丙戊酸治疗癫痫患儿诱发高氨血症的危险因素分析

目的观察血氨对癫痫患儿肝功能的影响,以及丙戊酸(VPA)诱发高氨血症的危险因素。方法将236例单用丙戊酸的癫痫患儿按血氨水平分为高血氨组(HG)40例、血氨异常组(AG)96例、对照组(CG)100例。用K-独立样本非参数检验方法考查血氨与患儿肝功能情况的相关性。通过Logistic回归分析年龄、性别、体重、日剂量、丙戊酸浓度对丙戊酸诱发高氨血症的危险。结果 HG组、AG组和CG组分别有25例(62.5%)、42例(43.8%)、43例(43.0%)患儿肝功能指标超出参考值范围,分别有5例(12.5%)、7例(7.3%)、2例(2.0%)患儿出现肝损伤。HG组的肝损伤患儿分布频率显著高于AG组和CG组(P<0.05)。Logistic回归结果显示,年龄(小)、日剂量(大)、丙戊酸浓度(高)是丙戊酸诱发高氨血症的危险因素。结论癫痫患儿在使用丙戊酸治疗时,应关注体内血氨浓度,在病情控制良好的情况下,及时调整用药剂量和血药浓度,避免高血氨的发生。     

Risk factors for nephrotoxicity associated with polymyxin B therapy in Chinese patients

International Journal of Clinical Pharmacy - Background The widespread application of Polymyxin B, an active agent against multidrug resistance and extensive drug resistance Gram-negative bacteria,...     

婴儿腹泻预后危险因素的研究

目的探讨影响婴儿腹泻病死率的危险因素。方法将2005年7月～2011年10月所有罹患腹泻的婴儿病例纳入研究,分为低体重患儿组和正常体重患儿组,并就临床特点相比较。结果研究期间纳入研究得罹患腹泻的504例患儿,低体重患儿20例,较高的病死率和较小的年龄。低体重患儿腹泻常合并败血症(25%)和脱水(21%)。低体重患儿腹泻相关病死率与男性、低的5分钟Apgar评分相关。结论为降低低体重患儿腹泻相关的病死率,重在及时识别高危和改善管理易患的低体重患儿。     

Risk factors associated with high linezolid trough plasma concentrations

Aim: The major concern of linezolid is the adverse events. High linezolid trough serum concentration (C_min) has been associated with toxicity. The aim of this study was to analyze factors associated with high C_min.

Methods: Main clinical characteristics of 104 patients treated with 600 mg/12 hours of linezolid were retrospectively reviewed. Samples were obtained just before the next dose after at least three doses and within the first 8 days of treatment. High C_min was considered when it was >8 mg/L. Univariate and multivariate analysis were performed.

Results: 34.6% patients had a C_min >8 mg/L, and they were older and had more frequently an estimated glomerular filtration by MDRD <40 mL/min. There were more patients co-treated with rifampin in the group with low C_min. The only factor independently associated with C_min >8 was the renal function. Patients with an eGF < 40 mL/min had significantly higher C_min than those with eGF > 80 mL/min (OR: 4.273) and there was a trend towards a high C_min in patients with eGF between 40-80 mL/min (OR: 2.109).

Conclusions: High C_min were frequent, especially in patients with MDRD <40 mL/min. Therapeutic drug monitoring could be useful to avoid toxicity in patients with renal dysfunction.     

Risk of haemorrhage associated with long term anticoagulant therapy

This literature review was conducted to determine: (a) the rate of bleeding (major, minor and fatal) during long term oral anticoagulant therapy (greater than 4 weeks) in various disorders (ischaemic cerebrovascular disease, prosthetic cardiac valves, chronic atrial fibrillation, ischaemic heart disease and venous thrombosis); and (b) the clinical and laboratory risk factors which predispose such patients to bleeding. Using strictly defined methodological criteria, 167 studies were evaluated and classified into 1 of 5 categories based on the strength of the study design, with level I (randomised trials) representing studies which provided the most reliable information and level V (cases series) the least reliable. The risk of bleeding was substantial, and was most marked in patients with ischaemic cerebrovascular disease (29%), ischaemic heart disease (19%) and venous thromboembolism (23%). Major bleeding in venous thrombosis and cerebrovascular disease was frequently associated with an underlying risk factor. In venous thromboembolism these coexisting conditions (cancer, recent surgery and paraplegia) were also predisposing factors for thrombosis. In cerebrovascular disease major bleeding was almost always intracerebral, possibly because of associated hypertension or the cerebrovascular disease per se. We were unable to determine whether bleeding events were concentrated soon after commencing anticoagulant therapy. Haemorrhagic episodes frequently occurred when the prothrombin time (or thrombotest) was within the targeted therapeutic range, but the relationship between bleeding and the level of anticoagulant therapy was properly evaluated in only 1 study (in venous thrombosis) which demonstrated that the risk of bleeding was reduced by using a less intense anticoagulant regimen. In conclusion, the risk of bleeding during oral anticoagulant therapy is substantial. Our analysis was limited by the lack of concise reporting of clinical and laboratory information and we would suggest that future clinical studies report these in greater detail.     

