NMDA受体拮抗药对阿片药镇痛作用影响

阿片类药是传统的强效镇痛药,但存在许多不良反应.NMDA受体拮抗药通过一系列反应影响μ-阿片受体兴奋后细胞内PKC的浓度,从而加强阿片类药物的镇痛作用,减少其用量和不良反应,为理想的镇痛药物.     

加强用药监管促进合理用药

2004年美国的统计数据表明住院病人中后果严重的药物不良反应发生率为6.7%,致死率为0.32%,被列在心脏病、癌症、肺病、中风之后主要死因的第五位;因用药原因为主的医疗错误致死人数超过交通事故、艾滋病、乳癌死亡的总数.     

非阿片类镇痛药的围术期应用进展

阿片类药物被广泛地应用于手术患者围术期镇痛,但其不良反应明显,且大剂量阿片类药物可能引起急性耐受和痛觉过敏,最终导致更严重的疼痛反应。因此,各种非阿片类药物和新技术逐渐被研发和应用于临床,目的是改善患者疼痛和减少阿片类药物的使用,降低阿片相关的不良反应。该文就几种主要非阿片类镇痛药围术期镇痛的应用进展做一综述,以期对患者围术期疼痛进行精确管理,避免过度使用镇痛药物。     

接受主动脉瓣置换术的黑人和白人老年患者的治疗差异

背景:大多数先前关于心脏治疗的种族差异的研究关注于不同医生和医院治疗方面的潜在差异。然而,不同实践模式医院采用不同方法也可能导致治疗差异。方法和结果:比较1999—2001年在904所美国医院接受主动脉瓣置换术的78154例黑人和白人患者中生物瓣膜(BPV)的应用,所有患者均为年龄≥65岁的医疗保险受益人。采用广义线性混合模型首先说明患者特征的差异,然后说明黑人和白人患者所住医院的差异。经患者特征校正后,BPV在黑人患者中的使用低于白人患者(RR0.93,95%CI0.91～0.95,P<0.001)。然而,黑人患者更易在BPV总使用率最低的医院进行手术…     

镇痛药有什么

<正>镇痛药是一种选择性缓解或消除痛觉的药物,其起作用的主要范围在于中枢神经系统,该类药物具有显著的镇痛效果,应用非常广泛。广义的镇痛药包括非甾体抗炎镇痛药、阿片类镇痛药和中成药镇痛药。前者在内外科一般疼痛的对症治疗非常广泛,中成药镇痛药一般多用于外科或骨科跌打损伤、理气活血定痛止痛等,但对阿片类及其合成药的使用要谨慎,主要原因是该类药物反复使用会有成瘾的风险。在药政管理上,将凡是容易形成瘾的药物,都统一称之为麻醉性镇痛药,而非成瘾性的西药则被称之为非麻醉镇痛药。根据国家相关规定的《麻精药品管理条例》,将麻醉性和精神性镇痛药列为麻精药品的行列中,必须进行严格限制和管理麻醉药物的使用和生产,以免造成对麻醉药品的滥用以及违法使用,从而威胁到人民群众的健康。镇痛药物的种类繁多,但我们可以将常见的分为3类,分别有非甾体抗炎药、阿片类以及其合成药类、中成药镇痛类。     

斯托和赖特小说中的美国黑人

哈里叶特.比彻.斯托的长篇小说《汤姆叔叔的小屋》和理查德.赖特《汤姆叔叔的孩子们》产生于两个不同时代,出自两个不同种族作家的手笔。但小说对黑人与白人关系的描写,在一定程度上反映了美国社会种族关系演变的轨迹。从中可以看出:在奴隶制时代,黑人作为白人的“财产”,虽然受到种种残暴对待,但也能获得一些白人的同情和帮助;而黑人在获得自由以后,白人的歧视和迫害反而加剧,种族关系完全笼罩在仇恨和暴力的阴影下。     

不同种族和病因左室收缩功能不全患者的预后差异

先前研究表明,收缩性心衰黑人患者的远期预后比白人患者差。产生这些种族差异的原因尚不清楚。研究种族和心衰病因对左室(LV)收缩功能不全患者预后的影响。对1977例接受过心导管检查、NYH A心功能分级为II～IV级且LV射血分数<40%患者(其中27%为黑人)的病历进行研究。以死亡、再     

癌痛患者阿片类药物相关性便秘中西医防治研究进展

阿片类药物是目前治疗中晚期癌痛最常用和最主要的药物,总体较为安全可靠,但不良反应也越来越受到人们关注。便秘是其最常见、最突出的消化道不良反应,可存在于阿片类镇痛治疗的始末。中西医药物治疗各具特色,文章主要就近年来中西医防治阿片类药物所致便秘作一简要综述。     

