丙泊酚静脉注射对大鼠心室功能及心肌β肾上腺素受体的影响

目的研究丙泊酚静脉注射对大鼠心室功能及心肌β肾上腺素受体密度及亲和力的影响。方法24只清洁级雄性Wistar大鼠随机分为3组,每组8只:对照组、丙泊酚5 mg·kg~(-1)组及丙泊酚10 mg·kg~(-1)组。记录丙泊酚给药前及给药后30 min内所有动物的心率(HR)、左室收缩压(LVSP)及左室内压力变化最大速率(+dp/dt_(max)、-dp/dt_(max)),并采用放免法测定给药后30 min时心肌β肾上腺素受体密度(B_(max))及亲和力(K_d)。结果(1)HR、LVSP、+dp/df_(max)及-dP/dt_(max)分别在丙泊酚5 mg·kg~(-1)静脉给药后9、5、30及9 min内明显低于给药前值;并在给药后9、7、7及9 min内分别明显低于对照组(P<0.05或0.01)。HR、LVSP、+dp/dt_(max)及-dp/df_(max)分别在丙泊酚10 mg·kg~(-1)静脉给药后25、5、30及8 min内明显低于给药前值;并在给药后8、7、7及8 min内分别明显低于对照组(P<0.05或0.01)。丙泊酚2组间比较无明显差异(P>0.05)。(2)丙泊酚5 mg·kg~(-1)组及10 mg·kg~(-1)组B_(max)明显高于对照组(P<0.01);丙泊酚10 mg·kg~(-1)组K_d值明显高于对照组及丙泊酚5 mg·kg~(-1)组(P<0.05);其余各组间比较无明显差异(P>0.05)。结论丙泊酚可引起给药后30 min内心室功能抑制,5 mg·kg~(-1)及10 mg·kg~(-1)上调给药后30 min心肌β肾上腺素受体密度。     

丙泊酚对胎儿型和α7烟碱型乙酰胆碱受体的作用

目的:通过重组受体,观察丙泊酚对胎儿型乙酰胆碱受体和神经型α7乙酰胆碱受体的作用.方法:通过脂质体转染法在HEK293细胞表达胎儿型或α7乙酰胆碱受体.应用全细胞电压-膜片钳技术研究不同浓度(0.1μmol/L-3mmol/L)丙泊酚对2种受体亚型的影响.结果:临床相关浓度丙泊酚对100μmol/L乙酰胆碱激发胎儿型和α7乙酰胆碱受体的电流均有抑制作用.不同浓度丙泊酚对胎儿型或α7乙酰胆碱受体电流抑制作用比较差异无统计学意义(P>0.05).相同浓度丙泊酚对胎儿型乙酰胆碱受体抑制大于对α7乙酰胆碱受体的抑制(P<0.05).结论:丙泊酚对γ-nAChR和a7-nAChR都有抑制作用,抑制程度与丙泊酚的浓度无关.     

丙泊酚对利多卡因致惊厥作用的影响

目的 探讨丙泊酚对利多卡因致惊厥作用的影响.方法 130只小鼠尾静脉注射生理盐水或不同剂量丙泊酚,1分钟后腹腔注射同等剂量的利多卡因,观察小鼠惊厥发作的潜伏期、持续时间,并按序贯法计算丙泊酚对利多卡因致惊厥作用的半数有效量(ED50)和半数致死量(LD50)的影响.结果 与生理盐水组相比,0.8 mg、g丙泊酚可显著延...     

新药橱窗

名称:盐酸索他洛尔片(Sotalol Hydrochloride Tablets) 商品名:施泰可~(TM)(Sotacor Tablets)。 特点:施粲可兼有Ⅱ类(β-肾上腺素受体阻断药)和Ⅲ类(延长心肌动作电位复极时间)抗心律失常药特性。索他洛尔非选择性阻断β-肾上腺素受体,但无内在拟交感活性和膜稳定作用,小剂量时,表现出β-受体作用,可延长窦房周期和房室(AV)结不应期,减慢房室传导(延长AV时间);较大剂量时可延长心房、心室动作电     