脑梗死患者微出血相关因素分析

目的 探讨脑梗死患者脑微出血一般临床因素及与同型半胱氨酸的关系.方法 选择我院2011年1-12月住院的脑梗死患者90例,经三维磁敏感加权成像检查判断是否合并脑微出血,,并对患者的临床特点及同型半胱氨酸等生化指标进行分析.比较有无合并脑微出血组相关危险因素及同型半胱氨酸等生化指标是否存在差异,并进行多因素回归分析.结果 脑微出血组36例,无脑微出血组54例.2组患者年龄、高血压病史、同型半胱氨酸含量差异有统计学意义( P=0.001,0.002,0.000).多因素回归分析显示,年龄(OR=1.041,95％ CI为1.00～1.08;P =0.030)、高血压病史(OR=1.101,95％CI为0.56～1.99;P =0.004)、同型半胱氨酸含量(OR=1.20,95％ CI为1.10～1.32;P =0.000)与脑微出血相关.结论 脑微出血与患者年龄、高血压病史、同型半胱氨酸含量相关.对于脑梗死患者合并脑微出血,更应该加强对血压、同型半胱氨酸的测定.     

丙戊酸单药治疗癫痫患儿导致肉碱缺乏的危险因素研究

目的探讨接受丙戊酸(VPA)单药治疗的儿童游离肉碱和酰基肉碱水平的变化以及丙戊酸导致肉碱缺乏危险因素。方法检测99例单用丙戊酸治疗2个月以上、年龄≤16岁的癫痫患儿(试验组)及50例健康儿童(对照组)的游离肉碱及酰基肉碱水平,用Mann-Whitney U检验分析肉碱水平的变化。通过多因素Logistic回归分析患儿性别、年龄、丙戊酸日剂量、服药时长、丙戊酸浓度、血氨等因素对丙戊酸导致肉碱缺乏的影响。结果试验组游离肉碱和总肉碱水平[27. 13(11. 59),37. 07(14. 16)μmol·L^-1]显著低于对照组[35. 08(12. 98),49. 88(18. 70)μmol·L^-1](P <0. 01),总酰基肉碱及短链(C2-C5)酰基肉碱水平较对照组明显下降(P <0. 01),中链(C6-C12)和长链(C14-C18)酰基肉碱与对照组相比差异无统计学意义,但二者与游离肉碱的比值均升高(P <0. 01)。18例(18. 2%)单用丙戊酸的癫痫患儿出现了肉碱缺乏,其中16例患儿无症状。高血氨(P <0. 05)和高丙戊酸浓度是丙戊酸导致肉碱缺乏的危险因素(P <0. 05)。结论单用丙戊酸可导致游离肉碱和酰基肉碱水平下降。高血氨和高丙戊酸浓度患儿更易出现肉碱缺乏。对于高危患者应筛查游离肉碱和酰基肉碱,及时诊断并进行治疗。     

Evaluation of factors associated with stability of anticoagulation therapy

Eighty-two patients receiving long-term warfarin therapy provided 199.34 patient-years of data that were evaluated to determine if certain variables could identify those who might be monitored safely at less frequent intervals. Most patient demographics, social habits, medical histories, indications for anticoagulation, and concurrent therapy were not useful in discriminating between patients with stable (n = 67) and unstable (n = 15) anticoagulation. A few trends were noted, but they failed to achieve statistical significance. Patients who never achieved stability (the unstable group) tended to be younger than those who did (p 0.13). Among the stable patients, those with a diagnosis of deep vein thrombosis or pulmonary embolus, or with elevated alanine aminotransferase values, were significantly more likely to require a dosage change. The probability of requiring a dosage change at monthly visits did not correlate with the time required to become stable, but it did correlate inversely with the duration of stable anticoagulation. This probability declined from almost 16% when monitoring frequency was first extended to monthly intervals to less than 8% at 2 months of stable anticoagulation, and tended to decline further with longer periods of stable therapy. Of the 67 patients who became stable, 23 did not require a dosage change during an average of 526 days of follow-up. Among the 44 stable patients who required a dosage change, the mean time to the change was 250 days after becoming stable. Few complications occurred, almost all of them early in therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperbilirubinemia during quinupristin-dalfopristin therapy in liver transplant recipients: correlation with available liver biopsy results