药源性死亡的药物调查与分析

目的:考察药源性死亡的规律和特点,以提高疾病预防和用药的合理性.方法:对2002～2007年间国内公开发表的文献进行检索,发现药源性死亡病例共80例.按给药途径、致死药品品种和致死药源性疾病进行分类统计和分析.结果:死亡病例组中,静脉给药途径发生药源性死亡的比例远高于其他给药途径;引起死亡的药物以抗微生物药物及中药制剂最多,其次为精神类药物;临床表现以发生过敏反应为主,其不良反应发生率远远高于其他类型.结论:明确用药指征,用药前详细询问过敏史,密切观察用药后反应,制定相应抢救措施,以确保临床用药安全、合理.     

阿片类药物导致便秘的机制及治疗

阿片类药物是中重度疼痛常用的止痛药物,通过与阿片受体的结合起到止痛的作用,但同时抑制了胃肠道的蠕动和分泌,容易导致便秘、恶心、呕吐等胃肠道不良反应,引起疼痛患者的不适。便秘是阿片类药物最主要的不良反应,而传统的通便药物的治疗效果不佳,目前国外致力于研究治疗阿片类药物导致便秘的新药,这些新药通过阻滞外周阿片受体起到治疗的作用,同时不影响中枢止痛作用。该文就阿片类药物导致便秘的发病机制及目前治疗情况予以综述。     

Drug surveillance data in a Canadian hospital.

Comparison of results of a Canadian hospital-based drug surveillance program with data from centres in the United States and Israel showed no important difference in the rate of drug exposures or adverse reactions. Drugs for symptomatic relief were frequently used in the Canadian centre. Women received more drugs and had more adverse reactions than men. Life-threatening and potentially fatal reactions were caused by commonly used drugs; autopsy findings may detect previously unsuspected relations between drug events and mechanisms of death. Voluntary reporting and intensive monitoring are both important in the field of adverse drug reactions.     

Alcohol and fatal injuries among US adults. Findings from the NHANES I Epidemiologic Follow-up Study

Use of alcohol is an important risk factor for fatal injuries. However, little information on the relationship between self-reported alcohol use and subsequent risk of fatal injury is available. Therefore, we examined the relationship between the usual number of drinks consumed per occasion and the incidence of fatal injuries in a cohort of US adults. Using data on self-reported alcohol use obtained from 13,251 adults who were included in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (mean length of follow-up, 9.3 years), we calculated the incidence of fatal injury according to the usual number of drinks consumed per occasion. After we adjusted for the effects of age, sex, race, and education, persons who consumed five or more drinks per occasion were nearly twice as likely to die from injuries (relative risk, 1.9; 95% confidence interval, 1.0 to 3.5) than persons who drank fewer than five drinks per occasion. A dose-response relationship was observed between the usual number of drinks consumed per occasion and risk of fatal injury, with persons who reported drinking nine or more drinks per occasion being 3.3 times more likely to die from injuries (95% confidence interval, 1.3 to 8.3). These data demonstrate the impact of alcohol use on mortality from injuries in the United States and suggest that self-reported alcohol consumption is an important indicator of risk for fatal injury.     

The probability of dying of injuries by the year 2000

Life tables in which the probability of dying of injuries in the United States from 1985 to 1999 are determined may be useful for clinicians in counseling persons concerning the risk of fatal injuries. Overall, more than 1% of persons aged 10 to 34 years in 1985 probably will die of injuries by the year 2000. For white males aged 5 to 29 years in 1985, white females aged 5 to 19 years in 1985, and black males aged 5 to 24 years in 1985, over half of all the estimated deaths during the next 15 years will be probably due to injuries.     

药物过敏性休克致死亡56例文献分析

目的:探讨药物所致过敏性休克死亡的特点、规律及相关危险因素。方法:检索中文医药卫生期刊1998～2006年报道的药源性过敏性休克死亡个案病例,并对文献资料进行整理、汇总和分析。结果:老年人和儿童发生比例较高;抗感染药物、中药制剂、酶类及其它生物制剂的过敏性休克死亡率居前3位。静脉给药发生率最高,占69.64%,速发型过敏性休克死亡比例最大,占73.21%。结论:药物所致过敏性休克死亡与患者年龄、用药时间、药物特点及给药途径等有关。     