葛根素的药理及临床应用

葛根素(puerarin)是中药葛根的主要有效成分之一,近10多年来对葛根素进行了许多研究,本文对其的临床前药理和临床研究作一概述.1 葛根素的药理作用1.1 对血压和心率的影响 葛根素具有降血压和减慢心率的作用.葛根素使正常Wis-tar大鼠、清醒自发高血压大鼠(SHR)、正常猫、正常及急性心肌梗死犬的血压和心率均明显或显著降低和减慢;对利血平化及右室旁路犬血压也显著降低;对清醒高血压犬也有一定的降压作用,对猴也引起心率减慢及相应的Q-T间期的延长.但葛根素的作用机制尚不清楚.离体和整体的经典实验说明葛根素对β-肾上腺素受体有明显阻断作用.对于受体水平,葛根素能显著降低细胞膜β-受体的最大结合容量,抑制受体与标记配体结合,阻断肾上腺素对细胞膜腺苷酸环化酶活性的激动作用,因而认为葛根素是β-受体阻滞剂.但该论点并未被其他学者所证实,这可能与两者采用剂量不同有关.1.2 对血流量的影响iv葛根素对正常和利血平化犬均显著增加冠脉血流量和降低冠脉血管阻力;对急性心肌梗死犬可降低主动脉压,但对缺血区侧枝冠脉血流量并不减少;在右室旁路制备犬使主动脉压恢复到给药前水平时,葛根素降低侧枝血管阻力、增加缺血区和非缺血区血流量的作用更加明显,并且减低冠脉血管阻力的作用比减低全身血管阻力     

新药橱窗

名称:盐酸索他洛尔片(Sotalol Hydrochloride Tablets) 商品名:施泰可~(TM)(Sotacor Tablets)。 特点:施泰可兼有Ⅱ类(β-肾上腺索受体阻断药)和Ⅲ类(延长心肌动作电位复极时间)抗心律失常药特性。索他洛尔非选择性阻断β-肾上腺素受体,但无内在拟交感活性和膜稳定作用,小剂量时,表现出β-受体作用,可延长窦房周期和房室(AV)结不应期,减慢房室传导(延长AV时间);较大剂量时可延长心房、心室动作电位时间和有效不应期(ERP),在体表心电图上表现为QT间期及心率校正QT(QTc)间期延长,表现出Ⅲ类抗心律失常药特征。索     

氯胺酮、丙泊酚和羟丁酸钠遗忘作用与NMDA受体的关系

目的观察氯胺酮、丙泊酚和羟丁酸钠的遗忘作用与NMDA受体的关系。方法小鼠分别腹腔注射(intraperito-neal injection,ip)氯胺酮(20 mg.kg-1)、丙泊酚(10 mg.kg-1)或羟丁酸钠(100 mg.kg-1)建立遗忘模型,在跳台实验和避暗实验中分别观察NMDA侧脑室注射(intracerebrov-entricular injection,icv)对遗忘小鼠错误次数(error times,ETs)、跳台潜伏期(step down latency,SDL)、步入潜伏期(step through latency,STL)的影响。结果侧脑室注射NM-DA可减少氯胺酮所致遗忘小鼠的ETs,延长SDL和STL;对丙泊酚或羟丁酸钠所致遗忘小鼠的ETs、SDL和STL无影响。结论 NMDA受体可能是氯胺酮所致遗忘作用的重要靶位,不是丙泊酚或羟丁酸钠所致遗忘作用的靶位。     

