安宫牛黄散中配伍药物对雄黄可溶性砷含量的影响

目的以安宫牛黄散为实例,研究中药复方中的配伍药物对雄黄中砷的溶解性的影响。方法安宫牛黄散中几种单味药与雄黄混合用人工胃液处理,用原子荧光法测定可溶性砷的含量。结果安宫牛黄散中几种单味药分别与雄黄混合用人工胃液处理后,测得的可溶性砷含量均比雄黄在人工胃液中的可溶性砷的溶出量低,使可溶性砷含量溶出减少的单味药次序依次为黄芩、黄连、珍珠、栀子、郁金和牛黄,溶出的可溶性砷含量依次减少55.1%,49.3%,29.4%,25.2%,25.0%和11.4%(P<0.01)。安宫牛黄散中的可溶性砷含量比雄黄的可溶性砷含量减少35.3%(P<0.01)。结论安宫牛黄散中的几种单味药均有抑制雄黄中可溶性砷溶出的作用,推测是降低砷的毒性作用的可能途径之一。     

牛黄解毒片中不同单味组分对雄黄可溶性砷含量影响的比较研究

目的研究牛黄解毒片中各单味组分对雄黄可溶性砷含量的影响。方法采用雄黄与牛黄解毒片中的7种单味药按牛黄解毒片处方比例分别组方分为9组供试品并经人工胃液处理后,用分光光度法分别测定可溶性砷的含量。结果与雄黄组相比,雄黄与处方中各组分单独组方后测得的可溶性砷含量均有不同程度降低。其中大黄+雄黄组和甘草+雄黄组使可溶性砷含量减少为84.9%和81.1%,而冰片+雄黄组等影响不显著。结论牛黄解毒片中的大黄、甘草等与雄黄配伍能较显著地抑制雄黄中可溶性砷的溶出,为进一步探讨雄黄复方中影响可溶性砷盐的主要物质提供参考依据。     

雄黄和六神丸中可溶性砷的溶出度研究

目的建立高效液相色谱-电感耦合等离子体质谱联用技术(HPLC-ICP-MS)法测定单味雄黄和六神丸可溶性砷的含量方法;考察六神丸配伍对雄黄中可溶性砷溶出度的影响,探讨六神丸的配伍机制。方法分别建立了ICP-MS和HPLCICP-MS法测定雄黄及六神丸中总砷和可溶性砷含量的方法,采用人工胃液和人工肠液为溶出介质,考察雄黄和六神丸中可溶性砷的溶出情况,分析配伍使用对雄黄中可溶性砷溶出的影响。结果 5种不同形态砷标准物质在5~500μg·L-1内线性关系良好,精密度和重复性均良好,回收率89%~102%。可溶性砷从六神丸复方中的溶出量和溶出速率均明显低于从单味雄黄中的溶出。结论六神丸复方配伍可显著降低雄黄中可溶性砷的溶出,从而降低其毒性。     

ICP-MS研究含雄黄中成药中的砷元素在胃肠液中的溶出特性

目的研究含雄黄中成药的砷元素在胃肠液中的溶出特性,为临床安全用药提供参考。方法应用ICP-MS技术建立砷元素的测定方法,并用该方法对不同厂家牛黄消炎片和小儿化毒散中的砷总量、水中砷溶出率、人工胃液中砷溶出率及人工肠液中砷溶出率进行测定、比较和分析。结果测定方法中两种药品砷元素的线性相关系数(r)均大于0.999 9;牛黄消炎片和小儿化毒散总砷测定方法及溶出液中砷元素测定方法的精密度、稳定性和回收率均能满足实验要求;NIST西红柿叶标准物质(SRM 1573a)的测定值和标准值之间也有良好的一致性。测定结果显示:部分厂家的牛黄消炎片和小儿化毒散存在雄黄投药不足的问题;各厂家牛黄消炎片和小儿化毒散的砷在胃肠液中溶出率均小于5%;各厂家牛黄消炎片在胃肠液中的溶出率均小于在水中的溶出率,而各厂家小儿化毒散在水和胃肠液中的溶出特性不同。结论牛黄消炎片和小儿化毒散的胃肠液溶出砷值得进一步研究。     

原子荧光光谱法测定牛黄解毒片中的可溶性砷含量

目的：测定牛黄解毒片的总砷含量以及在人工胃液、人工肠液和水中可溶性砷的含量,了解该复方制剂的砷含量情况,为牛黄解毒片在临床上的合理用药和安全性提供实验依据。方法样品经硝酸、高氯酸、硫酸和盐酸消化后,用硫脲抗坏血酸使五价砷还原为三价砷,再与硼氢化钾反应生成砷化氢气体,载入原子荧光光谱仪测定总砷;样品分别浸泡到人工胃液、人工肠液和水中,经不同时段分别取出上清液进行加酸定容处理,载入原子荧光光谱仪测定可溶性砷。结果可溶性砷在人工胃液及人工肠液中比在水中更早达到溶出平衡。在人工胃液中可溶性砷占总砷含量的2.86%,在人工肠液中可溶性砷占总砷含量的3.13%,在水中可溶性砷占总砷含量的0.11%。结论人工胃液中成人每天可溶性砷最大摄入量为31.38μg,人工肠液中为27.10μg,水中则为15.69μg,未超出世界卫生组织的标准,说明牛黄解毒片可安全服用。     

