B超在绝经后妇女宫内节育器取出术中的应用

目的 探讨B超在绝经后妇女宫内节育器取出术中的应用.方法 将124例绝经后取环患者随机分成实验组及对照组,观察两组患者手术时间、并发症及取环成功率.结果 实验组并发症显著下降,取环成功率100%,与对照组对比,有统计不差异(P＜0.01).结论 B超在绝经后妇女宫内节育器取出术中有利于降低并发症,增加手术安全性,提高手术成功率.     

音乐联合米索前列醇用于绝经妇女取环的效果观察

目的探讨音乐联合米索前列醇在绝经后妇女取出宫内节育器(IUD)手术中的应用。方法将要求取出宫内节育器而无禁忌证的绝经后妇女172例,随机分为观察组及对照组(各86例),观察组妇女在术前3 h阴道放置米索前列醇600μg,且术前15 min至术后15 min欣赏音乐;对照组术前术中均不做任何处理,常规取器。结果观察组妇女术中的疼痛强度明显低于对照组(P<0.05),且取器成功率明显高于对照组(P<0.05)。结论音乐联合米索前列醇能明显降低绝经后妇女取环手术中的疼痛强度,并能显著提高取环的成功率。     

药物联合B超监测用于剖宫产妇女绝经后宫内节育器取出困难的临床观察

目的：观察药物联合B超监测用于剖宫产妇女绝经后宫内节育器取出困难的临床效果。方法选取收治的80例剖宫产绝经后宫内节育器取出困难患者为研究对象,随机分为两组,对照组和试验组各40例,对照组实施传统取出方法,试验组实施药物联合B超监测取出。对比两组患者的临床取出效果。结果试验组患者的取器成功率明显比对照组高,手术时间明显比对照组短,术中出血量明显比对照组少,宫口扩张明显比对照组大,差异均具统计学意义（P＜0.05）。结论对剖宫产绝经后宫内节育器取出患者实施药物联合B超监测,能够有效提高取出宫内节育器的成功率,减少术中出血量以及手术时间。     

绝经后妇女摘取宫内节育器的临床观察

目的探讨笑气与利多卡因联合用于绝经后妇女摘取宫内节育器的临床疗效。方法165例绝经后要求取环的妇女应用笑气与利多卡因联合用药,观察镇痛效果、宫颈松弛情况及一次性取环成功率。结果实验组临床镇痛效果总有效率为97.6%,宫颈松弛度用5号扩张器通过率为90.9%,一次性手术成功率为90.9%,均显著高于对照组的45.0%、52.5%和52.5%,x~2=61.199、34.331和34.331(P<0.05)。结论笑气吸入联合利多卡因宫颈管内表面浸润麻醉宫内取环术,可减少绝经后妇女摘取宫内节育器的痛苦,提高一次性成功率。     

120例绝经后宫内节育器取出术的临床分析

目的探讨120例绝经后宫内节育器取出术的临床分析。方法 120例绝经后要求取出宫内节育器的患者,随机分为实验组和对照组,每组60例。实验组患者在取宫内节育器前2-3 d内服药尼尔雌醇4 mg/d,而对照组则不进行特殊处理。对两组患者的病史,用药情况,手术时间,术中出血量等指标进行统计分析。结果实验组中有49例（81.67%）顺利取出宫内节育器,11例（18.33%）存在取出宫内节育器困难。其中5例节育器取出困难,且取出后变形,另有2例取出后断裂。对照组中有35例（58.33%）顺利取出宫内节育器,25例（41.67%）存在取出宫内节育器困难。其中8例节育器取出困难,且取出后变形,另有4例取出后断裂,4例节育器环嵌顿。实验组手术时间,术中出血量等均低于对照组,差异具有统计学意义（P〈0.05）。结论对于绝经后的妇女,常规的宫内节育器取出术取出存在困难的可以采用服用尼尔雌醇辅助手术进行。     