大鼠丘脑酪氨酸羟化酶调控丙泊酚诱导的镇静作用

目的通过定量磷酸化蛋白质组学研究丙泊酚诱导大鼠丘脑镇静作用的新型调节机制。方法①采用同位素标记相对和绝对定量(iTRAQ)技术对丙泊酚(100 mg·kg-1,ip)诱导镇静模型SD大鼠丘脑差异磷酸化蛋白质进行标记和定量分析;基因本体(GO)富集分析差异磷酸化蛋白质的生物进程、细胞组分及分子功能;Western印迹法检测大鼠丘脑酪氨酸羟化酶(TH)第19位丝氨酸磷酸化表达水平。②利用TH抑制剂甲基酪氨酸(20 mg·kg-1,提前30 min ip给药),考察其对丙泊酚诱导C57BL/6J小鼠翻正反射消失的诱导时间、持续时间和翻正反射消失率的影响。结果质谱结果显示,与正常对照组相比,丙泊酚组SD大鼠丘脑中共92个磷酸化蛋白质表达水平发生改变,其中TH第19位丝氨酸磷酸化水平显著下调(P<0.01);与Western印迹法结果一致(P<0.05)。丙泊酚(70~120 mg·kg-1)剂量依赖性地增加小鼠的翻正反射消失率,TH抑制剂甲基酪氨酸预处理可使丙泊酚诱导小鼠翻正反射消失率的半数有效剂量(ED50)由92.32 mg·kg-1(95%CI:90.60~94.08,R2=0.9969)降至85.38 mg·kg-1(95%CI:81.30~89.67,R2=0.9768),量效曲线左移。与单用丙泊酚组比较,甲基酪氨酸预处理组可显著延长丙泊酚(90,100和120 mg·kg-1)诱导的C57BL/6J小鼠翻正反射消失持续时间(P<0.05)。结论本研究筛选出大鼠丘脑中多种磷酸化蛋白质参与调控丙泊酚诱导的镇静效应,抑制TH的活性可显著增强丙泊酚的镇静作用。     

胍丁胺抑制兔房室结细胞的自发活动(英文)

目的:研究胍丁胺(Agm)对兔房室结细胞自发活动的影响及其作用机制.方法:应用玻璃微电极方法.结果:Agm不仅剂量依赖地抑制兔房室结细胞自发活动的V_(max),APA和VDD,RSF;而且延长APD_(90);idazoxan能明显抑制Agm的作用;而L-NAME不能影响Agm的作用;提高灌流液中的Ca~(2 )浓度可对抗Agm的作用;ATP-敏感性钾通道开放剂(lemakalim)可拮抗Agm延长APD_(90)的作用.结论:Agm对房室结细胞自发活动的抑制作用由咪唑啉受体和/或肾上腺素α_2-受体介导,并与Ca~(2 )内流和K~ 外流减少有关.     

瑞芬太尼复合丙泊酚静脉麻醉在喉显微手术中的应用

目的:观察喉显微手术应用瑞芬太尼或芬太尼复合丙泊酚麻醉对血流动力学及术后清醒过程的影响。方法:105例ASAⅠ～Ⅱ级择期支撑喉镜下声带手术患者,随机分成三组,丙泊酚组(P组),芬太尼+丙泊酚组(FP组)和瑞芬太尼+丙泊酚组(REP组),每组35例。P组采用2%丙泊酚2．0～2．5 mg·kg~(-1),琥珀胆碱1．5 mg·kg~(-1)诱导,FP和REP组分别于诱导前静注芬太尼3．0μg·kg~(-1)和瑞芬太尼1．0μg·kg~(-1)。术中间断推注丙泊酚维持麻醉,观察诱导前、插管前1 min、插管后1 min、置支撑喉镜时及拔管时的收缩压(SBP)、舒张压(DBP)和心率(HR)的变化,并记录丙泊酚用量及麻醉恢复时间。结果:三组在诱导后插管前HR,SBP,DBP较诱导前均有明显下降(P＜0．05),但P组在气管插管后、置支撑喉镜及拔管时SBP,DBP,HR较诱导前有明显升高(P＜0．05),而FP组和REP组与诱导前比较无明显差异(P＞0．05)。FP组和REP组各时间点SBP,DBP,HR组间比较差异无显著性(P＞0．05)。术中丙泊酚追加量和总用药量P和FP组显著高于REP组(P＜0．05),苏醒时间P和FP组显著长于REP组(P＜0．05)。结论:瑞芬太尼复合丙泊酚麻醉应用于喉显微手术中血流动力学稳定,术后苏醒时间短,是比较理想的麻醉方法。     

