胆道感染患者临床抗感染治疗策略的研究进展

探究胆道感染临床抗感染治疗的策略,结合常见致病菌及其对抗菌药物的耐药特点、抗菌药物的药效学和药动学特点、患者感染的严重程度。综述近期国内外诊治"指南"和相关文献资料,并对胆道感染临床抗感染治疗研究进展做了分析。     

胆道疾病的胆汁细菌学研究——附150例临床分析

本文试图通过对各种类型胆道疾病胆汁的菌种(需氧菌及厌氧菌)分布、对药物的敏感性以及对容易引起胆汁细菌培养阳性的临床因素等的调查,以达到合理选择和使用抗菌药物预防术后感染及治疗胆道系统感染的目的。材料和方法     

胆道感染患者胆汁培养及药敏分析

<正>胆道感染是临床常见疾病,合理的经验性抗生素使用在胆道感染的治疗中起着重要作用。随着抗生素的普遍应用,胆道感染中的病原微生物及其对抗菌药物的敏感性发生了变迁。本文对我院2007年1月至2008年12月胆道感染患者胆汁培养阳性的253株病原菌的分布和耐药性作回顾性     

重度肾功能不全的老年胆道感染患者抗感染用药选择1例

本文通过分析1例重度肾功能不全的老年胆道感染患者抗感染用药问题,探讨根据抗菌药物临床应用管理规定,如何为特殊人群患者选择抗菌药物以及如何设计合适的治疗方案。     

两种给药方案预防胆道手术切口感染效果观察

目的：观察两种给药方案预防胆道手术切口感染效果。方法：2006年6月至2007年12月我院胆道感染并行择期手术162例,全部病例术前应用头孢哌酮／舒巴坦＋克林霉素治疗4d以上,治疗组82例,术前30min给予一剂量头孢呋辛2g,ivd;对照组80例,术前不应用抗菌药物预防感染。结果：治疗组3例发生感染,感染率3．65％,切口愈合平均时间7．8d．对照组2例发生感染,感染率2．56％,切口愈合平均时间7．6d,两组比较,P〉0．05,无统计学差异。结论：术前应用抗菌药物治疗4天以上的胆道感染手术患者不需再用抗生素预防切口感染。     

胆道感染235株病原菌分布及耐药性分析

胆道感染是临床外科的常见疾病,与胆石症常为因果关系。了解引起胆道感染的主要病原菌及其耐药情况,对临床经验治疗和术前抗感染治疗尤为重要。为此,笔者对福建省立医院3年内胆道感染患者胆汁培养阳性的235株病原菌的分布和耐药情况作回顾性分析,从而为临床合理选用抗菌药物提供参考。     

氟喹诺酮类抗菌药在胆道感染中的作用

自从喹诺酮类抗菌药问世以来 ,已被广泛地应用于临床 ,成为治疗感染性疾病的重要药物。特别是随着以诺氟沙星为代表的氟喹诺酮类的问世 ,更是以其抗菌谱广、抗菌活性强、组织分布广、不良反应相对少等特点显示了更大的治疗潜力。现将氟喹诺酮类抗菌药 (包括氧氟沙星、环丙沙星、氟罗沙星、培氟沙星、妥舒沙星、左氟沙星、司巴沙星、芦氟沙星 )在胆道感染 ( BIT)中的作用综述如下。影响抗生素对胆道感染治疗效果的因素包括 [1] :1所用抗生素对胆道感染中常见病原菌的抗菌活性 ;2含药胆汁的杀菌活性 ;3药物的药物动力学特性 ,特别是组织分布…     

临床药师参与1例急性胆管炎伴菌血症抗感染治疗的病例分析

目的 探讨临床药师在严重感染患者抗感染治疗中的作用。 方法 临床药师参与1例胆道感染伴菌血症患者的抗感染治疗,针对该患者进行病原菌分析,细菌培养结果分析,在抗菌药物的选择、剂量、疗程、不良反应、注意事项等方面提出合理建议的过程和体会。结果 临床药师参与治疗实践可促进抗菌药物临床合理应用。患者住院用药期间无相关不良反应发生,出院时感染得到控制。结论 临床药师参与药物治疗能提高临床药物治疗的疗效和安全性。     

胆道感染的用药指导

胆道感染是临床上的常见病，其治疗手术和用药正在不断完善，本文着重介绍了胆道感染的发病机理，抗菌药物的选择以及如何预防手术并发症的问题。     

胆道感染的常见病原菌构成及耐药性变迁

<正>现对我院5年内205例胆道感染住院患者的病原学、药敏学进行回顾性分析,并进行细菌耐药性变迁的研究,旨在为临床治疗胆道感染,合理选用抗菌药物提供依据。现报告如下。1资料与方法1.1一般资料:选择2006—2010年在我院确诊胆道感染患     

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.