动脉内输注高渗性甘露醇改变大鼠血脑屏障对甲氨喋呤的通透性(英文)

目的:研究高渗性溶液开放血脑屏障能否提高甲氨喋呤在皮层内的含量及这一开放过程的时程变化。方法:1)大鼠颈内动脉注射甘露醇,10分钟后分别从股静脉及颈内动脉给予甲氨喋呤,1小时后测定脑皮层内浓度。2)大鼠颈内动脉注射甘露醇,分别在不同时间间隔给予甲氨喋呤,给药1小时后测定脑皮层内药物浓度及脑皮层密度。结果:给予甘露醇后,静注甲氨喋呤和颈内动脉注射甲氨喋呤可以使相应侧脑皮层内浓度分别提高2.54倍和3.41倍。此作用在给予甘露醇10分钟后达到最大,6小时后完全消失;同时并不伴随明显的皮层密度改变。结论:甘露醇可逆性地开放血脑屏障,提高甲氨喋呤在脑皮层内的浓度,同时不会造成明显的脑损伤。     

压宁定针剂治疗高血压急症16例

目的 为了观察压宁定治疗高血压急症的急诊降压作用。方法对16例高血压急症病人给予压宁定12.5mg静脉推注,5分钟内起效后将150mg的压宁定加入10％葡萄糖液500ml中静脉滴注,观察治疗前、后3min、5min、10min、15min、20min、30min、40min、50min和1小时、1.5小时、2小时、2.5小时、3小时、3.5小时、4小时的血压、心率,同时记录不良反应。结果给药3分钟后SBP和DBP即有明显下降,给药后50分钟,降压至最低点,与给药前比较,SBP下降29.6％,DBP下降30.5％,且患者心率无明显变化。结论压宁定具有起效快、用药剂量易掌握、副作用少特点,而且降压时不引起反射性的心率增快,SBP.HR降低,压宁定不增加心肌耗氧量,特别适合于合并有冠心病、左心功能不全的高血压急症患者。     

大剂量阿托品抢救严重乌头硷中毒成功1例

患者,男,59岁,因误服川乌头药酒20ml,10分钟后出现头昏、心慌,半小时后神志不清,3小时后入院。体检:双瞳孔散大,EKG示室速。当即给利多     

吡喹酮引起的日本血吸虫体表皮层的损害和宿主白细胞侵入虫体的观察

感染日本血吸虫的小鼠一次口服吡喹酮300mg/kg后0.5小时,雄虫体表皮层即有不同程度的水肿、空泡样变化和空泡破裂,继则有细絮状物或絮状团块粘附在受损的体表或抱雌沟内。给药6小时后即见有白细胞附着在受损的皮层上,12小时后则已有白细胞侵入虫体。雌虫体表皮层的损害和出现白细胞附着与侵入虫体的时间较雄虫为迟。此外,对血吸虫经吡喹酮作用后,其皮层的损害和白细胞的附着与侵入虫体的意义进行了一些讨论。     

吡喹酮引起的日本血吸虫体表皮层的损害和宿主白细胞侵入虫体的观察

感染日本血吸虫的小鼠一次口服吡喹酮300mg/kg后0.5小时,雄虫体表皮层即有不同程度的水肿、空泡样变化和空泡破裂,继则有细絮状物或絮状团块粘附在受损的体表或抱雌沟内。给药6小时后即见有白细胞附着在受损的皮层上,12小时后则已有白细胞侵入虫体。雌虫体表皮层的损害和出现白细胞附着与侵入虫体的时间较雄虫为迟。此外,对血吸虫经吡喹酮作用后,其皮层的损害和白细胞的附着与侵入虫体的意义进行了一些讨论。     

痔手术围手术期抗菌药物预防应用策略效果比较

目的:比较痔手术围手术期预防使用抗菌药物的不同方案,探究最佳方案。方法:将360位拟行痔手术的患者分为A、B、C、D、E、F六组,A组患者术前24小时进行肠道准备,B组患者术前30分钟静脉给药;C组患者术前30分钟静脉给药,D组患者术前1小时静脉给药,A、B、C、D四组患者术后静脉给药,疗程48小时;E、F两组患者术前30分钟静脉给药,术后E组患者静脉给药,疗程48小时,F组患者口服药物,疗程48小时。统计各组术后切口感染情况。结果:A、B、C、D、E、F六组360名患者围手术期均未出现感染。结论:痔手术术前30分钟静脉用药与术前24小时进行肠道准备效果无明显差异;术前30分钟与术前1小时静脉给药效果无明显差异;术后口服与静脉使用药物效果无明显差异。     

