降钙素原在儿童下呼吸道感染的应用研究

目的探讨血清降钙素原(PCT)在儿童下呼吸道感染中的应用及其临床效果。方法选取我院儿科2012年9月~2014年8月收治的下呼吸道感染患儿180例,随机分为实验组和对照组,每组各90例,对照组采用常规抗生素治疗方法,实验组在血清降钙素原检查结果的指导下进行抗生素治疗。比较两组患儿的临床疗效、症状和体征消失时间、抗生素使用时间、抗生素费用、住院时间。结果两组患儿的平均发热时间、平均咳嗽时间差异无统计学意义(P0.05);实验组的总有效率、抗生素使用时间、抗生素费用、住院时间等均优于对照组,差异有统计学意义(P0.05)。结论在血清降钙素原检查结果指导下治疗儿童下呼吸道感染,临床效果显著,能够明显降低患儿抗生素使用时间、抗生素费用及住院时间。     

降钙素原与C反应蛋白在指导新生儿肺部感染抗生素使用中的价值探讨

目的:探讨降钙素原与C反应蛋白在指导新生儿肺部感染抗生素使用中的价值.方法:纳入的研究对象为该院2018年2月—2020年2月期间收治的80例肺部感染患儿,采用随机抽签的方式,将患儿分为2组,每组各40例,其中一组命名为对照组,根据患儿症状体征及血清C反应蛋白水平等指导抗生素使用,另外一组命名为观察组,根据检测患儿血清降钙素原水平指导抗生素使用,对比两组抗生素使用时间、抗生素药物费用、住院天数、住院费用,分析治疗过程中的降钙素原及C反应蛋白水平变化情况.结果:与对照组比较,观察组的抗生素使用时间及住院天数更短,抗生素药物费用及住院费用更低(P<0.05);治疗过程中动态监测患儿的降钙素原及C反应蛋白水平可发现,降钙素原下降明显,且每阶段两两比较均存在差异(P<0.05);C反应蛋白水平整体也呈下降趋势,但不能完全反应判断炎症控制情况及治疗效果,入院第1天的C反应蛋白水平与入院第3天比较,无统计学差异(P>0.05).结论:针对肺部感染患儿,实时监测降钙素原水平指导抗生素治疗较监测C反应蛋白水平更优,可减少抗生素滥用情况发生,缩短抗生素使用时间,节省抗生素药物费用及住院费用,缩短住院天数,可见降钙素原可作为抗生素治疗的定量指标,值得推广.     

血清降钙素原在儿童下呼吸道感染的临床意义

目的探讨并研究血清降钙素原（PCT）在儿童下呼吸道感染的临床意义。方法 160例下呼吸道感染的患儿作为临床研究对象,随机分为两组进行治疗。对照组（80例）采用常规的方式进行治疗,实验组（80例）采用在血清降钙素原（PCT）指导下进行抗生素治疗。结果实验组进行抗生素治疗时间较短,且实验组肺炎患儿在抗生素使用中明显比对照组少30%,差异具有统计学意义（P〈0.05）。结论实验组在血清降钙素原指导下针对儿童下呼吸道感染的患儿使用抗生素治疗效果较好,能够使患儿减少使用不必要的抗生素,对于临床治疗有较为重要的意义。     

降钙素原检测在小儿呼吸道感染抗生素治疗诊断中的应用价值分析

目的:探索降钙素原检测在小儿呼吸道感染的诊断以及应用对指导抗生素治疗的价值.方法:在我院于2014年6月~2016年6月收治的呼吸道感染患儿中随机抽取96例为研究对象,将其是否行降钙素原检测分成观察组和对照组,对照组给予常规标准化的抗生素治疗,观察组在经降钙素原检测后确定抗生素用药方案,对比分析两组治疗总有效率、抗生素使用疗程、抗生素使用率、临床症状缓解时间.结果:观察组总有效率96.0%比对照组的80.43%高,观察组抗生素使用率62.0%低于对照组的100.0%,P<0.05;观察组抗生素使用疗程短,P<0.05;临床症状缓解时间对比,两组差异不明显,P>0.05.观察组50例患儿治疗前经PCT检测,有31例患儿的PCT≥0.25μg/mL,经抗生素治疗12h、24h后,31例患儿的PCT值明显降低,P<0.05.结论:对小儿呼吸道感染治疗行血清降钙素原检测有助于指导抗生素治疗方案,促进患儿病情的缓解,提高治疗效果,促进患儿的康复,值得在临床推广.     

血浆PCT、CRP水平对呼吸道感染患儿合理应用抗生素的临床价值

目的研究血浆PCT、CRP水平对呼吸道感染患儿合理应用抗生素的临床价值。方法从2012年6月至2014年6月,于我院共有96例呼吸道感染患儿就诊。以数字法随机分成观察组(48例)和对照组(48例)。对照组进行常规抗生素药物治疗,观察组在根据PCT、CRP水平,选用抗生素治疗。对比观察两组患儿抗生素的使用情况,症状消失情况等。结果两组患儿在咳痰咳嗽等临床症状方面消失时间比较,差异不含有统计学意义(均P>0.05)。观察组使用抗生素比例显著少于对照组,使用抗生素时间和住院时间均显著少于对照组,且二重感染情况显著少于对照组,差异均含有统计学意义(均P<0.05)。结论 PCT、CRP指导下治疗患儿呼吸道感染,不会降低治疗效果,反而有助于医师对患儿病情的了解,从而进行针对性治疗,合理使用抗生素,最终减少因抗生素的过量及长期使用对患儿造成的不良影响,安全可靠,值得临床推广使用。     

