急性心肌梗死应用瑞替普酶和阿替普酶溶栓效果的对比研究

目的比较国产瑞替普酶和进口阿替普酶对急性ST段抬高型心肌梗死(STEMI)的溶栓效果。方法回顾性分析80例ST段抬高型心肌梗死患者,根据溶栓药物不同分为国产瑞替普酶治疗组40例,进口阿替普酶治疗组40例,比较两组患者在临床症状、梗死相关血管的再通率、射血分数(EF)值、心力衰竭发生率、心肌梗死后心绞痛发生率、出血率及出院前病死率的差别。结果瑞替普酶治疗组在患者临床症状的缓解、梗死相关血管的再通率、降低病死率方面均略高于阿替普酶组,但差异无统计学意义(P>0.05),在EF值、心力衰竭发生率、心肌梗死后心绞痛发生率、出血率方面比较亦无明显差别。结论临床上应用国产瑞替普酶及进口阿替普酶溶栓治疗急性心肌梗死疗效相当,但国产瑞替普酶使用快速、简便、经济、易操作,更适合在临床使用。     

瑞替普酶与阿替普酶对急性心肌梗死患者溶栓效果的对比研究

目的观察瑞替普酶与阿替普酶对心肌梗死溶栓的效果。方法对70例ST段抬高型心肌梗死患者行瑞替普酶和阿替普酶溶栓治疗,比较两组患者的再通率、住院天数、心功能等指标。结果两组患者在再通率心功能、并发症、住院天数等方面比较差异无统计学意义（P〉0.05）。结论在心肌梗死的溶栓治疗中,瑞替普酶可以取得较好的临床效果。     

探讨瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的应用效果

目的探讨瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的应用效果。方法选取我院收治的急性ST段抬高型心肌梗死患者参与本次实验,所选病例来自2016年1月至2017年2月,总病例为70例,采取抽签法将其分为治疗组(35例)与对照组(35例),治疗组患者采取瑞替普酶治疗,对照组患者采取阿替普酶治疗,分析比较两种药物的治疗效果。结果两组患者胸痛到溶栓时间和再通时间、再通率、心电图ST段回落≥50%的发生率、完全回落的发生率、心力衰竭发生率、存活率、并发症发生率均无明显差别,不具有统计学意义(P>0.05),治疗组患者治疗费用明显少于对照组,两组对比可见统计学意义(P<0.05)。结论瑞替普酶与阿替普酶在治疗急性ST段抬高型心肌梗死中均具有较好的临床疗效,且安全性高,但瑞替普酶更加简便经济。     

阿替普酶治疗急性心肌梗死的疗效观察

目的 探讨阿替普酶治疗急性心肌梗死临床疗效和安全性.方法 选取急性心肌梗死患者126例,随机分为对照组和观察组,每组63例,对照组给予瑞替普酶溶栓治疗,观察组则给予阿替普酶溶栓治疗,2组患者的其他治疗措施均相同,比较2组患者临床疗效和药物不良反应发生情况.结果 2组患者临床症状缓解率和冠状动脉再通率差异无统计学意义(P>0.05),观察组在梗死后心绞痛、心力衰竭和心律失常方面明显低于对照组(P<0.05),2组患者在心肌再梗死、出院前死亡和药物不良反应发生率差异无统计学意义(P>0.05).结论 阿替普酶治疗急性心肌梗死疗效确切,具有冠状动脉再通率高、临床症状缓解率高、主要终点事件发生率低,不良反应发生少且轻微.     

瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中对比研究

目的：对比分析瑞替普酶和阿替普酶治疗急性ST段抬高型心肌梗死溶栓患者的临床疗效。方法90例急性ST段抬高型心肌梗死患者,将所有患者随机分为观察组和对照组,每组45例。观察组给予静脉注射瑞替普酶,对照组给予静脉注射阿替普酶。观察对比两组患者再通时间、再通率以及并发症情况。结果观察组患者在治疗之后,再通时间与对照组对比差异无统计学意义（P〉0.05）;观察组再通率85%,高于对照组中80%,但是差异无统计学意义（P〉0.05）;两组患者并发症发生率比较,差异无统计学意义（P〉0.05）。结论对于急性ST段抬高型心肌梗死患者采用瑞替普酶和阿替普酶都能够取得比较好的治疗效果,且安全性无异,而瑞替普酶更加简便和经济,更值得临床广泛运用。     