西沙必利对食管运动功能的影响

16例健康志愿者参加了随机、双盲、交叉试验。在进餐3～4小时后,8例受试者在30秒内静脉注射安慰剂或西沙必利10mg;另8例口服安慰剂或西沙必利5、10和20 mg。每次给药间隔1周。每次给药前后定时测定有关参数。结果:静注西沙必利10mg,15分钟后静息食管下段括约肌(LES)压力较治疗前增加3 mmHg(P<0.05),45分钟后增加最明显(6 mmHg);口服西沙必利20 mg,45分钟后静息LES压力较治疗前增加5 mmHg(P<0.05),75分钟后增加最明显(8 mmHg),口服西沙必利5和10     

吗啡依赖大鼠视皮层GABA及分解代谢酶的变化

目的通过对吗啡依赖大鼠视皮层γ-氨基丁酸(GABA)含量及GAD与GABA-T活力的测定,研究吗啡成瘾过程中视皮层γ-氨基丁酸的代谢变化。方法30只SD大鼠分为6组,末次给药前10 min,后10 min,后3 h处死组及相应对照组,每组5只。纸电泳法检测各组大鼠视皮层中GABA含量,分光光度法检测GAD与GABA-T的活力。结果吗啡末次给药前处死组大鼠GABA含量(0.09±0.03)μmol/mg与对照组(0.17±0.05)μmol/mg比较,差异有统计学意义,末次给药后处死组GABA含量回复至对照组水平。结论吗啡依赖形成时视皮层处于去抑制状态。     

静脉滴注低分子羟乙基淀粉代血浆致过敏性休克1例

<正> 患者女,52岁,因子宫肌瘤住院,术前血流变学检查,全血粘度增高,遵医嘱给予低分子羟乙基淀粉代血浆500毫升,内加丹参10毫升给于静脉滴注,滴速40滴/分。10分钟后,患者胸闷、气急、面色苍白、大汗淋漓、四肢发冷,脉搏细微,血压10/6KPa,立即停药吸氧经注射盐酸肾上腺素、地塞米松、非那根等药物抢救15分钟后病情好转,1小时后恢复正常。     

静滴培氟沙星致反复过敏性休克的抢救体会

1　临床资料患者,女,56岁,既往对青霉素过敏。因上呼吸道感染,医嘱给5%葡萄糖150ｍｌ加培氟沙星04ｇ静滴,滴速2ｍｌ·ｍｉｎ-1,用药1分钟后,即感手痒、麻、胸闷、气促、面色苍白、烦躁不安、呼吸困难、脉触不清、血压测不到,立即停药,经抢救,10分钟后病人血压16/11ｋＰａ,脉80次/分,症状好转。为清除过敏源,给5%葡萄糖500ｍｌ加维生素Ｃ25ｇ,滴速1ｍｌ·ｍｉｎ-1,2分钟后病人感胸闷,四肢及颜面发绀,前胸及四肢出现大片红斑,呼吸困难喉头水肿,伴窒息感,立即停药,对症处理。10分钟后病人症状好转,红斑消退。4小时后病人因进食肉面片汤约2分钟…     

吡喹酮对21-d日本血吸虫童虫皮层损害的扫描电镜观察(英文)

目的:观察吡喹酮对21-d童虫皮层的作用.方法:小鼠于感染日本血吸虫尾蚴达21 d时,ig1剂吡喹酮,并在治疗后1-48 h的不同时间内剖杀取虫,作扫描电镜观察.结果:吡喹酮的剂量为300 mg·kg~(-1)时,宿主体内的21-d童虫示有轻度或中度的皮层褶嵴肿胀、融合、糜烂或破溃,且以盘状感觉器的肿胀为特征.用吡喹酮的较高剂量500 mg·kg~(-1)治疗,虫的体表亦有相似的变化,但较广泛和严重.若每d ig吡喹酮500 mg·kg~(-1),连给3 d,则虫的皮层严重肿、糜烂和剥落,并伴有宿主的白细胞附着.结论:结果表明,吡喹酮对21-d童虫有直接杀死作用.     

