丙泊酚人流致急性肺水肿1例

丙泊酚是一种起效迅速且短效的全身麻醉药，广泛应用于诱导和维持全身麻醉，重症监护病人接受机械通气时的镇静以及外科手术及诊断时的清醒镇静，如无痛人流、无痛胃镜检查等，因其起效迅速，复苏迅速深受广大医务人员和病人的欢迎。本人在无痛人流过程中发生急性肺水肿1例，现报告如下。供大家参考。     

非苯二氮类镇静催眠药的研发进展与临床评价

目的:介绍非苯二氮类镇静催眠药的研究进展与临床评价。方法:通过查阅国内、外近期有关文献进行评述。结果与结论:近年来,非苯二氮类镇静催眠药进展迅速,其耐药性和依赖性很小,几乎无反跳性失眠现象。此类药物是目前镇静催眠药的重要研发领域。     

非苯二氮(艹卓)类镇静催眠药的研发进展与临床评价

目的:介绍非苯二氮(艹卓)类镇静催眠药的研究进展与临床评价.方法:通过查阅国内、外近期有关文献进行评述.结果与结论:近年来,非苯二氮()类镇静催眠药进展迅速,其耐药性和依赖性很小,几乎无反跳性失眠现象.此类药物是目前镇静催眠药的重要研发领域.     

非苯二氮Zhuo类镇静催眠药的研发进展与临床评价

目的：介绍非苯二氮Zhuo类镇静催眠药的研究进展与临床评价。方法：通过查阅国内、外近期有关文献进行评述。结果与结论：近年来，非苯二氮Zhuo类镇静催眠药进展迅速，其耐药性和依赖性很小，几乎无反跳性失眠现象。此类药物是目前镇静催眠药的重要研发领域。     

无镇静作用的抗组胺药Loratadine

loratadine 是一种新的、无镇静作用的抗组胺药,正等待美国FDA 批准。近期已在5个国家出售,并计划在8个国家(包括美国)出售。无镇静作用的抗组胺药已迅速受到过敏患     

异丙酚在ICU中镇静降压的运用

分析了２０例术后机械通气病人运用异丙酚镇静、降压的治疗情况，就其注药前，注药后的血流动力学及镇静评分两个方面进行分析、研究。结果表明注药前后及停药后均有显著性差异（Ｐ＜０．０５），说明异丙酚具有镇静效果好、降压平稳、恢复迅速的特点     

失眠药物治疗进展

失眠治疗的最新观点强调在非药物治疗的同时,合理应用镇静催眠药,迅速改善病人的症状,使病人建立起治疗的信心,对病人的康复作用巨大。国内外早已对镇静催眠药物进行了大量研究,许多药物被发现并应用于临床。     

丙泊酚和瑞芬太尼在神经外科手术中的应用

<正>理想的神经外科手术麻醉要求麻醉诱导迅速,维持镇静、镇痛充分,降低颅内压和脑代谢,停药后清醒迅速而无躁动,无呼吸抑制和残余药物作用。瑞芬太尼为μ受     

ICU创伤后应激精神障碍和术后谵妄患者的镇静处理

目的研究不同镇静措施对重症监护病房(ICU)中创伤后应激精神障碍和术后谵妄患者的治疗效果。方法总结了20例老年患者术后发生谵妄(B组)和15例复合伤术后发生创伤后应激精神障碍(M组)患者的临床表现。B组患者采用丙泊酚镇静,而M组患者采用咪达唑仑镇静。结果两组患者年龄和性别组成差别非常显著,两种镇静措施均能够迅速控制并改善患者的精神症状。结论两种精神症状的机制未完全明了,但与睡眠紊乱和ICU的治疗环境有着重要的关系,针对两种精神紊乱应采取不同的镇静措施。     

右美托咪定复合丙泊酚在手外科手术中麻醉监护的随机对照研究

<正>传统的手外科手术中常常采用臂丛麻醉,但随着患者手术中无痛要求的日益提高,应用镇静、镇痛的不插管全麻已广泛应用于手外科手术中,全凭静脉麻醉下可为患者提供一个安静,舒适,记忆丧失的状态,并可起到良好的镇静,镇痛作用[1]。同时也可为外科医生提供良好的手术条件。在麻醉管理中最为重要的环节仍是保证在充分镇静,镇痛的情况下维持患者血流动力学稳定,避免呼吸抑制及气道阻塞的发生,具有在必要时迅速调节镇静深     

Remimazolam, a short-acting GABA(A) receptor agonist for intravenous sedation and/or anesthesia in day-case surgical and non-surgical procedures

