大剂量甲泼尼龙冲击治疗婴儿痉挛的疗效观察

摘 要 目的：观察大剂量甲泼尼龙冲击治疗婴儿痉挛的疗效及安全性。 方法: 婴儿痉挛症患儿70例随机分为常规剂量组和冲击治疗组各35例。常规剂量组给予醋酸泼尼松片口服治疗;冲击治疗组治疗前5d给予甲泼尼龙冲击治疗,其后治疗方案与对照组相同。两组疗程均为8周。观察两组患儿的脑电图转归情况,临床疗效和药品不良反应,及冲击治疗对不同病因和不同病程患儿的疗效。结果: 冲击治疗组总有效率为94.29%,明显高于常规剂量组的71.43%（P<0.05）。两组的脑电图转归图结果比较,差异无统计学意义（P＞0.05）。冲击治疗组的不良反应发生率略高,但与常规剂量组差异不明显（P＞0.05）。冲击治疗对不同病因与不同病程患儿的疗效比较,差异无统计学意义（P＞0.05）。结论:大剂量甲泼尼龙冲击治疗可以有效提高婴儿痉挛患儿的临床疗效,且对安全性无明显影响。     

甲泼尼龙联合常规治疗儿童重型手足口病观察

目的：探讨常规治疗基础上加用糖皮质激素甲泼尼龙治疗重型手足口病（HFMD）的疗效。方法：重型HFMD患儿120例随机分为激素组和非激素组各60例,非激素组给予常规治疗,激素组在此基础上加用甲泼尼龙2mg·kg-1·d-1治疗。5d后比较两组患儿退热时间、止痉时间、住院时间及疱疹消退时间。结果：激素组患儿发热、抽搐、疱疹消退时间明显优于对照组（P〈0.05）。但两组患儿住院天数差异无统计学意义（P〉0.05）。结论：标准治疗基础结合糖皮质激素治疗儿童重型手足口病HFMD有较好的临床疗效。     

小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎临床观察

摘 要 目的：观察小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎的疗效及对血清基质金属蛋白酶2（MMP2）、基质金属蛋白酶9（MMP9）、基质金属蛋白酶组织抑制因子1（TIMP1）水平的影响。 方法: 102例过敏性紫癜性肾炎患儿随机分为两组各51例,在基础治疗同时,对照组予小剂量醋酸泼尼松片联合环磷酰胺治疗,观察组予小剂量醋酸泼尼松片联合他克莫司治疗。持续治疗3个月后,比较两组治疗后临床疗效与药品不良反应、治疗前后肾功能和血清MMP2、MMP9、TIMP1水平变化。 结果: 治疗后,观察组和对照组治疗总有效率分别为94.12%和70.59%,差异有统计学意义（P＜0.05）。两组24 h尿蛋白定量（24hUpro）、尿β2 微球蛋白（β2 MG）、尿微量白蛋白（mALB）、血肌酐（SCr）、血尿素氮（BUN）以及血清MMP2、MMP9、TIMP1水平均较治疗前降低（P＜0.05）,且观察组上述指标明显低于对照组（P＜0.05）。两组药品不良反应发生率比较,差异无统计学意义（P＞0.05）。 结论: 小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎,疗效显著,同时能明显降低血清MMP2、MMP9、TIMP1水平。     