右美托咪定复合丙泊酚静脉麻醉对人工流产术后恶心呕吐发生率的影响

目的 研究右美托咪定复合丙泊酚静脉麻醉是否可以影响人工流产术后恶心呕吐的发生率.方法 选择2012年至2014年江门市中心医院同一手术组医生施行的无痛人流手术患者,采用随机数字表法分为DP组(右美托咪定复合丙泊酚静脉麻醉组)和FP组(芬太尼复合丙泊酚静脉麻醉组).DP组予右美托咪定及丙泊酚静脉推注;FP组予芬太尼及丙泊酚静脉推注.记录两组患者心率、平均动脉压、血氧饱和度变化;两组丙泊酚的用量和阿托品、麻黄素的用量;及两组患者术后恶心呕吐(PONV)的发生率.结果 ①两组患者在麻醉前(T1)、丙泊酚注射完毕时(T2)、扩张宫颈时(T3)、手术结束时(T4)、患者送入恢复室时(T5)及患者离院时(T6)心率、平均动脉压、血氧饱和度变化比较差异无统计学意义(P＞0.05).②两组患者麻醉过程中各种药物用量比较差异无统计学意义(P＞0.05).③在术后恶心呕吐发生率的比较中,FP组术后恶心呕吐的发生率明显高于DP组(P＜0.05).结论 ①右美托咪定复合丙泊酚静脉麻醉能提供安全的人工流产麻醉与镇痛.②右美托咪定复合丙泊酚静脉麻醉用于人工流产麻醉与镇痛,其术后恶心呕吐发生率下降.     

Comparative canine pharmacokinetics-pharmacodynamics of fospropofol disodium injection, propofol emulsion, and cyclodextrin-enabled propofol solution following bolus parenteral administration

The pharmacokinetics and pharmacodynamics of fospropofol (FP) disodium injection, propofol emulsion (PE), and cyclodextrin-enabled propofol (CDP) solution following bolus parenteral administration in dogs was evaluated. Three healthy male beagle dogs were treated in a three-way cross-over study (14 day washout period) with 6 mg/kg propofol equivalents. Blood samples were collected predose and at 16 points postdose through 1440 min and analyzed for propofol and FP, when appropriate. From 5 min predose to 30 min postdose, brain electrical activity [electroencephalography (EEG)] was recorded and analyzed by power spectrum analysis techniques. Each formulation appeared to be well tolerated with transient discomfort observed in the PE and CDP animals and minor excitability in the FP animals prior to loss of consciousness. Blood propofol followed three-compartment pharmacokinetic behavior and derived parameters were not statistically different except for elimination half-life from the CDP formulation and onset, and duration of anesthesia from the FP formulation. The effect site concentrations at 50% the maximum EEG effect for the FP and CDP formulations were approximately one-half that of the PE formulation. Onset and duration of anesthesia are correlated with modeled effect site propofol concentrations. The implications of formulation on pain on injection and propofol activity are discussed.     

Hemodynamic profile in rabbits of fospropofol disodium injection relative to propofol emulsion following rapid bolus injection

The effects of aqueous fospropofol disodium (FP) and propofol emulsion (PE) on hemodynamics and sympathetic nerve activity in rabbits following bolus injection were evaluated. Barodenervated and neuraxis-intact rabbits received PE at 4 mg/kg (PE(4)) or FP equal to 4 or 8 mg/kg propofol equivalents (FP(4) and FP(8), respectively) intravenously as a rapid bolus injection, and mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) were recorded for 20 min. The plasma propofol pharmacokinetic behavior from FP and PE was evaluated to support the pharmacodynamic observations. In barodenervated animals, MAP and RSNA decreased significantly in all groups (PE(4) > FP(8) > FP(4)). HR decreased only in the PE(4) group. The time for the maximum reduction of MAP was significantly longer with FP(8) compared with PE(4). MAP decreased, and RSNA and HR increased significantly in the neuraxis-intact animals (PE(4) > FP(8) > FP(4)). The time for maximum reduction of MAP was essentially the same in all neuraxis-intact groups. Plasma propofol levels from FP were lower than those from PE in the first 4 min following administration. The results suggest that the tachycardia observed in humans following injection of FP is not a direct physiological effect of the agent.     

