多巴胺联合去甲肾上腺素治疗心源性休克的临床观察

目的:探讨多巴胺联合去甲肾上腺素治疗心源性休克的疗效.方法:43例心源性休克患者随机分为两组,观察组给予多巴胺+去甲肾上腺素治疗;对照组给予去甲肾上腺素,观察两组生存天数和死亡率.结果:观察组24例,存活18例,死亡6例.对照组19例,存活14例,死亡5例,两组治疗效果差异具有统计学意义(P<0.05).结论:多巴胺联合去甲肾上腺素治疗心源性休克较单用去甲肾上腺素临床疗效更好.     

米力农联合艾司洛尔治疗危重型手足口病的效果观察

目的 探讨分析米力农联合艾司洛尔在危重型手足口病治疗中的临床应用价值.方法 2013年6月至2015年4月收住本院的危重型手足口病患儿82例,依据随机数字表法将其分为研究组(n=40)和对照组(n=42).在常规处理基础上,对照组米力农治疗,而研究组米力农联合艾司洛尔治疗.治疗前与治疗24 h后测量患儿血压、心率、左室射血分数以及心排出量,取静脉血测定血清脑钠肽和去甲肾上腺素水平.结果 治疗前,两组各指标差异无统计学意义(P＞0.05).治疗后,两组血压、心率、心功能以及实验室指标均优于治疗前(P＜0.05),但研究组改善程度优于对照组(P＜0.05).结论 米力农联合艾司洛尔治疗危重型手足口病可在较短时间内改善患儿心功能,提高临床治疗效果.     

硝普钠联合米力农治疗危重症手足口病中的疗效观察

目的观察硝普钠在治疗危重症手足口病的疗效。方法 64例危重症手足口病患儿,随机平分为A,B两组,两组均给予抗病毒、降颅压、机械通气、保护脏器及对症治疗,在此基础上,A组予米力农强心扩血管,B组予硝普钠联合米力农强心扩血管,观察两组患儿治疗前后血压(BP)、心率(HR)、心脏左室射血分数(EF)、心输出量(CO)的变化情况。结果 A组患儿治疗前后心率、血压、心脏左室射血分数、心输出量差异无统计学意义;B组患儿治疗前后心率、血压、心脏左室射血分数、心输出量差异具有统计学意义。结论硝普钠联合米力农用于手足口病危重症患儿临床疗效显著。     

多巴胺和去甲肾上腺素治疗脓毒症休克的疗效比较

目的比较多巴胺及去甲肾上腺素在治疗脓毒症休克过程中的疗效及并发症,以期为脓毒症休克患者确定一种更为经济、有效的血管活性药物。方法选择2010年6月至2011年12月入住我院ICU的脓毒症休克患者,经过充分的液体复苏仍存在低血压的患者80例,年龄18-75岁,随机分为2组,分别给予多巴胺及去甲肾上腺素维持血压。各组再以心脏指数(cardicac index,CI)标准分为两个亚组,记录每组及各亚组的心脏不良事件(包括各种心律失常及心肌缺血)发生情况。比较各组心脏不良事件的发生率以及28d死亡率。结果多巴胺组的心脏不良事件发生率为32.5%,去甲肾上腺素组的发生率为10%,差异有显著性(P<0.05),但两组的28d死亡率分别为27.5%和22.5%,无显著差别(P>0.05)。对于低心输出量的患者,多巴胺组的28d死亡率要显著高于去甲肾上腺素组(P<0.05)。结论多巴胺和去甲肾上腺素均能够改善脓毒症休克患者的血压,但是多巴胺组发生心脏不良事件的概率更高。特别是对于低心输出量的患者,去甲肾上腺素优于多巴胺。     

生脉注射液在急性心肌梗死并心源性休克中的应用

目的探讨生脉注射液治疗急性心肌梗死合并心源性休克的临床疗效。方法常规治疗基础上,对50例急性心肌梗死合并心源性休克的患者加用生脉注射液,与40例常规治疗该病的患者比较血压、心率、左室射血分数、心脏指数。结果与常规治疗组比较,生脉治疗组患者血压、心率、左室射血分数及心脏指数均好于常规治疗组,两组比较差异均有统计学意义(P<0.05)。结论生脉注射液治疗急性心肌梗死合并心源性休克患者的疗效显著,适合临床广泛应用。     