羧甲司坦辅助治疗稳定期慢性阻塞性肺疾病观察

摘 要 目的：观察羧甲司坦辅助治疗稳定期慢性阻塞性肺疾病（COPD）的临床疗效、不良反应及对炎症因子的影响。方法：114例稳定期COPD患者随机分为对照组和观察组各57例,对照组给予常规治疗,观察组在对照组基础上加用羧甲司坦片,12个月为一疗程。比较两组患者肺功能、6 min步行距离（6MWT）、1年内急性加重次数,圣乔治呼吸问题调查问卷（SGRQ）评价生活质量,测定诱导痰中炎症因子(IL-1β、IL-6、IL-8、TNF-α）含量,记录药品不良反应。结果：治疗后,两组患者的肺功能、6MWT、1年内急性加重次数均较前明显改善（P<0.05）,且观察组6MWT、急性加重次数明显优于对照组（P<0.05）;两组患者SGRQ量表各项评分均较前下降（P<0.05）,且观察组部分评分优于对照组（P<0.05）;两组患者痰炎症因子水平均较前显著降低（P<0.05）,且观察组明显低于对照组（P<0.05）。两组药品不良反应发生率相近（P>0.05）。结论：羧甲司坦可明显提高稳定期COPD患者的运动能力和生活质量,降低急性加重次数,这可能与其降低气道炎症因子水平有关。     

亚砷酸联合沙利度胺治疗骨髓增生异常综合征疗效观察

摘 要 目的：探讨亚砷酸与沙利度胺联合治疗骨髓增生异常综合征（MDS）的疗效和安全性。方法：MDS患者68 例随机分为观察组34 例与对照组34 例。对照组采用沙利度胺治疗,观察组在对照组基础上加用亚砷酸治疗。两组均以6 周为1 个疗程,连续治疗4 个疗程。比较两组疗效和药品不良反应发生情况;观察两组患者治疗2 个和4 个疗程时的骨髓象变化以及治疗前后患者血象变化。结果：观察组总有效率高于对照组（P<0.05）。观察组治疗2 个疗程和4 个疗程时,原始细胞比例减少的发生率均高于对照组（P<0.05）;且两组治疗4 个疗程原始细胞比例减少的发生率均高于治疗2 个疗程（P<0.05）。治疗后,两组患者WBC、Hb、Plt等指标较治疗前均有明显增加（P<0.05）,且观察组各项指标均高于对照组（P<0.05）。两组不良反应发生率比较,差异无统计学意义（P>0.05）。结论：亚砷酸与沙利度胺联合治疗骨髓增生异常综合征的疗效肯定,且安全性好。     

丹参川芎嗪联合前列地尔治疗糖尿病肾病疗效观察

摘 要 目的： 观察丹参川芎嗪联合前列地尔治疗糖尿病肾病的临床疗效。方法: 糖尿病肾病住院患者84例随机分为观察组和对照组各42例;对照组单纯应用前列地尔治疗,观察组给予丹参川芎嗪联合前列地尔治疗。连续治疗4周后比较两组患者临床疗效、血糖与肾功能指标变化和药品不良反应。结果: 观察组总有效率为95.2%,对照组总有效率为83.3%,两组比较差异无统计学意义（P>0.05）。两组患者空腹血糖、糖化血红蛋白,以及BUN、Scr及尿蛋白水平均较治疗前明显降低（P<0.05）,且观察组各项指标均优于对照组（P<0.05）。结论:丹参川芎嗪联合前列地尔治疗糖尿病肾病效果显著,有效促进患者肾功能恢复,值得临床推广应用。     

问荆合剂联合西药治疗湿热痹阻型类风湿关节炎临床观察

摘 要 目的：评价医院制剂问荆合剂联合西药治疗湿热痹阻型类风湿关节炎(RA)的临床疗效和安全性。方法：132例湿热痹阻型RA患者随机分为两组各66例。观察组给予问荆合剂、甲氨喋呤和来氟米特治疗,对照组给予甲氨喋呤和来氟米特治疗,疗程均为12周。观察两组患者的疾病疗效、中医证候疗效、28个关节病情活动评分(DAS28)等指标改善情况和安全性。结果：治疗第4周开始,两组晨僵持续时间、受试者整体状况评估、SJC、TJC、ESR、CRP及DAS28等指标均较治疗前明显改善（P＜0.01）;治疗第4周开始,两组间受试者整体状况评估存在差异（P＜0.05）,治疗第8周开始,两组间受试者晨僵持续时间存在差异（P＜0.05）,整体状况评估存在显著差异（P＜0.01）,其余指标组间差异无统计学意义（P>0.05）。治疗后观察组与对照组DAS28达到缓解标准的有效率分别为13.11%和5.08%,差异无统计学意义（P>0.05）。观察组和对照组的疾病疗效总有效率和中医证候总有效率比较,差异有统计学意义（P<0.05或P<0.001）。两组药品不良反应发生率差异无统计学意义（P>0.05）。结论：问荆合剂联合西药治疗湿热痹阻型RA,能提高临床疗效,减少不良反应,是治疗湿热痹阻型类风湿关节炎的有效方案。     

