氨甲环酸治疗黄褐斑临床疗效观察

目的观察口服氨甲环酸治疗黄褐斑的临床疗效及不良反应。方法将96例患者随机分为治疗组和对照组两组,治疗组54例,氨甲环酸1.0g/d,外用4%氢醌共12周;对照组42例,维生素C1.2g/d,外用4%氢醌12周,分别于治疗结束及结束后12周观察疗效及不良反应。结果 12周及24周时治疗组有效率为57.4%及51.9%,对照组有效率35.7%及28.6%,12周及24周时两组疗效比较差异均有统计学意义(P<0.05),未见明显不良反应。结论氨甲环酸治疗黄褐斑安全有效。     

HPLC法测定氨甲环酸胶囊的溶出度

目的 建立HPLC法测定氨甲环酸胶囊的溶出度.方法 色谱柱为C18(4.6mm×250mm,5μm)柱,磷酸盐缓冲液-甲醇(60:40)为流动相,检测波长220nm.结果 氨甲环酸在0.04mg·mL-1～0.4mg·mL-1,浓度范围内线性良好,r=0.9997;平均回收率为101.3%(RSD=1.0%).结论 本方法简便、准确,可作为氨甲环酸胶囊的溶出度控制标准.     

氨甲环酸片用于人工流产术止血的临床观察

目的探讨氨甲环酸片用于早孕孕妇行人工流产术的止血效果。方法将120例孕妇随机分为氨甲环酸组和对照组各60例,并按妇科检查及B型超声测定判断孕周大小进行配对。氨甲环酸组于人工流产术前2h予以氨甲环酸片500mg口服,对照组不服用任何药物。测量并比较2组术中及术后出血量,同时观察药物不良反应。结果氨甲环酸组术中、术后出血量及总出血量少于对照组,差异均有统计学意义(P<0.05)。氨甲环酸组出现轻度恶心18例(30.0%),轻度头晕8例(13.3%);对照组仅出现轻度恶心1例(1.7%),均未做任何处理自行好转。结论氨甲环酸片用于早孕孕妇人工流产术有较好的止血效果,术中及术后出血量均明显减少,无严重不良反应,有利于患者恢复。     

氨基己酸与氨甲环酸对体外循环血液保护效果的比较

目的比较氨基己酸(EACA)与氨甲环酸(TAX)对体外循环(CPB)的血液保护效果。方法择期行房间隔缺损修补术和(或)室间隔缺损修补术的先天性心脏病患者90例,随机分为3组(n=30):EACA组(A组),TAX组(B组)和对照组(C组)。A组在麻醉诱导后给予EACA100mg/kg,停机时追加EACA100mg/kg,手术结束时再补充EACA100mg/kg。B组在麻醉诱导后给予TAX10mg/kg,停机时追加TAX10mg/kg,手术结束时再补充TAX10mg/kg。C组给予等量生理盐水。于麻醉诱导前(基础状态,T0),CPB30min(T1),鱼精蛋白中和肝素后10min(T2),术后6h(T3)、12h(T4)和24h(T5)分别测定血浆凝血酶原时间(PT),活化部分凝血活酶时间(APTT),纤维蛋白原(FIB),纤维蛋白降解产物(FDP),血清栓溶二聚体(D-D);记录术后12h、24h每公斤体重纵膈心包引流量和成分输血量。结果 3组患者PT及APTT在围术期变化基本一致。与C组比较,A组和B组FIB、FDP和D-D浓度在麻醉诱导前差异无统计学意义(P>0.05),在T1～T3时FIB浓度升高(P<0.05),FDP和D-D浓度降低(P<0.05),在T4和T5时FIB、FDP和D-D浓度比较差异无统计学意义(P>0.05)。A组和B组术后12h、24h每公斤体重纵膈心包引流量及术后成分输血量明显少于C组,差异有统计学意义(P<0.05)。A组和B组比较,各项指标无明显差异(P>0.05)。结论氨基己酸与氨甲环酸均可明显抑制CPB引起的纤溶系统过度激活,减少术后失血量与输血量,且二者作用相似。     

