IVP方案与CAP方案治疗115例老年晚期非小细胞肺部的对比研究

目的 对比IVP方案与CAP方案治疗老年晚期非小细胞肺癌的临床疗效、生存期及毒副反应。统计分析用IVP（异环磷酰胺,鬼臼乙叉甙,顺铂）方案及CAP（磷酰胺,阿霉素,顺铂）方案治疗115例老年晚期非小细胞肺癌病例的临床资料。结果 IVP组有效率为58．6％,其中完全缓解5例,中位生存时间11个月,1年生存率31％;CAP组有效率为29．8％,中位生存时间6．5个月,1年生存率14％。毒副呱应主要为骨髓抑制,消化道反应及脱发。结论 IVP方案治疗老年晚期非小细胞肺癌疗效优于CAP方案,毒副反应轻,值得作为一线治疗方案进一步推广应用。     

NP与CAP方案治疗晚期非小细胞肺癌临床观察

目的比较NP(去甲长春花碱、顺铂)和CAP(环磷酰胺、阿霉素、顺铂)联合化疗方案治疗晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法统计分析72例接受NP或CAP方案联合化疗的晚期非小细胞肺癌患者的疗效和毒副反应,其中NP方案42例,CAP方案30例。结果NP组42例,有效19例,有效率为45.24%,CAP组30例,有效11例,有效率为36.67%,两者疗效无显著差异(P>0.05),两者毒副反应主要为骨髓抑制及恶心呕吐,均可耐受。结论NP和CAP方案治疗非小细胞肺癌疗效肯定,毒副反应可耐受,可作为一线治疗方案。     

双药方案治疗30例老年晚期非小细胞肺癌的临床观察

目的观察双药方案治疗老年晚期非小细胞肺癌的疗效和毒副反应。方法对30例经过筛选的老年晚期非小细胞肺癌患者采用紫坊醇周剂量十卡铂方案治疗,观察其疗效和毒性。结果有效率56.7%,中位生存期下8.6个月,1年生存率38.8%,限制性毒副反应主要为白细胞下降,发生率80%,经过处理均可耐受。结论双药方案治疗经过筛选的老年晚期非小细胞肺癌是安全有效的。     

多西他赛联合顺铂治疗晚期非小细胞肺癌的临床分析

目的探讨多西他赛联合顺铂治疗晚期非小细胞肺癌的疗效和毒副反应。方法应用多西他赛75mg/m2联合顺铂75mg/m2方案治疗38例晚期非小细胞肺癌患者。结果总有效率达36.8%,其中初治组有效率为41.2%,复治组有效率为33.3%。主要毒副反应为骨髓抑制、恶心呕吐、腹泻及周围神经炎等。结论多西他赛联合顺铂治疗晚期非小细胞肺癌有较好疗效,毒副反应可耐受。     

晚期非小细胞肺癌化疗方案成本-效果分析

目的探讨不同化疗方案对治疗晚期非小细胞肺癌(nSCLC)的经济效果.方法根据文献选择93例晚期肺小细胞肺癌患者,分为3组,分别给予IVP(异环磷酰胺、长春地辛、顺铂)、MVP(丝裂霉索、长春地辛、顺铂)和CAP(环磷酰胺、阿霉素、顺铂)方案进行化疗,运用药物经济学的成本-效果方法进行评价.结果IVP组、MVP组和CAP组的成本-效果比分别为193.83、146.39和155.39.结论从药物经济学的观点分析,MVP方案是治疗晚期NSCLC的最佳方案.     

多西他赛联合顺铂治疗老年晚期非小细胞肺癌的临床观察

目的观察多西他赛联合顺铂治疗老年晚期非小细胞肺癌的临床疗效及毒副反应。方法对37例老年晚期非小细胞肺癌患者采用多西他赛联合顺铂方案化疗。即：第一天多西他赛75mg／m^2静脉滴注，顺铂30mg／m^2静脉滴注第1-3d，每3周重复，至少治疗2周期。结果共完成113个化疗周期，有效率40．5％，中位生存期9．4个月。主要毒副反应为骨髓抑制，发生率81％，其中，Ⅲ-Ⅳ度占8．1％。结论多西他赛联合顺铂治疗老年晚期非小细胞肺癌有较好疗效，毒副反应较小，耐受性好。     

晚期非小细胞肺癌化疗方案成本-效果分析

目的 探讨不同化疗方案对治疗晚期非小细胞肺癌(nSCLC)的经济效果。方法 根据献选择93例晚期肺小细胞肺癌患，分为3组，分别给予IVP(异环磷酰胺、长春地辛、顺铂)、MVP(丝裂霉素、长春地辛、顺铂)和CAP(环磷酰胺、阿霉素、顺铂)方案进行化疗，运用药物经济学的成本—效果方法进行评价。结果 IVP组、MVP组和CAP组的成本—效果比分别为193．83、146．39和155．39。结论 从药物经济学的观点分析，MVP方案是治疗晚期NSCIC的最佳方案。     

紫杉醇联合卡铂治疗晚期非小细胞肺癌临床分析

目的探讨紫杉醇联合卡铂治疗晚期非小细胞肺癌的疗效及毒性。方法对42例应用紫杉醇联合卡铂治疗晚期非小细胞肺癌患者进行分析。结果治疗组紫杉醇联合卡铂的总有效率40．5％．其中腺癌有效率45．5％．鳞癌有效率40．0％。中位生存期12．1个月,1年生存率42．9％。对照组长春瑞滨联合顺铂的总有效率37．04％,其中腺癌有效率38．1％,鳞癌有效率40%。中位生存期11．7月,1年生存率40．7％。主要毒副反应为骨髓抑制及肌肉酸痛,绝大多数患者耐受性良好。结论紫杉醇联合卡铂治疗晚期非小细胞肺癌是一种安全、有效、值得临床推广应用的化疗方案。。     

顺铂联合多西他赛治疗老年晚期非小细胞肺癌临床诊治体会

目的探讨顺铂联合多西他赛治疗老年晚期非小细胞肺癌临床治疗情况。方法采用回顾性分析的方法,分析本院收治的60例非小细胞肺癌患者的临床疗效、生活质量评分、生存情况、毒副反应。结果60例老年晚期非小细胞肺癌患者临床治疗近期疗效完全缓解11例（18．3％）、部分缓解32例（53．3％）、无变化12例（20％）、进展5例（8．3％）,总有效率43例（71．6％）。生活质量评分优良率73．3％。中位生存期（11．5±6．8）个月,1年生存率30例（50％）、2年生存率17例（28．3％）、5年生存率8例（13．3％）,毒副反应小。结论顺铂联合多西他赛治疗老年晚期非小细胞肺癌临床疗效明显,安全性较高,值得临床推广应用。     

TP方案和NP方案治疗晚期非小细胞肺癌

目的探讨TP方案和NP方案治疗晚期非小细胞肺癌的疗效和毒副反应。方法采用随机法分为TP（紫杉醇＋顺铂）组和NP（长春瑞滨＋顺铂）组。结果 TP和NP两组有效率分别是63%和55.6%。两组比较疗效均无显著性差异。两组毒副反应,表现为骨髓抑制,恶心呕吐,周围神经毒性反应,过敏反应,脱发,静脉炎,肝功能损害等均可耐受,两组无显著性差异。结论 TP方案和NP方案治疗晚期非小细胞肺癌具有较好的临床疗效,毒副反应相似且均可耐受。     

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.