稳定期COPD患者联合应用补中益气汤及舒利迭的临床疗效

目的:分析稳定期COPD(慢性阻塞性肺疾病)患者联合应用补中益气汤及舒利迭的临床疗效。方法:以本院治疗的76例稳定期COPD患者为研究主体。分成A组和B组,均是38例。A组给予补中益气汤+舒利迭治疗,B组给予舒利迭单纯治疗。对比治疗效果。结果:治疗后,两组的肺功能指标均升高,且A组高于B组(P0.05)。治疗后,两组的6min步行距离均延长,且A组大于B组(P0.05)。结论:为稳定期COPD患者行补中益气汤+舒利迭治疗可改善患者的肺功能和活动耐量,具有较佳的临床疗效。     

舒利迭对老年慢性阻塞性肺疾病稳定期患者肺功能和骨密度的影响

目的:观察吸入舒利迭对老年慢性阻塞性肺疾病(COPD)稳定期患者肺功能和骨密度的影响.方法:将武警后勤学院附属医院呼吸与重症医学科80例老年COPD稳定期患者随机分成研究组40例和对照组40例.两组常规治疗相同;研究组加用舒利迭吸入治疗,500μg/次,2次/d,两组疗程均为6个月.比较两组治疗6个月前后的肺功能及L2-4椎体骨密度变化情况,并进行统计学分析.结果:①治疗后,研究组和对照组FEV1均有所改善,且研究组改善效果更为显著(P<0.05);②治疗后,研究组L2-4椎体骨密度值较对照组稍低,但无统计学意义(P>0.05).结论:利用舒利迭治疗COPD稳定期患者具有明显疗效,短期吸入舒利迭对COPD稳定期患者骨密度无影响,长期吸入舒利迭对骨密度影响需进一步观察研究.     

舒利迭吸入剂对56例稳定期慢性阻塞性肺疾病患者的临床疗效观察

目的观察舒利迭干粉剂对慢性稳定期慢性阻塞性肺疾病(COPD)的疗效。方法将56例处于慢性缓解期的COPD患者,随即分成实验组和对照组。对照组给予常规治疗,实验组在此基础上给予吸入舒利迭(50/250)。记录治疗前后的患者症状缓解情况,肺功能和血气分析指标。结果实验组的总有效率显著高于对照组,两组疗效比较差异有统计学意义(P<0.05)。结论应用舒利迭(50/250)治疗慢性缓解期COPD,能显著改善肺功能,动脉血气指标,患者依从性好,副反应少。     

噻托溴铵联合舒利迭治疗慢性阻塞性肺疾病稳定期的疗效研究

目的评价吸入噻托溴铵联合舒利迭治疗慢性阻塞性肺疾病（COPD）稳定期患者的疗效。方法 将60例确诊为COPDⅡ-Ⅲ级稳定期的患者随机分为噻托溴铵组、舒利迭组及噻托溴铵＋舒利迭组,出院后继续给予相对应的药物治疗。随访观察4个月,3组均于治疗前及治疗后4个月查肺功能及血气分析。结果 3组COPD患者经治疗后肺功能均有改善,而联合使用噻托溴铵与舒利迭治疗比单用噻托溴铵及舒利迭肺功能改善更显著（P〈0.05）。结论噻托溴铵联合舒利迭对治疗COPD稳定期患者肺功能有更好的疗效。     

舒利迭对COPD稳定期患者临床疗效及IL-8、TNF-α的影响

目的:观察长期吸入舒利迭对慢性阻塞性肺疾病(COPD)稳定期临床疗效及IL-8、TNF-α的影响.方法:对80例COPD稳定期患者,随机分为两组,对照组为常规治疗,治疗组给予常规治疗加用长期吸入舒利迭,观察两组治疗前后的临床疗效、血IL-8、TNF-α进行对比,评价舒利迭对COPD稳定期患者的影响.结果:舒利迭明显缓解COPD临床症状、降低COPD稳定期患者IL-8、TNF-α的表达,与对照组比较差异有显著性.结论:长期吸人舒利迭能缓解患者临床症状、降低IL-8、TNF-α的表达.     

舒利迭治疗慢性阻塞性肺疾病的疗效观察

目的 对比研究舒利迭(沙美特罗/丙酸氟替卡松)治疗稳定期严重程度为Ⅲ-Ⅳ级的慢性阻塞性肺疾病(COPD)的疗效.方法 对160例确诊为COPD的患者随机分为2组:分别吸入舒利迭(试验组)、辅舒酮加万托林(对照组),疗程6个月,测定肺功能指标FEV1,FEV1/FVC,FEV1占预计值百分比(%),评价治疗前后肺功能的变化.结果 与应用辅舒酮加万托林组比较,舒利迭组治疗后肺功能指标改善显著(P＜0.05).结论 舒利迭对稳定期严重程度为Ⅲ-Ⅳ级COPD患者的疗效明显优于其他复合制剂,是目前临床治疗COPD的最有效的药物.     