醋酸曲普瑞林与醋酸亮丙瑞林缓释微球治疗特发性中枢性早熟临床效果比较

摘 要 目的：比较醋酸曲普瑞林与醋酸亮丙瑞林缓释微球治疗特发性中枢性早熟的临床效果。方法：将特发性中枢性早熟女童74例随机分为A组与B组各37例。A组予醋酸曲普瑞林治疗,B组予醋酸亮丙瑞林缓释微球治疗。两组疗程均为6个月。比较两组治疗前后性激素水平、BA/CA、身高、体重指数、子宫体积、卵巢体积变化及药品不良反应发生情况。结果：两组治疗后血清FSH、E2、LH水平较前明显下降（P<0.05）;且A组血清FSH、E2、LH水平显著低于B组（P<0.05）,治疗前后血清FSH、E2、LH差值明显高于B组（P<0.05）。两组BA/CA和体重指数较前明显下降,身高较前明显增加（P<0.05）;且A组BA/CA和体重指数显著低于B组,身高显著高于B组（P<0.05）;A组治疗前后BA/CA、身高及体重指数差值均高于B组（P<0.05）。治疗后两组子宫体积和卵巢体积均较前明显降低（P<0.05）,且A组子宫体积和卵巢体积显著低于B组（P<0.05）,治疗前后子宫体积和卵巢体积差值高于B组（P<0.05）。两组药品不良反应发生率的差异无统计学意义（P>0.05）。结论：醋酸曲普瑞林用于特发性中枢性早熟患儿效果优于醋酸亮丙瑞林缓释微球,且无严重不良反应,用药安全性良好。     

非离子型与离子型对比剂不良反应及对肾功能指标影响观察

摘 要 目的：观察比较非离子型与离子型对比剂的不良反应及对肾功能指标变化的影响。方法：180例在我院行介入影像检查的患者随机分为两组。非离子型组90例患者使用非离子型对比剂碘普罗胺注射液,离子型组90例使用离子型对比剂76%泛影葡胺注射液。比较两组患者造影前后肾功能指标变化,评价造影剂肾病（CIN）以及造影后不良反应发生情况。结果：非离子型组发生3例轻度不良反应,不良反应发生率4.44%;显著低于离子型组的12.22%（P＜0.05）。 造影后2 d,两组患者BUN、SCr均较造影前均明显升高（P＜0.05）,而Ccr则较前明显降低（P＜0.05）,且非离子型组上述指标均优于离子型组（P＜0.05）;两组CIN分别发生3例和4例,差异无统计学意义（P>0.05）。造影后7 d,非离子型组SCr、BUN、Ccr与造影前比较无明显差异（P＞0.05）,离子型组SCr、BUN仍较造影前明显增高,Ccr则较前明显降低（P＜0.05）。两组各项指标仍有明显差异（P＜0.05）。结论：非离子型与离子型对比剂均会对患者肾功能产生一定影响,但非离子型对比剂影响较小,恢复更快;且不良反应发生较少,更为安全。     