Remimazolam (CNS-7056) is a short-acting GABA(A) receptor agonist, under development by PAION, in collaboration with Japanese licensee Ono Pharmaceutical, as an intravenous sedative agent for potential use in day-case procedures, and the induction and maintenance of anesthesia. A member of the benzodiazapene class of drugs, the structure of remimazolam was modified to produce a drug that displays organ-independent metabolism. The incorporation of a carboxylic ester moiety into the benzodiazapene core of remimazolam renders it susceptible to non-specific tissue esterases and it is rapidly metabolized into its pharmacologically inactive metabolite CNS-7054. Preclinical studies in sheep demonstrated that remimazolam produced a more rapid onset of action, and a shorter duration of action, compared with midazolam. In a phase IIa clinical trial evaluating remimazolam as a procedural sedative for upper gastrointestinal endoscopy in patients, the time to recovery from sedation was shorter and more consistent with remimazolam, relative to midazolam. Because of its organ-independent metabolism and rapid and predictable onset and recovery, remimazolam appears to have potential advantages over other currently available short-acting sedatives.     

Remimazolam: Pharmacologic Considerations and Clinical Role in Anesthesiology

Midazolam, fentanyl, and propofol are commonly used for sedation in modern anesthesia practice. These agents possess characteristics that have afforded various anesthetics to be delivered and produce relatively safe and effective outcomes. However, each agent has certain drawbacks in clinical practice. Remimazolam, a novel benzodiazepine created out of so‐called soft drug development, is an ultrashort‐acting intravenous sedative‐hypnotic currently being investigated in clinical trials. In this review, we evaluate the recent literature on the use of remimazolam in clinical practice as compared with current sedative agents, and we describe its potential roles for use in sedation. A literature search of the Medline database (2012–May 2016) was performed. Additional references were identified from a review of literature citations, manufacturer reports, and professional meeting abstracts. All premarket studies involving remimazolam as the primary study drug were evaluated. Literature describing the pharmacokinetics and pharmacodynamics of remimazolam, propofol, and midazolam was also included. Phase I and II studies in the United States have shown remimazolam to be a safe and effective option for procedural sedation. Unlike midazolam and propofol, remimazolam undergoes organ‐independent metabolism to an inactive metabolite. Because remimazolam follows first‐order pharmacokinetics, prolonged infusions or higher doses are unlikely to result in accumulation and extended effect, making it favorable for use as an intravenous anesthetic and for sedation in the intensive care unit. It is expected that phase III trials will further describe the niche that remimazolam may be able to occupy in clinical practice. Postmarket cost‐benefit analyses will need to be performed.     

Safety,pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy Chinese volunteers

The aim of the present study was to evaluate the safety, pharmacokinetic (PK) and pharmacodynamic (PD) properties of remimazolam besylate following single ascending dose (SAD) and continuous infusion in healthy Chinese volunteers. This was a randomized phase I study conducted in two parts. Part I was a double-blind, placebo- and midazolam-controlled, SAD study among healthy Chinese participants with a remimazolam dose of 0.025–0.4 mg/kg. Part II was an open-label, midazolam-controlled, continuous infusion study. Bispectral index (BIS) monitoring and Modified Observers Assessment of Alertness and Sedation (MOAA/S) score assessment were used to assess the PD properties. The half-life range of remimazolam was from 34.1 ± 8.1 to 59.8 ± 20.5 min in the SAD study. The sedation function was initially observed at the dose of 0.05 mg/kg remimazolam. Doses of ≥ 0.075 mg/kg exerted a peak sedation effect within 1–2 min after injection, resulting in a deeper and more rapid sedation. In the 2 h continuous infusion, remimazolam showed a deeper sedation and more rapid recovery than midazolam. For general anesthesia, an induction dosage of 0.2 mg/kg/min and a maintenance dosage of 1 mg/kg/h can achieve a satisfactory efficacy effect. Remimazolam was safe and well tolerated in healthy Chinese participants. Based on the phase I clinical study, we suggest that remimazolam besylate demonstrates greater sedation and quicker recovery from sedation than midazolam.     

苯磺酸瑞马唑仑联合阿芬太尼用于无痛胃肠镜患者的双盲对照研究

目的:研究分析苯磺酸瑞马唑仑联合阿芬太尼在无痛胃肠镜麻醉中的应用价值。方法:选取在青海省人民医院行无痛胃肠镜的患者200例,按1∶1比例随机分为2组,即注射用苯磺酸瑞马唑仑组(A组)和丙泊酚组(S组)。A组:静脉注射阿芬太尼7μg·kg^-1,随后静脉注射苯磺酸瑞马唑仑7mg待患者意识消失后开始进镜。S组:静脉注射舒芬太尼0.1μg·kg^-1,随后静脉注射丙泊酚1.5mg·kg^-1;待患者意识消失后开始进镜。观察2组有效性指标(起效时间、苏醒时间、离室时间),比较2组术前术中及术后血流动力学指标(如心率、平均动脉压),血氧饱和度,MOAA/S评分等,以及术后不良反应、医患双方满意度。结果:A组苏醒时间及离室时间均短于S组(P均＜0.05),两者起效时间差异无统计学意义(P＞0.05)。A组在给药后1,3,5,10,15,20,25,30min、结束时平均动脉压、心率、血氧饱和度均高于S组(P＜0.05)。在MOAA/S评分方面A组在给药1min时低于S组,而给药30min及检查结束时高于S组(P＜0.05)。A组在术中低氧血症、低血压、呛咳及术后恶心、呕吐、头晕、注射痛发生率与S组比较较低(P均＜0.05)。并且A组操作医生满意度及术后患者满意度均高于S组(P均＜0.05)。结论:苯磺酸瑞马唑仑联合阿芬太尼在无痛胃肠镜应用中具有血流动力学稳定,对呼吸影响小、苏醒快、无注射痛等优点,不良反应发生率与丙泊酚相比明显较低。     