Ultrastructural changes of the tegument on Diphyllobothrium erinacei and Hymenolepis nana treated with paromomycin sulfate in vitro

The effects of paromomycin sulfate on Diphyllobothrium erinacei and Hymenolepis nana in vitro were examined morphologically with a scanning and a transmission electron microscope. D. erinacei was incubated for 3 and 6 hours at 37 degrees C in a culture medium, 0.85% physiological saline solution, containing 0.5% paromomycin sulfate. H. nana was incubated in the same medium for 3 hours only. The concentration of paromomycin sulfate was set basing on the results which Kitamoto (1968) reported as the concentration level in feces after administrations of this drug in a clinical survey. The effect of the drug on the surface structure in both worms appeared markedly in the neck region. Mechanisms of breakdown on the tegument were supposed as follows. First, microtriches were disconnected from the tegumental surface and many vesicles were formed in the cytoplasm of the tegument. Finally, the tegument layer was excoriated to exposed the basal lamina. In 6 hours incubation, this surface of the worm suffered more damage than that in 3 hours. The damage of the basal lamina as in the case of D. latum expelled from a man by paromomycin (Y. Tongu et al.), however, could not be observed in the present study in vitro. It suggests that the destruction of basal lamina usually observed with the expelled worms from clinically treated human might be due to the combined effect of digestive enzymes secreted from host and the mechanical impact of intestinal peristalsis. Some of the vesicles in the tegument may originate from mitochondria because the fine structure of cristae were occasionally observed remaining in the vesicles.     

Ultrastructural investigations on the effects of praziquantel on human trematodes from Asia: Clonorchis sinensis, Metagonimus yokogawai, Opisthorchis viverrini, Paragonimus westermani and Schistosoma japonicum

The effect of praziquantel (Biltricide) on the ultrastructure of trematodes pathogenic to man in Asia was investigated in: Clonorchis sinensis, Opisthorchis viverrini, Schistosoma japonicum, Metagonimus yokogawai, and Paragonimus westermani. The different parasites were isolated from their respective experimental hosts and uniformly incubated for 5, 15, 30 or 60 min at 37 degrees C in medium TC 199 containing 0, 1, 10 or 100 micrograms praziquantel/ml. All parasites exposed to praziquantel were contracted and displayed tegumental alterations. 1. Clonorchis sinensis, Opisthorchis viverrini and Schistosoma japonicum reacted with severe tegumental vacuolisation within 5 min after exposure to 1 microgram praziquantel/ml. The extent of the damage induced increased with exposure time. 2. In vivo treated Opisthorchis viverrini worms had the same damages as in vitro treated ones. 3. Metagonimus yokogawai displayed the same degree of vacuolisation after exposure to all concentrations of praziquantel. Complete destruction of the tegumental surface was not achieved, however, possibly because of the presence of numerous tegumental hooks. 4. Paragonimus westermani was least sensitive to praziquantel. Only very few vacuoles were formed after incubation in 100 micrograms/ml for 60 min. It is assumed that the very dense texture of the thick tegument is responsible for the relative refractoriness to praziquantel in vitro. However, in vivo the parasite is successfully eliminated by praziquantel.     

利奈唑胺不同速度单次静滴在中国健康成年志愿者的耐受性

目的评价不同速度单次静滴利奈唑胺(噁唑烷酮类抗菌药物)在中国健康成年志愿者的安全性、耐受性。方法筛选12名符合条件的健康成年受试者,男女各半。分别以600 mg/0.5 h,600 mg/2 h和600 mg/4 h的速度,单次静脉滴注利奈唑胺。在给药前1 d、给药后6 h和给药第3 d,测定心电图、血常规及尿常规、血生化,并对体征指标每日观测,进行单因素方差分析;观察不良事件。结果体征及实验室检查指标大多无明显改变。试验中未见严重不良事件,未见可能与药物有关的不良反应。结论 3种速度(600 mg/0.5 h,600 mg/2h和600 mg/4 h)静滴利奈唑胺均具有良好的安全性和耐受性。     

瘢痕子宫孕妇中期妊娠引产术的临床观察与护理

目的 探讨瘢痕子宫孕妇孕中期引产的安全性、效果及并发症的情况.方法 将60例瘢痕子宫孕中期孕妇分为利凡诺组(32例)和米索前列醇组(28例),分别按照相应的用药方案引产和护理干预,观察孕妇宫缩情况,记录自服药至出现宫缩的时间、用药至分娩的时间、引产后的出血量、胎盘残留情况、引产成功率及子宫破裂的发生情况.结果 两组孕妇在引产成功率和产后出血量方面比较差异无统计学意义(P＞0.05).利凡诺组孕妇口服药物后至出现宫缩的时间和分娩的时间要长于米索前列醇组孕妇,两组比较差异有统计学意义(P＜0.05).米索前列醇组的孕妇有25例在服药24 h内分娩,分娩率达到89.3％;利凡诺组孕妇仅有5例在服药24 h内分娩,分娩率为15.6％,24例孕妇在服药48 h后才开始分娩.米索前列醇组的孕妇出现胎盘残留需要清宫治疗者仅有6例,胎盘残留率为21.4％,而利凡诺组孕妇有14例出现胎盘残留,胎盘残留率为43.8％,两组比较差异有统计学意义(P＜0.05).结论 对瘢痕子宫孕中期引产的孕妇要提高关注、严密观察引产过程,及时发现、处理问题,瘢痕子宫孕中期引产的效果是相对可靠的.     

