舒肝汤治疗乙型肝炎后肝硬化门静脉高压症23例临床研究

目的分析并研究乙型肝炎后肝硬化门静脉高压综合征应用舒肝汤进行治疗的疗效。方法本研究中纳入病例来源为我院住院部收治乙型肝炎后肝硬化门静脉高综合征患者,纳入病例时间段为2013年8月至2015年12月。将纳入研究的46例患者按照数字随机表方法进行分组处理,对照组、观察组分别纳入23例患者。对照组中纳入患者用常规方法进行支持治疗,观察组中纳入患者联合应用舒肝汤进行治疗。对比两组患者经不同方案治疗下用药前、用药后门静脉、脾静脉血管内径、血流速度内径、以及血流量等相关指标差异。结果用药前门静脉、脾静脉相关血流动力学指标对比均无显著差异(P>0.05),不具有统计学方面意义。用药后观察组患者门静脉血管内径、脾静脉血管内径、门静脉血流量、脾静脉血流量相关检出值均显著低于对照组(P<0.05),差异显著且具有统计学方面意义,门静脉血流速度内径、脾静脉血流速度内径相关检出值与对照组对比无显著差异(P>0.05),不具有统计学方面意义。结论对乙型肝炎后肝硬化门静脉高压症患者应用舒肝汤进行治疗的临床价值确切,对降低患者门静脉压力有积极作用,值得临床肯定并推广应用。     

丹参,黄芪对肝硬化门脉高压血流动力学的影响

目的：观察丹参、黄芪对肝硬化门脉高压血流动力学的影响。方法：６７例肝硬化门脉高压患者随机分为常规治疗组和丹参、黄芪治疗组,分别于治疗前及治疗１月、２月、３月监测门静脉内径、脾静脉内径、门静脉血流速度、脾静脉血流速度加快,门静脉血流量、脾静脉血流量减少,与常规治疗组比较有显著差异性。结论：丹参、黄芪能较好地改善肝硬化门脉高压。     

丹参注射液预防消化道出血的临床研究

目的:研究探索能降低肝硬化门静脉高压及副作用的药物,提高预防肝硬化上消化道出血的临床疗效。方法应用丹参注射液治疗肝硬化门静脉高压患者62例。分别测量用药前30min、用药后30min、用药1个月、用药3个月时的门静脉和脾静脉内径、血流速度和血流量。随访2年,统计用药后1年、2年上消化道出血的发生率。结果使用丹参注射液后门、脾静脉内径、血流速度和血流量均较用药前减低,上消化道出血的发生率也降低。结论丹参注射液能降低肝硬化门静脉高压的门脉压力,有效预防上消化道出血的发生。     

门体分流性脑病患者门静脉系统血流动力学研究

目的观察门体分流性脑病患者与尚未发生肝性脑病的肝硬化门静脉高压患者的血流动力学情况。方法应用彩色多普勒超声诊断仅对29例门体分流性脑病患者和32例尚未发生肝性脑病的肝硬化门静脉高压患者的门静脉内径、血流速度、血流量进行检测,并加以统计学分析.结果两组患者门静脉内径之间的差异无显著性(P>0.05),而门体分流性脑病患者组血流速度及血流量均下降,且统计学结果有显著性差异(P<0.05).结论门静脉系统血流动力学的多普勒超声监测有助于评价肝硬化门静脉高压患者的预后,可在一定程度上反映门体分流的程度,预测门体分流性脑病的发生.     

彩色多普勒超声检测肝硬化患者门静脉和脾静脉血流动力学的临床意义

目的探讨彩色多普勒超声对肝硬化患者门静脉和脾静脉的血流动力学的临床意义。方法选取在2012年11月~2014年11月期间到我院就诊并入院治疗的肝硬化患者共计58例,患者按照Child-Pugh法分成三个等级,并作为观察组,再选择在同时间段体检的健康志愿者共计58例,并作为对照组。通过应用彩色多普勒超声检测所有研究对象的门静脉内径(Dpv)、门静脉血流速度(Vpv)、门静脉血流量(Qpv)、脾静脉内径(Dsv)、脾静脉血流速度(Vsv)、脾静脉血流量(Qsv)以及腹水量等各项指标,进行对比分析。结果肝硬化患者Dpv、Dsv明显高于对照组,且随肝功能分级逐渐增大(P0.05);肝硬化患者Qpv、Qsv明显高于对照组,且随肝功能分级逐渐增多(P0.05);肝硬化患者Vpv、Vsv明显低于对照组,且随肝功能分级逐渐减慢(P0.05)。结论彩色多普勒超声检测门静脉血流动力学各项指标可以有效评估肝硬化患者的病情进展程度以及是否发生门静脉高压情况,具有重要临床意义。     

彩色多普勒超声测定肝硬化门脉血流的临床意义

目的探讨彩色多普勒超声检测肝硬化门静脉血流动力学改变的临床意义。方法采用彩色多普勒超声测量120例肝硬化患者门静脉、脾静脉内径、血流速度、血流量,其中64例进行电子胃镜检查,并对上述血流动力学指标与肝功能Child—Pugh分级、食管静脉曲张程度的关系进行分析。结果肝硬化Child-PtIsh分级越差,门静脉及脾静脉内径、血流量值越大,而血流速度则越慢（P〈0．05）。食管静脉曲张重度组门静脉及脾静脉内径、血流量均较轻中度组显著升高,而血流速度则较轻中度组显著下降（P〈0．05）。结论彩色多普勒超声测定肝硬化门脉血流对判断肝功能及食管静脉曲张程度有重要意义,有助于指导随访观察,为临床诊治提供帮助。     

