奥曲肽联合泮托拉唑治疗肝硬化并上消化道出血的效果观察

目的探讨奥曲肽联合泮托拉唑治疗肝硬化并上消化道出血的临床效果。方法选择我院2007年1月至2013年5月收治的98例肝硬化并上消化道出血患者,随机分为观察组和对照组,每组49例。两组均给予常规支持治疗,在此基础上,对照组给予泮托拉唑治疗,观察组给予奥曲肽和泮托拉唑治疗。结果观察组和对照组,每组48例,观察组总有效率为91.84%,对照组为77.55%,观察组有效率明显高于对照组(P<0.05)。观察组止血时间平均为(14.4±3.7)h,对照组止血时间平均为(16.7±2.6)h,观察组明显低于对照组(P<0.05)。结论奥曲肽联合泮托拉唑治疗肝硬化并上消化道出血安全、有效,值得推广。     

奥曲肽联合泮托拉唑治疗肝硬化上消化道出血疗效观察

目的观察奥曲肽联合泮托拉唑治疗肝硬化上消化道出血的临床效果。方法将98例肝硬化上消化道出血患者随机分为治疗组56例和对照组42例。对照组在常规治疗基础上加用奥曲肽治疗;治疗组在对照组治疗基础上加用泮托拉唑治疗。观察并比较2组疗效。结果治疗组总有效率为94.6%,高于对照组的78.6%,差异有统计学意义(P<0.05)。结论奥曲肽联合泮托拉唑联合治疗肝硬化上消化道出血效果显著。     

奥曲肽联合泮托拉唑、三七粉治疗上消化道出血疗效观察

目的观察奥曲肽联合泮托拉唑、三七粉治疗上消化道出血临床疗效。方法 40例患者随机分为治疗组和对照组各20例,在常规治疗基础上治疗组应用奥曲肽联合泮托拉唑、三七粉治疗,对照组应用奥美拉唑治疗,疗程3d,比较两组疗效。结果治疗组和对照组治疗有效率分别为97.50%和77.50%,再出血率和不良反应发生率治疗组明显少于对照组,差异有统计学意义(P<0.05),治疗组平均止血起效时间为(6.01±3.87)h,对照组为(17.22±5.08)h,2组比较差异有统计学意义(P<0.01)。结论奥曲肽联合泮托拉唑、三七粉治疗上消化道出血,减少了出血量,缩短了止血时间,止血效果好,不良反应少。     

泮托拉唑联合奥曲肽治疗急性非静脉曲张性上消化道出血

目的观察泮托拉唑联合奥曲肽在治疗非静脉曲张性上消化道出血的疗效。方法将86例非静脉曲张上消化道出血患者,随机分为治疗组(44例)和对照组(42例)。治疗组为泮托拉唑联合奥曲肽,对照组单用泮托拉唑,观察两组的止血效果。结果治疗组24 h止血总有效率与对照组比较,差异有统计学意义(93.65%vs 86.32%,P<0.01);治疗组的止血时间短于对照组要[(24.38±6.35)h vs(27.86±5.80)h],治疗组的输血量少于对照组[(6.20±1.34)U vs(8.45±3.26)U],差异均有统计学意义(P<0.05)。结论泮托拉唑联合奥曲肽在治疗非静脉曲张性上消化道出血疗效显着。     

奥曲肽联合泮托拉唑治疗高龄高危肝硬化并急性上消化道出血

目的观察奥曲肽联合泮托拉唑对于治疗高龄高危肝硬化并急性上消化道出血的临床疗效。方法将确诊的60例高龄高危肝硬化并急性上消化道出血的患者随机分为两组:观察组(奥曲肽联合泮托拉唑)38例。对照组(三腔两囊管压迫+垂体后叶素)22例。比较两组的止血起效时间、再出血率及不良反应等。结果观察组在止血有效率,止血时间上均明显优于对照组(P<0.01)。结论奥曲肽联合泮托拉唑治疗高龄高危肝硬化并急性上消化道出血有良好的止血效果。且不良反应少,值得临床推广应用。     

奥曲肽和泮托拉唑联合应用治疗上消化道出血疗效观察

目的 探讨奥曲肽和泮托拉唑联合应用治疗上消化道出血的疗效.方法 将52例上消化道出血患者随机分为观察组和对照组,各26例,观察组采用基础治疗+奥曲肽+泮托拉唑治疗,对照组采用基础治疗+泮托拉唑治疗,疗程3 d,观察两组的疗效.结果 观察组和对照组治疗总有效率分别为92.3%和73.1%,差异具有统计学意义(P<0.05),两组患者治疗中均未出现明显不良反应.结论 奥曲肽和泮托拉唑联合应用治疗上消化道出血止血效果好.     