Clinical outcomes of a home-based medication reconciliation program after discharge from a skilled nursing facility

STUDY OBJECTIVE: To assess the impact of a pilot pharmacist-managed medication reconciliation program on mortality and use of health care services in patients discharged to home from a skilled nursing facility (SNF). DESIGN: Quasi-experimental, controlled trial. SETTING: Health maintenance organization (HMO). PATIENTS: Five hundred twenty-one HMO members. INTERVENTION: Patients were assigned to the medication reconciliation program (113 patients) or to the usual care control group (408 patients) after discharge to home from an SNF. Assignment to the medication reconciliation group or to the control group was based on provider submission of a discharge summary within 0-48 hours of discharge or more than 48 hours after discharge, respectively. MEASUREMENTS AND MAIN RESULTS: Integrated electronic medical and pharmacy data and multivariate analyses were used to assess the medication reconciliation program with regard to its impact on postdischarge mortality, rehospitalization, and ambulatory clinic and emergency department visits. Compared with usual care during the 60 days after discharge from the SNF, patients who received the medication reconciliation intervention had an adjusted 78% reduction in the risk of death (adjusted hazard ratio 0.22, 95% confidence interval [CI] 0.06-0.88) and a trend toward an increased rate of ambulatory care visits (adjusted incidence risk ratio 1.17, 95% CI 0.99-1.37). No significant differences were noted in adjusted risks of an emergency department visit and rehospitalization (p>0.05) between the medication reconciliation and usual care groups. CONCLUSION: Our data support the hypothesis that a formal medication reconciliation process, with its increased coordination of information between health care providers and patients, can decrease mortality after discharge from an SNF. Our findings support the role of medication reconciliation as an integral step in the transitional care process and interests of health care accrediting agencies, such as the Joint Commission, that have included medication reconciliation as an important initiative.     

硝硫氰胺对日本血吸虫作用的电子显微镜观察

本文通过透射电子显微镜观察感染日本血吸虫病的小白鼠经硝硫氰胺治疗后,其体内虫体体壁的超微结构的变化。结果表明,硝硫氰胺对血吸虫虫体壁包括表皮,肌层和皮层细胞的超微结构都有程度不等的影响。并且发现表皮内的二种主要包含物,多膜层小泡(M、L、V、)及盘状颗粒(D、G)的减少与消失对表皮的超微病理改变有密切的关系。同时,对血吸虫虫体标本超薄切片的制备方法也进行了探索。     

Medication history reconciliation by pharmacists in an inpatient behavioral health unit.

PURPOSE: The effectiveness of a pharmacy-obtained medication history on the medication reconciliation process in the behavioral health unit (BHU) of a community hospital was studied. METHODS: Patients admitted to the BHU of a 411-bed, not-for-profit hospital from 6 a.m. on Monday through 12 p.m. on Friday from September 1, 2005, through October 6, 2005, were candidates for the study. Within 18 hours of admission to the BHU and after the medication history had been obtained by a nurse, a pharmacy technician gathered patient demographic and medication information from the chart and the patient's medication bottles. Once the technician completed the documentation, the pharmacist was notified of a new admission. The pharmacist reviewed the collected documentation and patient chart before interviewing the patient. RESULTS: Of the 54 patients who met the study's inclusion criteria, 91% were seen by a pharmacist within 18 hours of admission. The mean +/- S.D. time delay to interview the patient was 11.6 +/- 5.1 hours. Pharmacists spent a mean of 13.9 minutes completing patients' medication histories. The mean +/- S.D. number of medications identified by nursing on admission was 4.0 +/- 3.2, compared with 5.3 +/- 3.7 identified by pharmacists (p < 0.05). The mean number of medication discrepancies identified per patient was 2.9. Of the discrepancies, 48% were related to an omitted or incorrect medication, 31% to an omitted or incorrect dose, and 13% to an omitted or incorrect frequency; 8% were categorized as miscellaneous. CONCLUSION: Pharmacists' participation in obtaining patients' medication histories through chart review and patient interview increased the effectiveness of the medication reconciliation process in an inpatient BHU.