Influence of intralipid on free propofol fraction assayed in human serum albumin solutions and human plasma

AIM: It is generally assumed that only unbound drugs can reach the site of action by diffusing across the membranes and exerting pharmacological effects by interacting with receptors. Recent research has shown that the percentage of free drugs may depend on the total drug concentration. The aim of the paper is to verify whether the mentioned dependence reported for propofol also takes place in plasma and human serum albumin samples in the presence of intralipid-the medium used as a vehicle for propofol infusions and a parenteral nutrition agent. METHODS: Artificial plasma samples and human plasma were spiked with intralipid or ethanolic solutions of propofol. The samples were then assayed for free propofol concentration using ultrafiltration and high performance liquid chromatography with fluorimetric detection. RESULTS: The decrease of the total drug concentration results in free propofol fraction increase, irrespectively of the used type of propofol solvent and sample type. The addition of intralipid causes the lowering of the overall free drug fraction with respect to the samples spiked with ethanolic solutions of the drug. CONCLUSION: The presence of intralipid does not influence the phenomenon of free propofol fraction rise at low total drug concentration. Such a rise cannot be ignored in clinical conditions when the drug is applied for sedative, antiemetic or other low-dosage purposes.     

Fluticasone propionate and Salmeterol combination induces SOCS-3 expression in airway epithelial cells

Fluticasone propionate (FP) and Salmeterol (SAL) are commonly used in combination therapy for patients with Chronic obstructive pulmonary disease (COPD). Clinical studies show that FP/SAL used in combination therapy was found to inhibit airway inflammation in COPD patients. However, the mechanisms associated with FP/SAL induced anti-inflammatory effects were not clear. We have evaluated the effect of FP/SAL and tobacco smoke (TS) on SOCS-3 and interleukine-6 expression in bronchial airway epithelial cells (BAEpCs). Human BAEpCs were exposed to TS and subsequently treated with FP or SAL alone or in combinations in the presence and absence of mitogen activated protein kinase (MAPK) inhibitors for either Erk1/Erk2, or p38 or PI3 kinase. In BAEpCs, TS induced IL-6 expression via ERK1/ERK2 MAPK pathway and FP/SAL inhibited TS mediated IL-6 expression. TS down regulated the SOCS-3 expression via activation of Erk1/Erk2, and p38 MAPK signaling. When TS exposed BAEpCs were treated with FP/SAL SOCS-3 expression was restored. FP/SAL combinations induced significantly higher expression of SOCS-3 in BAEpCs when compared to individual drug. Pretreatment with Ly294002 a PI3 MAPK inhibitor significantly attenuated FP/SAL induced SOCS-3 expression in BAEpCs. Furthermore, FP/SAL blunted TS induced phosphorylation of Erk1/Erk2 and p38 MAPK in BAEpCs. Our study suggests that TS inhibits SOCS-3, combination of FP/SAL has a profound synergistic effect on SOCS-3 induction in BAEpCs and it is dependent on PI3 kinase signaling pathway. SOCS-3 may represent a potential biomarker for understanding the efficacy and a novel anti-inflammatory mechanism of FP/SAL combination therapy in the treatment of COPD.     

The misuse and abuse of propofol

Media attention on the misuse of propofol increased significantly when the drug was implicated in the death of pop music superstar Michael Jackson in 2010. The misuse and abuse of propofol among healthcare providers has been reported worldwide, with some misuse resulting in death. Propofol policies guiding healthcare worker re-entry into the workplace after misusing propofol have received rare attention in the research literature. The paucity of information regarding propofol-specific re-entry policies suggests that little research has addressed this problem and the lack of research and policy guidance can contribute to unsafe re-entry and even death. This paper focuses on healthcare providers because they have an easy access to propofol and therefore are vulnerable to misusing or abusing the drug. To accomplish this, the pharmacology and misuse/abuse potential of propofol and the influence of the 12-step recovery paradigm in the re-entry literature are reviewed. In conclusion, existing research and policy are drawn upon to suggest employment re-entry guidelines for healthcare workers.     

The Misuse and Abuse of Propofol

Media attention on the misuse of propofol increased significantly when the drug was implicated in the death of pop music superstar Michael Jackson in 2010. The misuse and abuse of propofol among healthcare providers has been reported worldwide, with some misuse resulting in death. Propofol policies guiding healthcare worker re-entry into the workplace after misusing propofol have received rare attention in the research literature. The paucity of information regarding propofol-specific re-entry policies suggests that little research has addressed this problem and the lack of research and policy guidance can contribute to unsafe re-entry and even death. This paper focuses on healthcare providers because they have an easy access to propofol and therefore are vulnerable to misusing or abusing the drug. To accomplish this, the pharmacology and misuse/abuse potential of propofol and the influence of the 12-step recovery paradigm in the re-entry literature are reviewed. In conclusion, existing research and policy are drawn upon to suggest employment re-entry guidelines for healthcare workers.     