STUDY OBJECTIVE: To review the liver histopathology in transplant recipients who developed hyperbilirubinemia during therapy with quinupristin-dalfopristin, a new streptogramin antibiotic, and to ascertain whether objective histologic evidence of adverse drug effect could be correlated to serum bilirubin levels. DESIGN: Retrospective analysis. SETTING: University of Pittsburgh Medical Center. PATIENTS: From a database of 34 liver recipients who received quinupristin-dalfopristin for vancomycin-resistant Enterococcus faecium infection who were prospectively enrolled in a multicenter, open-label, emergency-use protocol, the data for a subset of 25 patients who underwent one or more liver biopsies during therapy were reviewed for this study. INTERVENTIONS: Quinupristin-dalfopristin was administered intravenously at 7.5 mg/kg every 8 hours. Available serum bilirubin levels from before, during, and 1 week after therapy were tabulated. Liver biopsy results obtained within 1 week before and during therapy were retrospectively reviewed. Histopathologic results were characterized and correlated to bilirubin level. MEASUREMENTS AND MAIN RESULTS: Cholestatic changes were already present in 15 of 17 patients who underwent biopsy before therapy. During therapy, the most common findings from 40 biopsies (25 patients) were cholestasis (33 biopsies), acute rejection (10), and periportal inflammation (8). There was no evidence of drug-specific histopathologic injury. CONCLUSION: Hyperbilirubinemia in these patients was likely multifactorial and most frequently due to sepsis and prior graft injury.     

产后阔韧带及腹膜后血肿11例高危因素分析及治疗体会

目的:探讨产后阔韧带及腹膜后血肿的高危因素及主要治疗措施。方法:对2009年11月1日—2015年10月31日产科收住的11例产后阔韧带和/或腹膜后血肿患者的临床资料进行回顾性分析。结果:3例阴道分娩导致的腹膜后血肿,全部为急产,其中2例(66.7%)为巨大儿;8例剖宫产分娩形成的阔韧带和/或腹膜后血肿患者,身高<160 cm者5例(62.5%),妊娠并发症3例(37.5%),第二产程剖宫产2例(25.0%),瘢痕子宫3例(37.5%)。11例患者中,介入治疗6例,占54.5%,开腹急诊手术行髂内动脉结扎和/或子宫切除术4例(36.4%),1例保守治疗。11例患者均治疗成功。结论:急产、巨大儿可能是阴道分娩导致腹膜后血肿的高危因素。身高矮小、瘢痕子宫二次剖宫产、妊娠并发症及试产后第二产程剖宫产可能是剖宫产术中形成阔韧带和/或腹膜后血肿的高危因素。介入手术栓塞盆腔血管与开腹手术结扎盆腔血管治疗阔韧带及腹膜后血肿疗效相似,但开腹血管结扎有一定的技术难度,建议有介入手术条件单位尽可能选择微创介入手术。     

住院病人抗凝治疗后下肢静脉血栓形成的危险因素分析

目的了解住院病人抗凝治疗后静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素,为对其的治疗和预防提供依据。方法收集中国人民解放军总医院2010年2月—2011年6月期间各科室经过系统抗凝治疗的住院患者320名,其中80例为经过系统抗凝治疗后仍发展为VTE的患者,设为病例组。按个体1∶3的配比比例,按年龄(差别小于5岁内)、性别、病种匹配等相同的配比原则,选取同期抗凝治疗后未发生VTE的240例患者设为对照组。应用单因素和多因素Logistic回归模型进行相关危险因素筛查。结果我们发现尽管给予系统的抗凝治疗,颅脑损伤、重症监护以及中心静脉置管三种因素仍为独立危险因素。结论即使给予系统抗凝治疗,颅脑损伤、重症监护、中心静脉置管三种危险因素是住院病人VTE的发生的独立危险因素。临床上提高对这类危险因素的警惕并提前给予抗凝治疗将有助于降低发生VTE的风险。     