奥曲肽联合泮托拉唑治疗上消化道出血效果观察

目的观察奥曲肽联合泮托拉唑治疗上消化道出血的临床疗效。方法将100例上消化道出血患者,随机分为观察组和对照组,每组50例,观察组为奥曲肽联合泮托拉唑组,对照组为单用泮托拉唑组,观察2组的临床表现改变情况和止血效果。结果治疗后治疗组患者临床表现,如呕血、黑便、周围循环障碍以及贫血状况的好转情况均明显好于对照组(P<0.05)。治疗后治疗组和对照组的止血总有效率分别为98%和82%,差异有统计学意义(P<0.05)。结论奥曲肽联合泮托拉唑治疗上消化道出血止血迅速,不易复发,经济有效,值得临床推广应用。     

应用泮托拉唑联合奥曲肽治疗上消化道出血的临床疗效观察

目的探讨泮托拉唑联合奥曲肽治疗上消化道出血的临床疗效。方法 240例上消化道出血患者随机分成观察组和对照组患者各120例,对照组给予泮托拉唑40 mg加入100 mL 0.9%氯化钠溶液中静滴,每日2次。观察组在此基础上予奥曲肽0.1 mg静注,随后每2 h静滴0.05 mg,连用72 h。两组患者均观察7 d。结果观察组总有效率98.34%,对照组总有效率84.17%。两组患者总有效率比较差异有统计学意义(P<0.05)。结论泮托拉唑联合奥曲肽治疗上消化道出血疗效可靠,值得临床推广。     

奥曲肽和生长抑素治疗急性上消化道出血的临床疗效观察

探讨奥曲肽和生长抑素联合泮托拉唑治疗急性上消化道出血的临床疗效及安全性。对我院收治的148例急性上消化道出血患者随机分为奥曲肽联合泮托拉唑组(56例)、生长抑素联合泮托拉唑组(50例)和对照组(42例),观察3组患者的临床疗效及不良反应情况。奥曲肽联合泮托拉唑组与生长抑素联合泮托拉唑组患者总有效率无明显差异,但均明显高于对照组(P<0.05)。奥曲肽联合泮托拉唑组与生长抑素联合泮托拉唑组患者出血明显缓解时间亦无明显差异,但均明显短于对照组(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。对于急性上消化道出血的患者,在泮托拉唑治疗基础上加用奥曲肽和生长抑素进行治疗均能明显提高临床疗效,能缩短止血时间,且并未增加不良反应发生率,值得临床应用。     

泮托拉唑与奥美拉唑联合奥曲肽治疗上消化道出血的临床效果

目的探讨泮托拉唑与奥美拉唑联合奥曲肽治疗上消化道出血的临床效果。方法 93例上消化道出血患者,根据治疗方式不同分为对照组(43例)和观察组(50例)。对照组患者给予奥美拉唑联合奥曲肽治疗,观察组患者给予泮托拉唑联合奥曲肽治疗。对比两组患者用药时间、出血停止时间及治疗效果。结果观察组患者用药时间为(3.2±1.1)d,出血停止时间为(1.5±0.3)d;对照组患者用药时间为(5.4±2.1)d,出血停止时间为(3.6±0.8)d;观察组患者用药时间与出血停止时间均短于对照组,差异有统计学意义(P<0.05)。观察组患者总有效率为88.0%,显著高于对照组的69.8%,差异有统计学意义(P<0.05)。结论泮托拉唑联合奥曲肽在上消化道出血患者治疗中效果显著,可减少药物应用时间,短时间内止血,可作为上消化道出血首选的治疗方式。     

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。     

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。     

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.     

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.