未完全缓解,为行进一步诊治入院。入院查肝功能异常,肾穿刺病理切片重新阅片后诊断更正为膜性肾病（Ⅱ期）,给予糖皮质激素联合环孢素A治疗,同时给予保肝、抗凝、调脂、降低尿蛋白等对症治疗。针对患者肝功能异常、需长期应用糖皮质激素和环孢素A等特点,药学监护集中于监测他汀类调脂药的肝损害、应用环孢素A时调脂药的选择、糖皮质激素性骨质疏松的预防,同时通过用药教育提高病人用药依从性,减少潜在的用药风险。患者出院后继续规律应用糖皮质激素和环孢素A并缓慢减量,随访8个月,患者尿蛋白完全缓解（24h尿蛋白定量〈300mg）,肝功能、血脂均正常。     

盐酸小檗碱与环孢素合用的药物经济学研究

目的：了解盐酸小檗碱与环孢素合用能否降低环孢素的费用。方法：采用回顾性调查方法,进行盐酸小檗碱与环孢素合用的药物经济学评估。结果：盐酸小檗碱可显著增加环孢素的血药浓度。在满足正常疗效的同时,可降低环孢素的药物费用,每个每年可节约药费6000-8000元。结论：小檗碱与环孢素合用能降低费用,减轻病人和社会的经济负担。