降钙素原检测在小儿呼吸感染抗生素治疗诊断中的应用

目的：探讨血清降钙素原（PCT）在小儿呼吸感染抗生素治疗诊断中的应用。方法：选取2014年12月～2015年12月我院收治的呼吸道感染儿童150例,其中75例进行常规标准治疗,为对照组,另外75例患儿以PCT为指导进行用药治疗,为观察组。比较两组用药和治疗效果。结果：以PCT为指导进行治疗的观察组,使用抗生素平均2.58d,使用率为43%,对照组抗生素平均使用4.99d,使用率为88%。观察组与对照组抗生素使用率对比有明显差异,P＜0.05,具有统计学意义。两组的热退正常天数以及病情恢复天数对比,没有显著差异。结论：针对目前在小儿呼吸感染的诊断和治疗中滥用抗生素的现象,使用PCT进行治疗指导能够有效区别呼吸道细菌感染和其他感染,对于小儿呼吸感染的诊断有着非常重要的临床和经济学意义。但是对于PCT测定指导高危患儿的用药还需要研究。     

重症感染患儿降钙素原水平变化意义及指导合理用药的临床研究

目的通过比较重症感染患儿治疗前后降钙素原水平的变化,探讨降钙素原在患儿重症感染中诊断的意义及指导临床合理用药的价值。方法选取2011年1月至2013年10月在本院治疗的175例患儿,根据患儿感染情况分为非细菌感染组(70例),重症细菌感染组(55例),局部细菌感染组(50例)。根据治疗方法将重症感染组患儿分为2个亚组,以降钙素原指导用药组(30例)和未按降钙素原指导用药组(25例),分别在入院时和治疗3 d及1周后检测患儿降钙素原、超敏CRP及WBC。偏态计量资料以中位数P50(P25,P75)表示。计数资料采用t检验。3组资料的比较采用Kruskal wallis H检验;2组之间的比较采用SNK-Q、Bonferroni校正等方法;治疗前后比较采用配对t检验,P<0.05为差异有统计学意义。结果 3组之间降钙素原和超敏CRP及WBC的P50(P25,P75)水平,差异有统计学意义(P<0.05)。治疗3 d后当感染明显得到控制并好转时,复查降钙素原和超敏CRP,治疗前后的降钙素原水平变化差异有统计学意义(P<0.05),能较好地反映感染控制情况;以降钙素原指导用药的患儿在住院时间和抗感染费用均较未按降钙素原指导用药的患儿明显偏低,差异有统计学意义(P<0.05)。结论降钙素原在重症感染早期即显著升高,且可反应细菌感染的严重程度。其准确性、特异性均优于超敏CRP及WBC,可作为重症感染的新型诊断指标。利用降钙素原水平指导合理用药,可及时、准确地控制感染,减少患儿住院时间和治疗费用。     

血清降钙素原、C-反应蛋白及白细胞变化对儿科呼吸道感染的临床价值分析

目的：探讨血清降钙素原（PCT）、C-反应蛋白（CRP）及白细胞（WBC）变化在儿科呼吸道感染的临床价值。方法将2015年6月至2016年2月期间因呼吸道感染入院的103例患儿根据感染类型分为两组：细菌感染组56例；病毒感染组47例。同时设正常对照组80名，检测分析各组患儿血清降钙素原、C-反应蛋白及白细胞差异，计算三种指标的灵敏度、特异度及约登指数，探究其在儿科呼吸道感染诊断中的临床价值并在治疗后观察三者变化对疾病进行监控。结果通过检测患儿血液 CRP、PCT 及 WBC 水平发现细菌感染组患儿 CRP、PCT 含量及WBC 数量均显著高于病毒感染组及正常组（P ＜0．05）。通过计算三项指标的灵敏度，特异度及约登指数发现， PCT 约登指数0．84相较于其它两项更高更稳定。细菌感染组抗生素治疗一周后 CRP、PCT 及 WBC 水平显著降低。结论血清降钙素原、C-反应蛋白及白细胞变化在儿科呼吸道感染的临床诊断及疗效观察中具有重要意义。     

抗生素序贯疗法在小儿下呼吸道感染中的应用观察

目的：观察序贯疗法在小儿下呼吸道感染中的治疗效果。方法：对纳入观察的患儿随机分为治疗组和对照组。治疗组在静脉滴注抗生素3-7天后改为口服相应抗生素，对照组静脉滴注抗生素7～14天。比较两种治疗方法的临床效果。结果：治疗组在患儿症状的消失及住院天数上均与对照组差异有显著性，具可比性。结论：序贯疗法可以减少住院天数，节约费用，还可减少院内交叉感染。     

重症监护病房合并下呼吸道感染的抗生素降阶梯治疗效果评价

目的:研究重症监护病房合并下呼吸道感染的采用抗生素降阶梯方案进行治疗的临床效果.方法:选取以往我院重症监护病房收治的患者88例,随机分为对照组和治疗组,每组44例.对照组采用常规单一剂量标准抗生素方案进行治疗;治疗组采用抗生素降阶梯方案进行治疗.对比两组下呼吸道感染病情控制总有效率、用药期间不良反应、呼吸道感染症状消失时间和临床治疗总时间.结果:治疗组下呼吸道感染病情控制总有效率为90.9％,高于对照组的70.5％,组间差异显著(P<0.05);用药期间仅出现1例不良反应,少于对照组的7例,组间差异显著(P<0.05);呼吸道感染症状消失时间和临床治疗总时间短于对照组,差异显著(P<0.05).结论:重症监护病房合并下呼吸道感染的采用抗生素降阶梯方案进行治疗,可以迅速控制下呼吸道感染症状,减少不良反应.     

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.