华蟾素注射液联合化疗抗肿瘤临床应用研究进展

华蟾素注射液作为一种传统中药抗肿瘤制剂,临床应用范围较广。近年来许多研究证明华蟾素注射液联合化疗在抗肿瘤方面有重要的作用,能够起到协同增效,降低化疗药物毒副反应的作用,显示较好的临床应用价值。本文就2001年以来的华蟾素注射液联合化疗在治疗恶性肿瘤临床应用方面的研究作一综述。     

Clinical trials and outpatient dispensation: the pharmaceutical counseling place

Drug dispensations in clinical trials essentially concern outpatients (90%), and several mistakes and bad uses have been noted. The aim of this work is to set up a pharmaceutical counselling for outpatients in clinical trials. The bibliographic research on this subject did not learn us about similar experiences, but several references helped us to select the support of information: personal meeting between patient and pharmacist to introduce a written leaflet. Pharmaceutical information mentioned in the leaflet has to be validated and has to respect the clinical trials regulations. In the same way, information does not interfere with the inclusion-exclusion criteria or with the physician's observations. Then, information has been deliberately limited to the practical aspects of medications. Anonymous questionnaires have been delivered to the thirty first patients concerned to value their satisfaction with our services. The need of a clear and practical pharmaceutical counselling in clinical trials has been clearly established. Such a pharmaceutical counselling in clinical trials is one component of the overall drug-use process and potentially increases drug compliance. This pharmaceutical counselling on drug management has been well accepted by patients and has been supported by physicians and clinical trial sponsors.     

利奈唑胺在儿科应用研究进展

利奈唑胺(linezolid)是第一个临床应用的新型(噁)唑烷酮类抗生素,通过抑制细菌蛋白质的合成达到抑菌的作用.因利奈唑胺独特的作用位点和方式,故不易与其他基于抑制蛋白合成发挥抗菌作用的药物发生交叉耐药,而本身也不易诱导产生耐药性,其临床疗效已经得到一系列Ⅲ期临床研究证明.现就其作用机制、儿科临床应用及不良反应进行综述.     

临床实习带教中值得把握的几个环节

临床实习是医学生成长的关键时期,带教老师针对当前临床实习教学中面临的现状,以培养医学生临床实践能力为主线,从把握实习之舵、把握诊断学基本技能、独立分管病床、培养临床思维方法、注重德技融合等五个方面,综合培养医学生临床实践能力作了探索,取得了较好的实习教学效果,对医学生临床实习教学改革具有一定的参考价值。     

Use of hand-held computers to record and analyze intervention data

Using the Wizard to document clinical activities has been well received by the clinical staff. What had previously been a dreaded task has become an ongoing part of daily activities. The revised Clinical Activity Log also provided the staff pharmacists with an easier method of documenting their clinical activities. The task of inputing the information from the staff pharmacists' paper logs into the computer is time consuming and is currently being done by the clinical staff. Procurement of additional Wizards for the staff pharmacists to use in the central pharmacy and satellite pharmacies is currently being considered. Using the Wizard has enabled the clinical staff to document clinical activities into the computer database in an ongoing manner throughout the day. Documentation has increased and is now more complete. Productivity is being monitored. Physician responses and patient outcomes are now being documented. Most importantly the computerized system allows for easy retrieval of the documented information for evaluation so that tracking and trending can be done and we can thereby continue to improve the quality of pharmaceutical care being provided.     

新型降脂药物bempedoic acid

血脂异常是心血管疾病的一个高危因素,目前临床上仍以药物治疗为主要手段。bempedoic acid是一种人工合成的、以口服为给药途径的二羧酸衍生物,其对肝脏三磷酸腺苷-柠檬酸裂解酶(ACL)和腺苷单磷酸-活化蛋白激酶(AMPK)有双重调节作用,很有潜力成为另一个非他汀类的降脂药。多项临床试验研究表明bempedoic acid具有良好的安全性和有效性。主要从bempedoic acid的药物概况、相关背景、合成路线、作用机制和药理作用、临床研究等方面进行介绍。