米非司酮联合米索前列醇在围绝经期宫内节育器取出时的应用效果研究

目的探讨米非司酮联合米索前列醇应用于围绝经期宫内节育器取出时的临床效果。方法选取我院2010年1月至2012年1月行宫内节育器取出的围绝期妇女134例随机分为对照组和观察组,对照组在术前不做特殊处理,观察组术前给予米非司酮联合米索前列醇。然后统计两组妇女一次性取出成功率、失败率、困难率、阴道壁弹性、宫颈软化程度、手术时间以及术中出血量等。结果观察组的宫内节育器取出术成功率、宫阴道壁弹性、宫颈软化效果明显优于对照组,P<0.01,差异性非常显著,具有统计学意义;对照组的手术失败率、困难率、手术时间、术中出血量明显高于观察组,P<0.01,差异性非常显著,具有统计学意义。结论米非司酮联合米索前列醇应用于围绝经期宫内节育器取出术,可以明显的提高手术一次成功率,增加阴道壁的弹性,促进宫颈的软化,缩短了手术时间,减少了术中的出血量,同时减少了术后并发症的发生,非常值得临床应用、推广。     

替勃龙在绝经后妇女宫内节育器取出中的应用

目的观察替勃龙用于绝经后妇女宫内节育器取出的临床效果。方法将216例要求取出宫内节育器的绝经后妇女随机分为观察组和对照组各108例。观察组每天给予替勃龙2.5mg口服,连服7d,第8天手术。对照组未服用任何药物,直接手术。对2组手术时间、出血量及取器成功率进行观察比较。结果观察组手术时间短于对照组,出血量少于对照组,取器成功率高于对照组,差异均有统计学意义（P〈0.01）。结论替勃龙用于绝经后妇女宫内节育器取出,有助于宫颈软化,手术效果较好。     

尼尔雌醇在妇女绝经后宫内节育器取出术中的应用

目的探讨妇女绝经后宫内节育器取出术前服用尼尔雌醇的临床价值。方法用药组口服尼尔雌醇，术前1周顿服4mg,1次；对照组不用任何药物，两组均按宫内节育器取出术常规操作取宫内节育器。结果用药组取节育器成功率100％．对照组成功率85％，两组比较差异有统计学意义（P〈0．05）。结论应用尼尔雌醇行妇女绝经后宫内节育器取出术．是一种安全有效的方法。     

米索前列醇用于绝经妇女宫内节育器取出术效果

目的探讨米索前列醇片应用于绝经后妇女宫内节育器（IUD）取出术的临床可行性。方法来我院就诊要求取IUD的绝经妇女98例作为观察组,于术前3h阴道后穹隆置米索前列醇片400μg。记录宫颈软化度、患者疼痛程度、手术时间等,并与2011年10月以前我院接诊不作任何处理的绝经后取IUD妇女的相关指标进行对照。结果观察组取器成功率为99．0％（97／98）,对照组为91．3％（84／92）,两组比较差异有统计学意义。与对照组比,观察组宫颈软化率高、术中疼痛程度轻、手术时间短,两组比较差异有高度统计学意义。结论米索前列醇片用于绝经妇女官内节育器取出术,可有效软化宫颈,缩短取器时间,减轻患者疼痛程度,提高取器成功率。     

B型超声在围绝经期妇女宫内节育器取出术中的应用观察

目的分析B型超声在围绝经期妇女宫内节育器（IUD）取出术中的应用效果。方法将70例要求行IUD取出术的围绝经期妇女随机分为观察组和对照组各35例。观察组在B型超声引导下行IUD取出术,对照组行常规取环术。比较2组手术时间、术中出血量、一次性成功率、总成功率及患者满意度情况。结果观察组手术时间短于对照组,术中出血量少于对照组,一次性成功率、总成功率及患者满意度高于对照组,差异均有统计学意义（P〈0.05）。结论围绝经期妇女在B型超声引导下行IUD取出术,具有操作简便、创伤轻、成功率高、患者易于接受等优点,值得基层单位推广应用。     

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.