多普勒超声检测慢性乙型肝炎及肝硬化患者门静脉和脾静脉血流的临床意义

目的 探讨多普勒超声对慢性乙型肝炎及肝硬化患者门静脉和脾静脉血流参数的检测价值。方法 64例慢性乙型肝炎患者及92例肝硬化患者作为研究对象,分别设为慢性乙型肝炎组及肝硬化组,对患者行多普勒超声检测。比较两组患者门静脉和脾静脉血流参数、超声半定量评分。结果 肝硬化组门静脉内径(1.47±0.11)cm、血流速度(13.11±1.42)cm/s、血流量(1285.43±120.14)ml/min,脾静脉内径(1.01±0.05)cm、血流速度(15.40±2.93)cm/s、血流量(894.51±304.44)ml/min;慢性乙型肝炎组门静脉内径(1.16±0.19)cm、血流速度(17.69±3.59)cm/s、血流量(1109.35±116.79)ml/min,脾静脉内径(0.62±0.16)cm、血流速度(17.09±1.97)cm/s、血流量(254.89±157.76)ml/min。肝硬化组门、脾静脉内径及血流量均大于慢性乙型肝炎组,血流速度小于慢性乙型肝炎组,差异有统计学意义(P<0.05)。肝硬化组的肝实质回声、胆囊壁、肝脏被膜、肝边缘形态、脾脏面积、肝静脉清晰度评分...     

肝硬化门静脉高压的血流动力学变化及超声诊断观察

目的探讨超声诊断肝硬化门静脉高压的血流动力学变化的临床价值和意义。方法选取我院收治的148例肝硬化门静脉高压患者作为研究对象。另取健康对照组40例。采用超声检查患者门静脉(PV),脾静脉(SV)及肠系膜上静脉(SMV)的内径D、平均血流速度V和血流量Q,比较两组检查后的数据结果;对肝硬化进行分级,比较各级肝硬化的血流动力学变化。结果肝硬化组患者较对照组的PV、SV、SMV内径明显增宽,Q增加、V减慢,P<0.05,具有统计学意义;A、B、C三级的PV内径递增,但P>0.05,不具有统计学意义;而V值三级之间差异较为明显,P<0.05,具有统计学意义;而A、B组在Q上无差异(P>0.05),C组差异较为明显(P<0.05)。结论应用超声检查肝硬化门静脉高压可准确分析出其血流动力学变化,对肝功能判断和治疗方案的选择有着重要的指导意义。     

阿魏酸钠对肝硬化合并门脉高压患者血流动力学的影响

目的观察阿魏酸钠注射液对慢性乙型肝炎肝硬化（代偿期）合并门脉高压患者血流动力学．旬影响。方法67例代偿期肝硬化患者随机分为两组。对照组32例常规予甘草酸二胺注射液综合治疗并加用普萘洛尔,10mg／次,3次／d,口服;治疗组35例,在上述常规治疗基础上加用阿魏酸钠注射液300mg加入5％葡萄糖注射液250ml中静脉滴注,每日1次,20d为1个疗程。观察两组患者治疗前后的门静脉内径（PV）、脾静脉内径（SPV）、最大门静脉流速（PVX）、最大脾静脉流速（SPVX）和门静脉血流量（QPV）。结果治疗组治疗后PV径、平均血流速度、血流量等参数均明显改善,与对照组差异有统计学意义（P〉0．05或P〉0．01）,对照组的血流动力学指标没有发生明显的变化。结论阿魏酸那能够在不影响门脉血流量的条件下有效地改善慢性乙型肝炎肝硬化患者的门脉血流动力学。     

普萘洛尔三联小剂量对肝硬化门脉高压症近期疗效临床研究

目的:探讨普萘洛尔三联小剂量疗法对肝硬化门脉高压症(PHT)的近期疗效及其作用机制。方法:对68例肝硬化门脉高压症患者随机分为2组:34例三联治疗组和34例二联治疗组。三联治疗组采用口服普萘洛尔(propranolol)10mg,每日3次,螺内酯40mg,每日2次,新亚丹肖(5-单硝酸异山梨酯)20mg,每日2次(PIS方案)。二联治疗组患者采用口服普萘洛尔10mg,每日3次,螺内酯40mg,每日2次(PS方案)。两组疗程均为半年以上。用彩色多普勒超声仪(CDFI)检测两组治疗前、后门静脉系统血流动力学的变化。结果:用药1周后两组门静脉血流量(Qpv)、脾静脉血流量(Qsv)、门静脉血流速度(Vpv)和脾静血流速度(Vsv)均显著下降(P均<0.01);用药4周后Qpv、Qsv、门静脉内径(Dpv)、脾静脉内径(Dsv)均显著下降,与用药前比较差异有显著性(P均<0.01);经3个月的随访,临床上未见明显不良反应。PIS方案组PHT显著低于PS方案组,PHT出血率PIS方案组20.6%(7/34),显著低于PS方案组44.1%(15/34)(P<0.05)。病死率PS方案组为32.4%(11/34),PIS方案组为11.8%(4/34),PS方案组显著高于PIS方案组(P<0.05)。两组中ChildC级患者的再出血率和病死率差异无显著性(P>0.05)。用药12周后PIS方案组Qpv、Qsv、MAP显著低于PS方案组(P均<0.05)、HR显著高于PS组(P均<0.01)。结论:PIS     

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.