Effects of smoking on health care costs

Smoking is the leading preventable cause of death in the United States. The US Centers for Disease Control and Prevention (CDC) estimate that smoking kills approximately 419,000 people in the United States each year. Cigarette smoking is the nation's leading cause of premature mortality, and is responsible for one-third of all deaths among working-age Americans. Smoking cigarettes is both psychologically and physiologically addictive. Smoking is an important risk factor for cardiovascular diseases, especially coronary artery disease, stroke, carcinoma of the lung, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema. It also increases the risk for peripheral vascular disease and is associated with cancers of the larynx, oral cavity, esophagus, pancreas, and urinary bladder. Smoking by pregnant women can cause adverse health effects on their babies, like low birth weight and preterm delivery; increases the risk of miscarriage; and has also been found to be an important cause of sudden infant death syndrome. Careless smoking also can cause severe burn injuries and death. Many of these adverse effects of smoking occur in "second-hand" smokers.     

An outbreak of designer drug--related deaths in Pennsylvania

3-Methylfentanyl ("China White") is a "designer" opiate that has caused more than 100 overdose deaths in California since 1979, but that has not been associated previously with deaths east of the Rocky Mountains. During 1988, 3-methylfentanyl was identified in 16 fatal overdose cases in Allegheny County, Pennsylvania, contributing to a fourfold rise in overdose mortality during October of that year. Morphine was detected in the blood of five persons (31%) and cocaine in the blood of three persons (19%) dying of 3-methylfentanyl overdoses; these were demographically similar to 99 other fatal overdose cases investigated by the county coroner from 1986 through 1988. This documents the contribution of 3-methylfentanyl to overdose mortality in an eastern city and the use of 3-methylfentanyl with other illegal drugs. Drug abusers in the northeastern United States should be considered at risk for more "designer drug" overdose outbreaks in the future.     

Diarrheal deaths in American children. Are they preventable?

We reviewed national mortality data for 1973 through 1983 to assess the importance of diarrheal diseases as a cause of preventable childhood death in the United States. An average of 500 children aged 1 month to 4 years died each year with diarrhea reported as the cause of death. These diarrheal deaths were most common among children who were younger than 1 year of age, black, and living in the South, and were most common during the winter. In Mississippi, review of fatal cases of diarrhea identified maternal factors--black race, young age, unmarried status, low level of education, and little prenatal care--to be most associated with diarrheal death in the child. Fifty percent of these deaths occurred after a child had reached a medical facility. Our findings suggest that diarrheal deaths may be preventable and that targeted interventions could contribute to improved child survival in the United States.     

2,4-Dinitrophenol: A threat to Chinese body-conscious groups

2,4-Dinitrophenol (2,4-DNP), a yellowish compound, has historically been used in the manufacture of dyes, explosives, and fungicides. As it uncouples mitochondrial oxidative phosphorylation, the compound was also used as an antiobesity agent early in the past century. The compound was subsequently banned by the United States Food and Drug Administration in 1938 due to its potentially fatal adverse effects, including hyperthermia, cataract, agranulocytosis, hepatoxicity, nephrotoxicity, and cardiotoxicity. However, the popularity of 2,4-DNP as a slimming aid has appeared to increase again in recent years. The Hong Kong Hospital Authority Toxicology Reference Laboratory recently confirmed two cases of self-administered 2,4-DNP with different clinical presentations to hospitals in the area. Here we describe those two cases, in an attempt to underscore the potential of misuse of this substance by body-conscious groups among the Chinese population.     

Recent trends in breast surgery in the United States and United Kingdom

Data on breast surgery from national samples of patients discharged from hospital in the United States and in England and Wales were reviewed for the years 1970-80. In the United States the rate of breast surgery increased dramatically in 1974 and 1975, but in Britain it remained constant and well below the level in the United States. In both countries the proportion of radical mastectomies declined and the proportion of less extensive procedures rose. The increase in mastectomy rates in the United States probably resulted from increased public concern about breast cancer and from the promotion of breast screening in the mid-1970s. The costs, morbidity, and early mortality associated with a higher rate of mastectomy are substantial and the advantages unclear.     

Fatigue and chills in a 60-year-old hypertensive alcoholic

Two Saudi Arabian patients, one adult and one child, developed acquired immunodeficiency syndrome (AIDS) 2 1/2 and 3 1/2 years after blood transfusion. Both patients received blood imported from the United States in 1981. These are the first cases reported in Saudi Arabia. Since an undetermined number of Saudi patients have received blood imported from the United States, an outbreak of AIDS in Saudi Arabia might prove to be a serious problem in the near future. Measures such as limiting the importation of blood products from countries with a high incidence of AIDS and screening for human T-cell lymphotropic virus type III should be taken to stop the spread of this fatal disease.