度洛西汀与文拉法辛治疗抑郁症疗效和安全性的Meta分析

摘 要 目的： 评价度洛西汀和文拉法辛治疗抑郁症的疗效与安全性。方法: 计算机检索PubMed、CNKI、VIP、万方数据库等文献数据库,以及手工检索相关文献,采用RevMan5.3进行Meta分析。结果: 纳入研究12项,共872例患者,Meta分析显示：在痊愈率(RR=0.99, 95%CI：0.78~1.27)和有效率(RR=1.01, 95%CI：0.91~1.13）方面,度洛西汀组（治疗组）和文拉法辛组（对照组）的差异无统计学意义（P>0.05）;治疗组和对照组的不良反应分析（RR合并=1.05, 95%CI：0.86~1.28）显示,两组的差异无统计学意义（P>0.05）。但是通过亚组分析显示,消化系统(RR=1.43, 95%CI：1.11~1.84)和心血管系统(RR=0.41, 95%CI：0.21~0.79)方面的不良反应发生率的差异有统计学意义（P<0.05）,治疗组胃肠道反应比对照组多,心血管方面不良反应较对照组少。结论:度洛西汀和文拉法辛治疗抑郁症疗效相当,不良反应也无明显差异,但是在临床使用中对于有消化系统疾病或心血管系统疾病的患者,在药物选择时应有所区别,以减少不良反应风险,提高治疗效率。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

HACCP在学校集体食堂卫生管理中的应用研究

目的 通过HACCP在学校集体食堂管理中的应用,提高食品卫生水平,保障学生的身体健康。方法 HACCP原则。结果 食品卫生达到较高水平,极大地减少了食物中毒的发生。结论 提示HACCP原则可在学校集体食堂的卫生管理中发挥有效作用。     

半导体激光治疗老年人压疮疗效观察

目的探讨半导体激光局部照射治疗老年人压疮疗效.方法:收集2012年1月-2015年6月48例压疮患者,分为半导体组和常规组各24例.常规组采用常规治疗,半导体组采用半导体激光加常规治疗,10 d为1个疗程,不超过3个疗程.疗程结束后比较两组疗效.结果:半导体组压疮愈显率为83.33％,创面愈合时间为(12.75±5.51)d,常规组分别为54.17％和(19.63±8.65)d,组间差异有统计学意义(P＜0.05),两组均未见不良反应.结论:半导体激光加常规治疗压疮效果肯定,无明显不良反应,且操作简便.     

脑卒中恢复期患者社区综合康复的疗效观察

目的：探讨社区开展康复活动对于脑卒中患者肢体功能康复的影响。方法：选取2014年4至10月参与社区“陈睿健康工作室”康复活动的脑卒中恢复期患者50例作为观察组,选取同期延吉社区卫生服务中心门诊的50例脑卒中恢复期患者作为对照组（进行门诊随访、服药、自我康复）。采用知识、信念、行为（KAP）量表对观察组患者进行问卷调查。采用简化Fugl-Meyer肢体运动功能评分表（Fugl-Meyer assessment of motor function,FAM）比较两组患者入组时和入组6个月时的肢体功能恢复情况及对家庭医生（门诊医师）的满意度。结果：入组6个月时,两组患者的FAM均有所改善,观察组FAM得分[上肢（50.92±7.05）分,下肢（33.01±1.37）分]较对照组[上肢（34.85±6.55）分,下肢（25.20±4.88）分]更高,差异有统计学意义（t上肢=11.8215,t下肢=10.8595,P均＜0.01）。观察组患者的满意率为92%（46/50）,明显高于对照组的30%（15/50,P＜0.05）。结论：在社区开展康复活动可以促进脑卒中患者肢体功能的康复,提高患者的满意度。     

Evaluation of the safety of enalapril in the treatment of heart failure in the very old

