安宫牛黄丸的临床应用研究进展

安宫牛黄丸是传统中药最负盛名的急症用药,具有清热解毒、镇惊开窍的功效,在临床中多用于治疗各种脑部疾病、高热、炎症等,在治疗颅脑损伤、脑梗死、脑出血、小儿发热、癌性发热、病毒性脑炎、肺炎、盆腔炎、毛细急性支气管炎等具有很好的临床应用价值。另外对癫痫、惊厥以及其他脓毒症、手足口病等都有良好的治疗效果。对安宫牛黄丸的临床应用进展进行综述,并对其今后的应用和发展提出思考,旨在为今后的研究工作提供参考。     

口服腰痛宁胶囊致烦躁、胸闷、心动过速1例

腰痛宁胶囊具有消肿止痛、疏散寒邪、温经通络之功效，用于腰椎间盘突出症、腰肌劳损、腰肌纤维炎等，为临床常用中成药。近期遇1例2次服用该药后，引起了过敏反应，报告如下。     

薄芝糖肽注射液致全身疼痛、高热1例

目的报道薄芝糖肽注射液致全身疼痛、高热的不良反应1例。方法对我院1例患者使用薄芝糖肽注射液致全身疼痛、高热进行分析、总结,提出合理使用该药的建议。结果与结论应加强对薄芝糖肽注射液引起不良反应的重视,临床选用该药时需注意患者自身病情,对于年老体弱患者需调整剂量;在使用时要密切观察药物反应,同时应避光输注、严格控制滴注速度。     

HPLC法测定大败热注射液中绿原酸的含量

大败热注射液是一种具有清热解毒功效的复方天然药物。经药理和临床验证,其中的绿原酸具有清热解毒、抗菌消炎和抗衰老作用,为主要有效成分。笔者现结合该药的组成和特点采用高效液相色谱(HPLC)法对该药中的绿原酸进行了分析,以为该药的质量标准研究提供技术参考。     

兔毛蒿药理的初步研究(摘要)

兔毛蒿是我省地产草药,据报导原植物系西伯利亚艾菊Tanacetum sibiricumL.别名兔子毛、线叶菊、疗毒花、惊草等。药用全草,性味苦寒,具有清热解毒,抗菌消炎,安神镇惊,调经止血的功效。全草含挥发油0.3％,黄酮类,三萜皂甙,酸性成分,糖及多糖类。我校检验科以三种抑菌法,证明兔毛蒿水煎剂及其挥发油饱和水溶液,对患者标本分离的金黄色葡萄球菌高度或中度抑制。近年来,齐市和嫩江地区部分医院用之治疗上呼吸道感染、急慢性气管炎,可缓解咳、痰症状。为配合该药临床应用,按文献方法,对兔毛蒿水煎剂的药理作用及毒性进行了初步筛选,简要报道如下。实验材料     

通心络胶囊治疗冠心病的疗效分析

冠心病是临床常见病之一，严重影响患者的生活质量。通心络胶囊是根据中医络病理论研制而成的中药复方制剂，它具有通络活血、解痉止痛及益气养阴之功效。为了探讨该药的临床疗效，我们用通心络胶囊对冠心病患者进行了治疗观察，现将结果报告如下。     

痰热清注射液的配伍禁忌

<正>痰热清注射液具有抗病毒、抑菌、抗炎的作用,该药清热解毒、化痰镇惊疗效确切,临床用药安全,且不易产生抗药性。然而在临床应用过程中,痰热清注射液与其他药物的配伍反应多有报道。文献[1,2]对其配伍禁忌进行了研究,但仅就少数几个(类)药物进行了综述,经过后期的大量临床实践和药剂研究又发现了较多的配伍禁忌问题,本文现对其配伍禁忌进行进一步的综述。     

安宫牛黄丸治疗癫痫

安宫牛黄丸治疗癫痫河南安阳１５１医院（河南安阳４５５０００）李复发，张荣厚安宫牛黄丸是一种常用的名贵中成药。具有清热解毒、镇惊开窍的功能。传统用于治疗热病、邪入心包、高热惊厥、神昏谵语等症。我们试用安宫牛黄丸治疗癫痫９例，现报告如下。９例均为我院门诊...     

失眠及其药物治疗（续）

3．1．3其他镇静催眠药①水合氯醛：水合氯醛(chloral hydate)比巴比妥类的出现时间更早，至今仍在临床应用。该药口服或直肠给药均易吸收，15～30min即可诱导入睡，维持时间4—8h。该药催眠作用温和，不缩短REM睡眠时间，无明显的后遗作用，尤其适合老年失眠患者。较大剂量有抗惊厥作用，可用于小儿高热、破伤风以及子痫引起的惊厥。大剂量可引起昏迷和麻醉，     

壮骨灵颗粒剂的制备及临床应用

几年来，我们与本院伤骨科专业人员合作，通过反复的临床实践，研制出壮骨灵颗粒剂，用于治疗骨折迟缓愈合、骨不连以及骨折后期的调养。该药具有补气养血，壮筋强骨的功效，从临床治疗210例观察统计，证明疗效确切，质量稳定。     