舒利迭联合BiPAP通气对稳定期COPD患者肺功能影响的临床观察

目的 探讨沙美特罗替卡松粉吸入剂(舒利迭)联合双水平气道正压通气(BiPAP)对稳定期慢性阻塞性肺疾病(COPD)患者肺功能的影响.方法 稳定期COPD患者150例,随机分为A组50例,B组49例和C组51例,A组单纯使用舒利迭,B组单纯使用BiPAP通气,C组使用舒利迭联合BiPAP通气.观察3组治疗前后肺功能改善和SGRQ评分及总分变化情况.结果 150例患者中出现COPD急性发作8例,其中A组3例、B组3例、C组2例,均退出研究,余142例患者均完成3个月治疗.C组治疗后肺功能改善情况优于治疗前,且明显优于A、B组,差异均有统计学意义(P<0.05和P<0.01);治疗后A组与B组肺功能改善情况比较差异无统计学意义(P>0.05).3组治疗后SGRQ评分及总分均低于治疗前,差异有统计学意义(P<0.05和P<0.01).治疗后A组与B组SGRQ评分及总分比较差异无统计学意义(P>0.05),而治疗后C组SGRQ评分及总分均显著低于A、B组,差异均有统计学意义(P<0.01).结论 舒利迭联合BiPAP通气治疗稳定期COPD安全有效,值得临床推广应用.     

舒利迭联合异丙托溴铵对COPD稳定期患者肺功能的影响

目的：探讨舒利迭联合异丙托溴铵对老年慢性阻塞性肺疾病（COPD）稳定期患者肺功能的影响。方法COPD稳定期患者患者150例,采用随机数字表法分为对照组（75例）和观察组（75例）;两组患者均给予常规对症支持治疗,包括祛痰、平喘及止咳等;对照组患者给予异丙托溴铵吸入治疗;观察组患者在此基础上加用舒利迭吸入治疗;比较两组患者治疗前后肺功能和血气分析指标。结果对照组与观察组患者治疗后各项肺功能和血气分析指标均显著优于治疗前,且观察组患者治疗后改善程度优于对照组,差异有统计学意义（P〈0.05）。结论舒利迭联合异丙托溴铵可显著改善COPD稳定期患者肺功能,提高生活质量。     

思力华联合舒利迭对稳定期COPD患者肺功能的疗效观察

目的观察联合应用思力华(沙美特罗替卡松粉吸入剂)和舒利迭(噻托溴铵粉吸入剂)治疗稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的临床疗效。方法96例稳定期中重度COPD患者被随机均分为两组,试验组(联合应用思力华和舒利迭)和对照组(仅应用舒利迭),两组患者治疗疗程为3个月。观察两组患者临床症状、动脉血气分析、肺功能的改善情况,比较两组患者治疗疗效的差异。结果①治疗后对照组和试验组患者临床症状均有明显改善,且试验组患者临床缓解率明显高于对照组患者,P<0.05,差异具有统计学意义。②治疗后对照组和试验组患者FEV1%、FEV1/FVC、PaO2均较治疗前升高,PaCO2较治疗前减低;且治疗后试验组患者较对照组患者FEV1%、FEV1/FVC、PaO2高,PaCO2较对照组低,P<0.05,差异具有统计学意义。③治疗组和对照组均无明显不良反应发生。结论联合应用思力华和舒利迭有利于改善COPD稳定期患者的肺功能。     

不同剂量沙美特罗替卡松治疗稳定期慢性阻塞性肺疾病临床疗效观察

目的评价稳定期重度至极重度慢性阻塞性肺疾病(COPD)予不同剂量沙美特罗替卡松(舒利迭)的治疗效果。方法将46例稳定期重度至极重度COPD患者随机分为两组:A组23例予舒利迭(50/500μg)+噻托溴铵(天晴速乐)治疗;B组23例予舒利迭(50/250μg)+天晴速乐治疗。于治疗前,治疗1、6个月后行肺功能检测,采用6min步行距离评价运动能力,应用生活质量评估测试(CAT)问卷评价生活质量。结果两组患者治疗后肺功能、运动能力、生活质量评分均有明显改善(P<0.01),A组改善更为显著(P<0.01)。在减少加重病例、延缓病情发展的比较中,A组明显优于B组(P<0.01)。结论稳定期重度至极重度COPD患者予舒利迭(50/500μg)+天晴速乐治疗效果较好,降低了急性发作次数,而不良反应无明显增加。     

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。     

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.     

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.     

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.     

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.