不同剂量去甲肾上腺素对感染性休克患者心脏及血流动力学的影响

目的研究不同剂量去甲肾上腺素对感染性休克患者心脏及血流动力学的影响。方法选取我院2013年10月至2016年2月的感染性休克患者76例,随机分为观察组和对照组,各38例。两组患者均给予常规治疗,观察组加用2μg/min去甲肾上腺素,对照组加用1μg/min去甲肾上腺素,对比分析两组血肌酐(Cr)、尿氮素(BUN)、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、心脏指数(CI)、心搏指数(SI)指标。结果治疗后观察组的Cr及BUN指标高于对照组,差异显著(P<0.05);两组治疗前的MAP、HR、CVP、CI、SI指标比较差异无统计学意义(P>0.05);两组治疗后的MAP、HR、CVP、CI、SI指标优于治疗前,差异显著(P<0.05);观察组治疗后的MAP、HR、CVP、CI、SI指标优于对照组治疗后的MAP、HR、CVP、CI、SI指标,差异显著(P<0.05)。结论较高剂量的去甲肾上腺素可改善感染性休克患者心脏及血流动力学指标,在使用去甲肾上腺素时应密切监测患者机体指标,调整剂量以达到最佳治疗效果。     

米力农辅治难治性心力衰竭的临床观察

目的观察米力农辅治难治性心力衰竭的临床疗效。方法将72例难治性心力衰竭患者随机分为治疗组和对照组各36例。对照组给予常规治疗,治疗组在常规治疗的基础上加用米力农。对比2组临床疗效,并观察治疗组治疗前后心搏出量(CO)、左室射血分数(LVEF)、每搏量(SV)、心脏排血指数(CI)水平。结果观察组总有效率为80.6%高于对照组的55.6%,差异有统计学意义(P<0.05)。治疗组治疗后CO、LVEF、SV、CI水平均高于治疗前水平,差异有统计学意义(P<0.01)。结论米力农作为新一代治疗难治性心力衰竭的药物,可取得较明显的近期效果,且使用安全,值得临床推广应用。     

探讨药物联合心脏康复计划对心肌梗死患者心脏功能的影响

目的探讨分析使用药物联合心脏康复计划对于心肌梗死患者心脏功能的影响。方法 40例心肌梗死患者,随机分为试验组和对照组,每组20例。对照组采用药物治疗,试验组药物治疗的同时给予心脏康复计划。比较两组治疗后的心脏舒张功能。结果治疗前后两组早期波(E)、晚期波(A)、E/A、减速时间E的峰值速度等对比差异无统计学意义(P>0.05),试验组心脏容积增大、最大心率增加、静息心率降低,均优于对照组,差异有统计学意义(P<0.05)。结论药物联合心脏康复计划对于心肌梗死患者的心脏功能以及心率等具有显著效果。     

低剂量持续泵入特立加压素对感染性休克患者血流动力学的影响分析

目的：探讨小剂量持续输注特立加压素（TP）对感染性休克患者心脏及血流动力学的影响。方法：2008年1月～2009年5月解放军第309医院普外科收治的感染性患者45例,其中25例去甲肾上腺素抵抗患者给予小剂量TP持续静脉泵泵入2mg·（24h）-1治疗。按患者最终的存活情况分为存活组18例,死亡组7例,记录2组治疗前、治疗后6、12、24、48h心脏的[心率（HR）、心脏指数（CI）]血流动力学参数[肺动脉楔压（PAWP）、平均动脉压（MAP）、全身血管阻力（SVR）]和去甲肾上腺素剂量等。结果：与治疗前比较,治疗6h后,存活组、死亡组的平均动脉压均显著升高,差异均有统计学意义（P〈0.05）,而心脏指数（CI）、肺动脉楔压（PAWP）、以及全身血管阻力（SVR）均无明显改变,差异均无统计学意义（P〉0.05）。与死亡组比较,存活组MAP较高（治疗6h后）、心率较低（治疗12h后）,维持目标MAP（9.975kPa）所需的去甲肾上腺素剂量较小（治疗24h后）,差异均有统计学意义（P〈0.05）。结论：小剂量持续泵入TP能有效改善感染性休克患者的血流动力学,降低去甲肾上腺素的使用剂量,且未明显增加心脏后负荷,因而可作为一种有效的血管加压素,用于感染性休克的治疗。     

参芪扶正注射液治疗心源性休克的疗效观察及其护理

目的观察参芪扶正注射液联合护理治疗心源性休克患者的疗效。方法将入选患者随机分成试验组和对照组。试验组在常规治疗护理基础上,加用参芪扶正注射液,对照组仅给予常规治疗护理。比较两组的临床疗效及心率、血压、尿量、动脉血氧分压。结果①试验组总有效率(92.11%)显著高于对照组(73.68%),差异有统计学意义(χ2=4.547,P=0.033)。②两组治疗后1h、6h、12h试验组血压及尿量均显著大于同时点对照组,差异有统计学意义(P<0.05)。结论参芪扶正注射液联合护理可提高心源性休克患者临床疗效,有利于血压提升及尿量恢复。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.