石墨炉原子吸收分光光度法测定雄黄和牛黄解毒片中可溶性砷的含量

目的:建立测定雄黄和牛黄解毒片中可溶性砷的含量,完善中药中砷含量测定的方法。方法:采用稀盐酸和人工胃液2种溶剂分别提取雄黄、牛黄解毒片中的可溶性砷,加入基体改进剂,用石墨炉原子吸收分光光度法测定砷的含量。光源发射波长:光度呈良好的线性关系(r=0.999 0);平均回收率分别为99.20%、98.67%、100.77%,RSD=2.01%。结论:本方法简单、快速、准确,可作为中药中微量水溶性砷的含量测定方法。     

含雄黄复方制剂中可溶性砷的研究

目的测定雄黄复方制剂在人工胃液中可溶性砷的含量,探讨可能被人体日摄入的可溶性砷盐含量,为指导雄黄复方制剂临床合理用药提供科学依据。方法采用原子荧光光谱法、人工胃液提取对11种雄黄复方制剂的可溶性砷盐含量进行测定。结果人工胃液中的可溶性砷盐含量可能和处方有关,本次抽检的样品绝大部分日最高摄取可溶性砷盐量均未超出安全限量。结论雄黄复方制剂中雄黄含量高、日摄取量超出安全限量并不能说明其毒性大,对日服药量较高的雄黄复方制剂的毒性成分可溶性砷盐应进行定量研究。     

大黄中蒽醌类化合物对雄黄可溶性砷含量的影响

目的研究大黄中蒽醌类化合物对雄黄可溶性砷含量的影响。方法设立雄黄、雄黄配伍大黄及雄黄配伍大黄总蒽醌实验组,采用人工胃液和人工肠液提取各组中的可溶性砷,并用电感耦合等离子体质谱法测定各组样品中可溶性砷的含量。结果雄黄与不同剂量大黄总蒽醌配伍后,可溶性砷含量均有不同程度降低,但大黄总蒽醌对雄黄可溶性砷的影响不及大黄明显。结论大黄中的蒽醌类化合物可起到降低雄黄可溶性砷的作用。     

雄黄及含雄黄复方中砷含量、形态和晶形分析

目的 对雄黄及含雄黄复方制剂中的砷含量、砷形态和雄黄晶形进行分析.方法 采用微波消解-原子荧光法测定雄黄和复方制荆中的总砷含量,人工胃液提取.原子荧光法测定可溶性砷,离子树脂交换分离.原子荧光法测定可溶性三价砷(AⅢ)和五价砷(AsV),X衍射荧光法对雄黄粉末进行物相(晶形)分析,X荧光光谱法进行雄黄粉末的全元素分析.结果 受试雄黄含硫化砷97.3%,主成分是β-雄黄(As4S4)和α-雄黄(AsS)的混合物,同时含有少量二硫化二砷(As2S2)和雌黄(As2S3).As/S(摩尔数之比)为1.00001.还含有少量Al、Si、K、Ca、Ti、Fe、Sb、Ni、Cu、W等杂质.在雄黄及含雄黄复方制剂的人工胃液提取液中均检出了可溶性砷、AsⅢ和AsV;且不同来源的雄黄,可溶性砷以及两种价态的砷的比例也不同.雄黄中可溶性砷百分含量为0.62%,其中AsⅢ和AsV比例为2.30:1.结论 雄黄及含雄黄复方中混杂存在三价和五价无机砷.有必要加强对雄黄药材的质量监控.     

2种测定雄黄和牛黄解毒片中可溶性砷含量的方法比较

目的:建立和完善中药中可溶性砷含量测定的方法。方法:采用稀盐酸和人工胃液2种溶剂分别提取雄黄和牛黄解毒片中的可溶性砷,比较古蔡氏法和二乙基二硫代氨基甲酸银(DDC-Ag)法测定可溶性砷含量的结果。结果:古蔡氏法测定样品中的可溶性砷符合2005年版《中国药典》(一部)的要求;DDC-Ag法测定可溶性砷浓度在0～6.00μg·mL-1范围内与吸光度呈良好的线性关系(r=0.9993),平均回收率为99.73%,RSD=2.88%。结论:2种方法各有优缺点。古蔡氏法测中药中可溶性砷含量,方法简单,成本低;但DDC-Ag法比较准确,成本较低,两法均可作为中药中微量可溶性砷含量的测定方法。     

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.     

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.     

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.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。