儿童脓毒症相关性脑病发生的危险因素分析

目的 分析脓毒症病儿发生脓毒症相关性脑病(SAE)的危险因素.方法 选取2018年1月至2020年2月入住徐州市儿童医院的脓毒症病儿158例,其中符合SAE诊断标准病儿57例,未发生SAE病儿101例,通过单因素分析和多因素回归等方法,研究脓毒症病儿发生SAE的危险因素.结果 SAE组病儿死亡率(29.8％)高于非SAE组(9.9％),差异有统计学意义(P<0.05).凝血功能障碍、高同型半胱氨酸血症、高尿酸血症是儿童SAE发生的独立危险因素,差异有统计学意义(P<0.05).结论 凝血功能障碍、高同型半胱氨酸血症、高尿酸血症对脓毒症病儿是否发生SAE有一定预测价值.     

Risk factors associated with early smoking onset in two large birth cohorts

We use prospective data from the ongoing British Cohort Study (BCS) and Millennium Cohort Study (MCS) to: 1) document changes in the prevalence of childhood smoking onset; 2) assess whether broad historic shifts in key risk factors, such as maternal education, parental smoking, and peer childhood smoking, explain observed cohort changes in childhood smoking; and 3) evaluate whether inequalities in onset have narrowed or widened during this period. The children in these two studies were born 31 years apart (i.e., BCS in 1970; MCS in 2001), and were followed from infancy through early adolescence (n = 23,506 children). Our outcome variable is child self-reports of smoking (ages 10, 11). Early life risk factors were assessed via parent reports in infancy and age 5. Findings reveal that the odds of childhood smoking were over 12 times greater among children born in 1970 versus 2001. The decline in childhood smoking by cohort was partly explained by increases in maternal education, decreases in mothers' and fathers' smoking, and declines in the number of children whose friends smoked. Results also show that childhood smoking is now more linked to early life disadvantages, as MCS children were especially likely to smoke if their mother had low education or used cigarettes, or if the child had a friend who smoked. Although the prevalence of child and adult smoking has dropped dramatically in the past three decades, policy efforts should focus on the increased social inequality resulting from the concentration of early life cigarette use among disadvantaged children.     

老年人呼吸机相关肺炎的危险因素及耐药性分析

目的：研究老年人呼吸机相关肺炎的危险因素以及耐药性。方法选取2012年4月至2014年4月ICU老年呼吸机相关肺炎（ VAP）患者160例的临床资料,分析VAP发生与年龄、机械通气时间、是否行气管切开以及原有疾病的关系,并进行药敏实验对耐药性进行统计。结果原有慢性阻塞性肺疾病、机械通气时间超过7 d、年龄超过65岁患者VAP发病率（16．8％、13．4％、18．5％）均显著增加（χ2＝11．592、11．989、13.187,均P＜0．05）,切开气管VAP的发生机会并不增加（P＞0．05）。老年VAP感染的主要病原菌铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌,药敏实验发现患者存在多重耐药性,耐药性依次为氨苄西林、哌拉西林、环丙沙星、氧氟沙星以及头孢曲松。结论原有慢性的肺部疾病、机械通气时间过长以及年龄超过65岁是老年人VAP的危险因素,患者存在多重耐药,以氨苄西林耐药最多。     

Risk factors associated with drug use: the importance of 'risk environment'

This paper discusses research findings on non-biological risk factors associated with illicit drug use. There is an established body of North American research in this field, and a growing European literature. We find that there is an interplay of individual and environmental factors associated with drug use, with the permeation of their interactions potentially limitless. Within the behavioural science literature, we identify three main analytical dimensions for understanding 'risk factors'. These are: 'intrapersonal'; 'micro-environmental'; and 'macro-environmental'. We note that it is not new to emphasize drug use as a social activity, involving social interactions within particular social environments, but that, despite this, the balance of focus in research tends towards 'extra-environmental' or 'individualistic' interpretations. We emphasize that future research is best oriented towards generating data of practical value for the development of interventions rather than attempting to delineate causative factors. The failure of most risk factors research rests in its incapacity to capture the variety of social and environmental influences on drug use, and the relevance of these for developing socially appropriate interventions. In addition to recognizing the importance of targeting interventions towards 'high risk' populations and 'high risk' forms of drug use, we emphasize throughout the importance of the 'risk environment' in mediating patterns of drug use.