气管切开患者床旁纤支镜吸痰灌洗术的护理配合

目的：探讨气管切开患者床旁纤支镜吸痰灌洗术的护理配合,确保吸痰灌洗过程能顺利进行。方法：对27例气管切开患者的排痰困难、气道阻塞而导致的呼吸困难、低氧血症,在实施气道管理常规方法的基础上,配合用纤支镜从气管切开处行吸痰及肺灌洗术,从术前准备、术中监护和配合及术后观察等总结护理经验。结果：27例气管切开患者床旁纤支镜吸痰灌洗术均顺利进行,所有患者经吸痰灌洗术后,呼吸道痰液潴留、阻塞、肺不张、呼吸困难、SpO2等均有不同程度改善。结论：床旁纤支镜吸痰灌洗是解除气管切开患者呼吸道阻塞的一种简便易行且行之有效的好方法。     

242例咯血患者的胸部X线和纤维支气管镜检查结果对照分析

目的 通过对242例咯血患的胸部X线和纤维支气管镜(纤支镜)检查结果的对照分析，探讨两种检查方法在咯血诊断上的应用价值。方法 回顾性分析了242例咯血患的胸部X线和纤支镜检查结果。结果 242例咯血患的胸部X部线检查发现异常231例。纤支镜检查235例诊断得到明确。胸部X线检查对纤支镜检查的符合率86％。结论 胸部X线检查为纤支镜检查提供了影像学的重要资料。纤支镜检查在胸部X线检查的基础上对明确病灶性质及咯血原因提供了重要依据。     

便携式纤维支气管镜在急诊抢救中的应用

目的 总结便携式纤维支气管镜(简称纤支镜)在急诊抢救中的应用.方法 对38例需要进行紧急气道管理的急诊患者应用便携式纤支镜进行床边操作.结果 38例患者纤支镜操作顺利,未发生任何意外,临床效果良好.其中急诊床旁经纤支镜气管插管27例;吸痰或支气管肺泡灌洗解除肺不张、改善低氧血症17例;清除气道异物2例;急性大咯血解除窒息并心肺复苏成功1例;诊断支气管外伤1例.结论 便携式纤支镜有利于急诊危重病尤其是急性呼吸衰竭的抢救,是急诊科必备的抢救设备之一.     

经纤支镜支气管黏膜活检在机械通气患者中的应用

目的探讨纤支镜支气管黏膜活检技术在重症监护病房里机械通气患者中应用的可行性。方法本研究将我院重症监护中心于2006年1月至2009年9月对18例机械通气患者进行的床旁非X线引导下经纤支镜支气管黏膜活检患者的病历资料及行该项操作进行分析。结果本组18例患者中,病检结果示肺癌4例,肺部烟曲霉菌感染1例;其余13例病检结果示慢性炎症,本组18例患者在经纤支镜气管黏膜活检中均有少量出血(出血量<50 mL),持续生命体征监测未出现心律失常、低血压及休克、血氧饱和度低于90%的情况,术后复查床边胸片均未出现气胸。结论重症监护病房里机械通气的患者如有诊断未明确等纤支镜检查的适应证,可考虑在床旁非X线引导下行纤支镜支气管黏膜活检术。     

纤支镜检查60例支气管结核的临床分析

目的提高对支气管结核（EBTB）的认识和诊断水平。方法采用Olympus BF TYPE20型纤支镜,在纤支镜直视下进行活检及刷检,取标本送病理学、细菌学及抗酸染色检查。结果刷检找到抗酸杆菌26例,病理及刷检同时阳性14例,另外10例经纤支镜检查在痰中找到抗酸杆菌。结论经纤支镜支气管内采样做细菌学、组织学检查是诊断EBTB最重要的手段,对术前痰细菌学检查阴性的EBTB诊断价值更大,而纤支镜检查术的痰（涂片）是痰细菌学检查的良好补充。     

纤支镜技术对肺癌的诊断价值探讨

纤支镜不仅可以直视观察支气管粘膜病变,又可进行活检、刷检、支气管冲洗及纤支镜术后痰液检查以获得细胞学及组织学标本,提高诊断水平。本文对124例纤支镜检查的肺癌作回顾性研究,探讨纤支镜常用的三种技术活检、刷检、支气管冲洗液检查在肺癌诊断中的价值。     

重症监护室纤维支气管镜的应用

目的：探讨纤维支气管镜在重症监护室中的应用。方法：27例重症监护室患者床旁给予纤支镜气道吸痰;支气管肺泡灌洗、深部痰标本培养和纤支镜引导下经鼻气管插管。结果：24例患者经1～3次纤支镜吸痰治疗,15例肺部感染得到控制,9例肺不张均复张;17例行深部痰培养,11例培养结果阳性(64.7％)：5例引导经鼻气管插管均成功。结论：在重症监护室危重病人,在保证氧供的情况下,经纤支镜行呼吸道吸痰,支气管肺泡灌洗术,可有效改善痰液引流,解除肺不张,改善肺通气。行深部痰培养可指导抗生素的应用。引导经鼻气管插管较快建立人工气道。且无任何并发症,值得推广应用。     

纤支镜在ICU重症患者中的临床应用与分析

目的探讨纤支镜对ICU危重病患者的诊治价值。方法对于62例危重患者行床旁纤支镜检查、吸痰、灌洗、注药、引导下经鼻气管插管等。结果本组62例，显效36例，有效21例，无效5例，总有效率91．93％。标本阳性率92．30％，气管插管率为25．80％。结论纤支镜下检查诊治肺部炎症、损伤、肺不张及肺脓疡和引导气管插管，可提高救治成功率，减少气管插管、气管切开率。     

238例咯血患者纤维支气管镜与胸片胸部CT检查对照分析

目的探讨纤维支气管镜(纤支镜)检查在胸部X线(包括CT)检查的基础上对咯血病因的诊断价值.方法分析了238例咯血患者的胸部X线检查与纤支镜检查的结果.结果238例咯血患者胸部X线检查发现导常232例(97.5%);纤支镜检查结果为恶性肿瘤117例(49.16%),炎症60例(25.2%),结核29例(12.2%),支气管扩张6例(2.25%),异物2例(0.8%).纤支镜检查为病灶性及咯血病因诊断率达89.92%(214/238).结论纤支镜检查在胸部X线检查基础上对咯血病因诊断有重要的临床实用价值.     

纤支镜联合痰细胞学检查对X线隐性肺癌的诊断价值

目的探讨纤维支气管镜(纤支镜)检查术及其术后咳痰找脱落细胞(术后痰)检查对X线隐性肺癌的诊断价值。方法采用回顾性分析方法 ,对我院2006年6月~2008年6月X线胸片阴性而经纤支镜检查术及术后痰检查确诊为肺癌的41例患者进行总结,对两种检查阳性率进行比较分析。结果 41例中经纤支镜诊断阳性率73.17%(30例),术后痰诊断阳性率53.66%(22例)。其中有11例(26.83%)纤支镜未检出,而术后痰检出癌细胞确诊。结论纤支镜检查术联合痰细胞学检查可优势互补,可提高对隐性肺癌的诊断率。     

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.     

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.     

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.