Opposite effects of CRF and ACTH on reserpine-induced hypothermia

The effects of CRF, ACTH 1–24, α-MSH, and an ACTH 4–49 analog, at doses of 0, 0.1, 1, and 10 mg/kg, were tested on temperature, ptosis, and sedation in mice pretreated 18 hr previously with reserpine. IP injection of CRF at doses of 1 and 10 mg/kg significantly potentiated the reserpine-induced hypothermia while ACTH 1–24 at the same two doses had the opposite effect of significantly reversing the hypothermia as compared to diluent. The highest dose of α-MSH exerted a similar action to that of ACTH 1–24, but none of the doses of the ACTH 4–9 analog changed body temperature. β-endorphin also failed to cause a reliable effect even though naloxone blocked the action of CRF on body temperature. The results suggests that CRF, like other hypothalamic peptides, can exert extra-pituitary actions after peripheral administration.     

Antagonism of reserpine rigidity without inducing sedation

The effects of pretreatment with chloropromazine, promethazine or SKF 7265 on the severity of reserpine-induced rigidity were evaluated using a series of behavioral responses. Chlorpromazine (10 mg/kg) reduced the severity of the syndrome, particularly the tremor, but only at doses that also produced marked sedation. SKF 7265 was more effective than chlorpromazine and produced no detectable sedation or other motor impairment. Promethazine was ineffective in protecting against the effects of reserpine. These studies demonstrate that motor and behavioral abnormalities induced by high doses of reserpine can be blocked without inducing generalized sedation. This would suggest that it is possible to separate pharmacologically the motor pathways responsible for reserpine rigidity and those responsible for sedation.     

Exploration of Novel Co-processed Multifunctional Diluent for the Development of Tablet Dosage Form

The aim of this investigation was to develop a novel multifunctional co-processed diluent consisting of microcrystalline cellulose (Avicel PH 102), crospovidone (Polyplasdone XL) and polyethylene glycol 4000. Colloidal silicon dioxide and talc were also incorporated as minor components in the diluent to improve tableting properties. Melt granulation was adopted for preparation of co-processed diluent. Percentage of Avicel PH 102, Polyplasdone XL and polyethylene glycol 4000 were selected as independent variables and disintegration time was chosen as a dependent variable in simplex lattice design. The co-processed diluent was characterised for angle of repose, bulk density, tapped density, Carr''s index, percentage of fines and dilution potential study. Acetaminophen and metformin were used as poorly compressible model drugs for preparation of tablets. The blend of granules of drug and extra-granular co-processed diluent exhibited better flow as compared to the blend of drug granules and physical mixture of diluents blend. The diluent exhibited satisfactory tableting properties. The tablets exhibited fairly rapid drug release. In conclusion, melt granulation is proposed as a method of preparing co-processed diluent. The concept can be used to bypass patents on excipient manufacturing.     

右美托咪定在儿科临床镇静的应用现状

儿童检查前及术前常需要应用镇静药物使操作顺利进行。许多临床常用的麻醉镇静剂在动物研究中,被发现具有神经毒副作用;对于某些镇静药物,在应用过程中可能会产生呼吸抑制作用,这些不良反应对处于发育期的儿童是不可忽视的。右美托咪定（dexmedetomidine,DEX）是一种高选择性α₂-肾上腺素受体激动剂,具有镇静及镇痛作用。通过检索国内外DEX在儿童镇静中的应用,结果显示,DEX引发并维持自然非动眼睡眠状态,产生镇静、催眠作用,镇静过程中无呼吸抑制作用,为安全有效的镇静药物。虽然DEX在我国未被推荐用于儿科镇静,但是它的应用越来越受到广大麻醉医生及药师的关注,DEX临床研究可能为儿科临床镇静提供更好的选择。     

Vascular effects of topically applied bradykinin on the human nasal mucosa

To evaluate the vascular effects of topically applied bradykinin on the human nasal mucosa, 13 asymptomatic hay fever patients and 11 non-allergic subjects were challenged with diluent or bradykinin in three increasing doses. Mucosal blood flow was determined with the 133Xenon wash-out method and expiratory peak flow measurements used to assess nasal airway resistance before and after challenge. Nasal symptoms were recorded. Nasal secretion quantity was measured from preweighed paper handkerchiefs. Bradykinin induced a slight increase in nasal airway resistance which was similar in both allergic and non-allergic subjects. Nasal secretion was clearly increased after challenge with bradykinin compared with challenge with diluent in both allergic and non-allergic subjects. Bradykinin did not, however, induce any change in mucosal blood flow in either group. The present findings could be explained by direct effects of bradykinin on the vascular bed without reflex activity. Bradykinin would then induce an increase in vascular permeability with subsequent oedema formation and increased amounts of fluid on the mucosal surface. In contrast to allergen challenge, bradykinin challenge had no effect on the resistance vessels, changes of which had previously been shown to be largely reflex-mediated.     