丙泊酚联合右美托咪定用于无痛人工流产术的成本-效果分析

目的:评价丙泊酚联合右美托咪定用于无痛人工流产术的成本-效果。方法:将我院孕早期自愿行人工流产术的患者240例随机均分为丙泊酚组和联合用药组。丙泊酚组患者仅采用丙泊酚进行麻醉;联合用药组采用丙泊酚复合右美托咪定麻醉。观察两组的镇痛效果及不良反应,记录两组患者术中体动反应次数及丙泊酚总药量,并采用成本-效果分析法进行评价。结果:联合用药组的镇痛总有效率(77.50%)显著高于丙泊酚组(56.67%),且其除头晕外的不良反应发生率、术中体动反应次数和丙泊酚总药量均低于丙泊酚组,两组比较差异均有统计学意义(P<0.05)。丙泊酚组和联合用药组的成本-效果比分别为2.27、3.93元;联合用药组相对于丙泊酚组的增量成本-效果比为8.45。经敏感度分析结果不变。结论:丙泊酚联合右美托咪定用于无痛人工流产术的镇痛效果较好,治疗费用高于单用丙泊酚,但每提高一个单位的效果仅需多支付8.45元,因此条件允许时采用联合用药方案更佳。     

Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature

The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966–December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross‐referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative‐hypnotic that exerts its actions through agonism of GABA_A receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N‐methyl‐d ‐aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more‐resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine‐ and haloperidol‐sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first‐line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with propofol may be considered but requires further research to recommend its use either preferentially or as monotherapy.     

糖皮质激素雾化吸入混悬液应用于儿童哮喘急性期综合评价

目的:以丙酸氟替卡松(FP)雾化吸入用混悬液为核心开展吸入性糖皮质激素(ICS)类药物应用于儿童哮喘急性期治疗 的临床综合评价。 方法:系统梳理国内外相关指南、文献等资料并开展经济学分析,从有效性、安全性、经济性、适宜性、可及性、 创新性多维度开展综合评价。 结果:(1)有效性,FP 与双倍剂量布地奈德(BUD)混悬液相比,可明显改善晨间最大呼气峰流量 (PEF),而双倍剂量吸入用 BUD 混悬液则在夜间无哮喘发作率方面更优。 (2)安全性,儿童哮喘急性期应用 FP 与 BUD 混悬液 在晨间血清皮质醇水平、夜间尿皮质醇水平、不良事件发生率、促肾上腺素激素、血清糖化血红蛋白、身高及体质量增长等方面 比较差异均无统计学意义。 (3)经济性,成本效果分析和最小成本分析显示,以晨间/ 夜间 PEF、第 1 秒用力呼气量(FEV1)、用 力肺活量(FVC)、日间无哮喘发作率、日间/ 夜间应急缓解药使用率作为效果指标,FP 比 BUD 混悬液具有更优的经济性;以夜 间无哮喘发作率作为效果指标,BUD 经济性优于 FP,但当意愿支付值(WTP) <160. 00 元时,FP 则具有更优经济性。 (4)适宜 性,相比于丙酸倍氯米松(BDP),FP 与 BUD 具有较好药理学优势。 FP 雾化吸入用混悬液是儿童专用药品,适用于>4 岁儿童, 有效期最长,可降低基层医疗机构的药品管理成本,适宜慢性疾病长期治疗管理。 吸入用 BUD 混悬液有多种仿制药,可用于>6 个月儿童。 吸入用 BDP 混悬液适用于>2 岁儿童。 (5)可及性,医疗机构覆盖率 BUD>BDP>FP(原研),部分 BUD 仿制药因进 入集采目录机构覆盖率较高。 可负担性,疗程费用 FP4 岁儿童,且可及性(医疗机构覆盖率)低于 BUD 和 BDP。 鉴于 FP 雾化吸入用混悬液为新上市药品,现有文献 证据有限,研究结果需定期更新和长期论证。