瑞替普酶治疗急性心肌梗死的观察与护理

目的探讨瑞替普酶治疗急性心肌梗死患者的疗效及护理方法。方法对140例急性心肌梗死患者在基础治疗的同时给予瑞替普酶溶栓治疗,观察瑞替普酶治疗急性心肌梗死的疗效。结果 140例患者予瑞替普酶溶栓治疗后,119例患者临床闽接判断为溶栓再通,再通率85%,脑出血2例,消化道出血1例,牙龈出血26例,占18.57%。结论瑞替普酶治疗急性心肌梗死再通率高、不良反应少,是一种高效而安全的治疗急性心肌梗死的溶栓药物。     

替罗非班联合瑞替普酶治疗急性心肌梗死的临床评价

目的探讨替罗非班联合瑞替普酶治疗急性心肌梗死的效果。方法选取我院应用药物溶栓治疗的166例急性心肌梗死患者,其中85例为瑞替普酶+盐酸替罗非班联合溶栓组(简称联合组),81例为瑞替普酶单独溶栓组(对照组),所有患者溶栓前后均常规应用肝素,对比两组血管再通情况以及临床不良终点事件发生情况。结果联合组血管再通率(91.76%)显著高于对照组(79.01%),临床不良终点事件(14.12%)明显低于对照组(24.69%),P<0.05,组间数据存在显著性差异。结论替罗非班联合瑞替普酶是急性心肌梗死较为安全、可靠的药物溶栓治疗方案,值得推广。     

基层医院阿替普酶治疗急性心肌梗死的应用

目的观察阿替普酶在基层医院急性心肌梗死溶栓治疗的必要性。方法笔者2007年1月～2011年10月对阿替酶治疗105例急性心肌梗死患者早期溶栓的效果进行回顾分析。结果本研究中阿替普酶溶栓再通率与文献报道相似。结论对于尚不能开展经皮冠状动脉成形术的基层医院,阿替普酶溶栓治疗急性心肌梗死再通率高,死亡率低,值得推广。     

瑞替普酶静脉注射治疗急性心肌梗死52 例疗效观察

目的：观察急性心肌梗死瑞替普酶静脉溶栓疗法的效果。方法：对52例急性心肌梗死患者用瑞替普酶静脉溶栓疗法进行治疗。结果：瑞替普酶临床再通率84．6％,4例出现上消化道出血,经治疗好转。结论：急性心肌梗死患者选用瑞替普酶静脉溶栓再通率高,是一种安全有效的再灌注疗法。     

替奈普酶治疗急性缺血性脑卒中疗效及安全性的Meta分析

目的 系统评价替奈普酶用于治疗急性缺血性脑卒中（AIS）的疗效和安全性，为临床合理选择静脉溶栓药物提供循证依据。方法 计算机检索PubMed、Embase、the Cochrane Library、Web of Science、Sinomed、中国知网、万方数据库和维普网，收集替奈普酶对比阿替普酶（对照）治疗AIS疗效与安全性的随机对照试验，检索时限均为建库起至2022年6月。由2位评价员独立筛选文献，从文献中提取资料并评价纳入研究的偏倚风险，采用Stata 15软件对数据进行Meta分析。结果 最终纳入8篇文献，共计2129例患者。Meta分析结果显示，0.25 mg/kg（中剂量）替奈普酶组患者早期神经功能改善率[OR(95%CI)=2.44(1.09,5.46),P=0.030]、神经功能恢复良好率（静脉溶栓治疗90 d后改良Rankin量表评分0～2分）[OR(95%CI)=1.54(1.00,2.36),P=0.048]高于阿替普酶组。其余结局指标（包括再通率、再灌注病变百分比、神经功能恢复优异率、出血发生率、症状性颅内出血发生率及90 d内全因死亡率）方面，替奈普酶组与阿替...     

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.     

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。     

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.