Review article: moderate sedation for endoscopy: sedation regimens for non-anaesthesiologists

BACKGROUND: Moderate sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands with or without light tactile stimulation. Moderate sedation is typically accepted in the anaesthesia community as an appropriate target for sedation by non-anaesthesiologists. AIM: To describe drug regimens that can be successfully and safely targeted to moderate sedation for endoscopy by non-anaesthesiologists. RESULTS: Moderate sedation can be achieved using narcotics and benzodiazepines. There is interest in some countries in propofol for endoscopy, which is often viewed as an agent for deep sedation. Indeed, propofol cannot be targeted to moderate sedation for endoscopy as a single agent because of coughing during upper endoscopy and pain withdrawal responses during colonoscopy. Pre-treatment with low doses of narcotic and/or benzodiazepine blocks these effects, allowing propofol to be targeted to moderate sedation. Fospropofol, a prodrug of propofol in clinical development, can also be targeted to moderate sedation if co-administered with narcotic. CONCLUSION: Moderate sedation provides a safety margin when compared with deep sedation and general anaesthesia. Development of protocols that target agents such as propofol to moderate sedation will expand the sedation agents available to non-anaesthesiologists and help ensure that this expansion occurs safely.     

水合氯醛和咪达唑仑用于儿科门诊镇静的给药途径研究

目的:优选儿科门诊应用水合氯醛和咪达唑仑镇静的给药途径。方法:选择需镇静的门诊患儿120例,随机分为水合氯醛口服组、水合氯醛灌肠组、咪达唑仑肌肉注射组、咪达唑仑滴鼻组各30例并以相应方法进行镇静,记录并比较镇静深度、起效时间、持续时间、Ramsay评分、一次成功率和不良反应。结果:咪达唑仑滴鼻组与咪达唑仑肌肉注射组比较,起效时间差异无统计学意义(P>0.05),但持续时间较长(P<0.05)。水合氯醛灌肠组与水合氯醛口服组比较,起效时间较短、持续时间较长、Ramsay评分<3分的患儿较少(P均<0.05)。四组患儿镇静一次成功率比较差异无统计学意义(P均>0.05)。患儿在镇静期间均未发生严重不良反应。咪达唑仑肌肉注射组出现低氧合和呼吸抑制,咪达唑仑滴鼻组均未出现,且心血管抑制发生率较低(P<0.05)。水合氯醛灌肠组恶心呕吐发生率低于水合氯醛口服组(P<0.05)。结论:儿科门诊应用水合氯醛灌肠、咪达唑仑滴鼻进行镇静,效果较好,不良反应较少,安全性较高。     

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis

Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect‐site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect‐site target‐controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3–4] and deep sedation (OAA/S scores of 1–2) were developed using nonlinear mixed‐effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce₅₀ values for adequate and deep sedation were 0.94 and 1.52 μg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce₅₀ values for adequate sedation in 20‐year‐old patients with a T₁₂ sensory level and in 80‐year‐old patients with a T₄ level were 1.63 and 0.53 μg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.     

Sedation and analgesia in critically ill neurologic patients

Critically ill neurologic patients can pose a challenge when it comes to providing sedation and analgesia, primarily with the balance of maintaining sedation to provide patient comfort while still allowing a neurological examination. Determination of the optimal agent requires assessment and understanding of the underlying requirement for sedation: provision of analgesia, anxiolysis, or treatment of delirium. Pharmacological options exist that can affect individual or multiple underlying sedation requirements. Numerous evaluation tools exist to monitor the efficacy of sedation as well as help clinicians titrate agents to predefined goals; these tools allow the safe administration of drugs that can otherwise have serious adverse effects. Sedation regimens must ultimately be individualized to each patient to account for differences in pharmacokinetics and dynamics of the various agents, and this is particularly true in sedating neurologically injured patients. The agents frequently used to provide sedation and analgesia in the critically ill neurologic patient will be reviewed.     

37例艾滋病患者药物热临床分析

目的：探究艾滋病患者发生药物热的临床特征,以期为其药物热的诊疗提供参考。方法：回顾性收集发生药物热的艾滋病患者基本情况、诊疗经过、药物热发热特点、致热药物等,将感染性发热与药物热比较,总结药物热临床特征。结果：（1）共收集发生药物热的艾滋病患者37例,其入院时均因合并其他感染性疾病有不同程度发热,体温（39.2±0.87）℃,抗感染治疗后体温均恢复正常,感染性发热病程（17.72±12.98）d。（2）β-内酰胺类抗生素、美罗培南、异烟肼及利福霉素类抗结核药物、复方磺胺甲基异唑均可导致药物热,以β-内酰胺类最常见（51%）,其次是利福霉素类（30%）。（3）与感染性发热比较,药物热高热者更多（70.3%）,以弛张热、稽留热为主,而感染性发热高热者43.2%,以不规则热更常见（均P<0.05）;药物热时血白细胞数及中性粒细胞比例均明显低于感染性发热,而嗜酸性粒细胞比例明显高于感染性发热患者（均P<0.05）。结论：药物热是艾滋病患者发热原因中并不少见的原因,β-内酰胺类抗生素及利福霉素类抗结核药物最常见。发热的热型、热度、用药情况及实验室检查结果可作为药物热鉴别诊断要点。