Summary We have introduced enalapril, in doses equal to or less than the 2.5 mg currently recommended, as an adjuvant to digoxin and diuretics in 17 patients of mean (SD) age 83 (5) years with severe heart failure. Only eleven patients tolerated its introduction. Unlike those reported in younger patients, all but one of the adverse drug reactions occurred 8 h or more after the first dose. Aged patients started on ACE inhibitors should be observed in hospital until stabilized on a maintenance dose. Three patients had an adverse reaction which differed in nature from those previously reported: acute confusional state, ataxia and mesenteric ischaemia.Ten patients were discharged on 5 mg or 10 mg maintenance doses of enalapril. In nine of them improvement on triple therapy was sustained for a minimum of three months. ACE inhibition was lost in the other patient when her compliance with enalapril therapy fell to around 75%: monitoring compliance is essential when ACE inhibitors are used in low dosages.Enalapril was withdrawn during follow up in three patients because of symptoms of mesenteric ischaemia and in four because of dramatic deterioration of renal function. One of the latter was found subsequently to have severe bilateral atheromatous renal artery stenosis. When isosorbide dinitrate was substituted for enalapril, symptoms of mesenteric ischaemia resolved and renal function returned to baseline. Continuing surveillance for adverse effects is essential in patients of this age group with severe heart failure, and the risk of occult renal artery stenosis requires regular biochemical screening during follow up.The benefit to cost ratio of ACE inhibitors might be improved in aged patients by their use at an earlier stage in the natural history of heart failure, when perfusion of essential organs is not grossly impaired, but carefully monitored trials would be necessary to establish this.     

Effect of the Immunomodulator Tilorone on the in Vivo Acetylation of Procainamide in the Rat

Interferon and interferon inducers have been found to inhibit cytochrome P-450-dependent metabolism in animals and man. The effect of these agents on the acetylation of drugs has not been previously reported. Since these agents stimulate the reticuloendothelial system, together with the abundance of N-acetyltransferase in the reticuloendothelial system, it was hypothesized that these immunomodulators may affect drug acetylation. To test this hypothesis, the effect of tilorone (a synthetic interferon inducer) on the in vivo acetylation of procainamide was examined in the rat. Pretreatment with tilorone hydrochloride (50 mg/kg) 48 hr prior to the administration of procainamide hydrochloride (50 mg/kg) resulted in a 32% increase in the urinary recovery of N-acetylprocainamide and a 35% increase in the metabolic clearance of procainamide to N-acetylprocainamide. These data indicate that interferon inducers increase the N-acetylation of drugs in vivo.     

药物经济学成本-效果分析应用的相关问题探讨

目的探讨药物经济学成本-效果分析(CEA)应用的相关问题。方法运用文献计量学方法、数学证明方法等。结果与结论在运用CEA进行药品的经济性评价时,尤其需要重视临床治疗指标的选择、成本的确定、增量分析的使用和与最小成本分析的比较。     

替普瑞酮治疗老年慢性浅表性胃炎的疗效分析

目的 分析替普瑞酮治疗老年慢性浅表性胃炎的疗效.方法 100例老年慢性浅表性胃炎患者,通过计算机随机表数字法分为对照组和实验组,每组50例.对照组患者选择西咪替丁作为本次治疗药物,实验组患者选择替普瑞酮作为本次治疗药物.比较两组患者临床疗效、不良反应发生情况以及生活质量.结果 实验组治疗总有效率92.00％高于对照组的...     

Adenosine mechanisms in the regulation of breathing in the rat

The central respiratory effects of various adenosine (A) analogues were studied in halothane-anesthetized rats. Intracerebroventricular (i.c.v.) and intraperitoneal (i.p.) injections of the A analogues (2-Cla, L-PIA, CHA and NECA) reduced minute ventilation (VE) due to decreases in respiratory frequency (f) as well as tidal volume (VT). Dose-dependent effects were seen after i.c.v. L-PIA in both normal and vagotomized rats. Analysis of the A-induced changes using the occluded breath technique revealed an increase in expiratory time (TE) as well as a decrease in inspiratory drive. NECA, a relatively specific A2 agonist seemed to be somewhat more potent in eliciting respiratory depression than a relatively specific A1 agonist like L-PIA. Pretreatment with the methylxanthine theophylline completely antagonized the respiratory depression induced by L-PIA. It is concluded that central A receptors are involved in the central regulation of breathing and that A interacts with the respiratory control system mainly by decreasing inspiratory neural drive and prolonging expiratory time.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.