普鲁卡因与垂体后叶素用于老年肺结核咯血止血治疗的对比研究

目的对比和分析普鲁卡因与垂体后叶素两种方法治疗老年肺结核并中、大咯血的止血效果、禁忌证和不良反应。方法观察组：普鲁卡因300mg加入5％葡萄糖或生理盐水500ml中静脉滴注，15～20滴／min，每天2次，维持至咯血停止后72h；对照组：垂体后叶素10～20u加入5％葡萄糖500ml中静脉滴注，15～20滴／min，每天2次，维持至咯血停止后72h。结果普鲁卡因组止血效果显著高于脑垂体后叶素组（P〈0．05），而且脑垂体后叶素组禁忌证及不良反应显著高于普鲁卡因组（P〈0．005）。结论普鲁卡因比垂体后叶素更适宜于治疗老年肺结核中、大量咯血。     

氨甲环酸在全膝关节置换术中局部应用和静脉应用的止血效果比较

目的比较氨甲环酸局部应用和静脉应用在减少全膝关节置换术患者出血量方面的效果和安全性。方法选择2012年6月至2013年12月符合标准的行初次单侧全膝关节置换术的100例患者。局部应用氨甲环酸术中止血的47例患者作为A组,静脉使用氨甲环酸术中止血的53例患者作为B组。分别记录两组术中出血量、术后失血量、输血例数、输血量、术后第1、3、5天血红蛋白值、红细胞压积、术前和术后3 h纤维蛋白原、凝血酶原时间、活化的部分凝血酶原时间、D-二聚体,术后5~7 d双下肢静脉超声筛查有无深静脉血栓(DVT)。结果 A组术后引流量、总失血量、输血量少于B组,未输血患者术后1、3、5 d血红蛋白值高于B组,差异有统计学意义(P<0.05);两组患者术前和术后3 h纤维蛋白原、凝血酶原时间、活化的部分凝血酶原时间、D-二聚体比较差异无统计学意义(P>0.05);术后经双下肢静脉超声检查均未见下肢深静脉血栓,术后随访均无下肢深静脉栓塞和肺栓塞。结论全膝关节置换术中局部应用氨甲环酸和静脉应用比较能明显减少术后出血量、降低输血量,二者均不增加DVT形成的风险。     

Pharmacokinetics of tranexamic acid after intravenous administration to normal volunteers

Summary The pharmacokinetics of tranexamic acid has been investigated in two healthy volunteers. The behaviour of the drug can be described in terms of a two compartment open model; the disposition (biological) half-life was 2.7 h and 1.9 h, respectively. In five normal volunteers the mean total recovery in urine 48 h after dosing was 94.8%. The renal clearance in the two subjects, adjusted to 1.73 m² body surface area, was 135 and 132 ml/min/1.73 m², respectively, indicating that tranexamic acid is eliminated by glomerular filtration and that neither tubular excretion nor absorption takes place.     

氨甲环酸与抑肽酶在小儿体外循环中对鸟苷一磷酸140影响的比较研究

目的观察并比较氨甲环酸和抑肽酶在体外循环（CPB）中对鸟苷一磷酸140（GMP-140）及CPB后失血的影响。方法随机选取先天性心脏病首次手术患者45例，分为氨甲环酸组（T组）、抑肽酶组（A组）和对照组（S组）各15例。分别于CPB开始前、中、后测定血小板表面GMP-140的含量，并记录各组术后纵隔心包引流量。结果CPB结束、手术结束2hGMP-140的阳性率T、A两组与S组比较差异均有显著意义（P〈0.05）；T、A两组间差异无显著意义。T组在术后3h的累积胸腔和心包引流量与S组比较差异有显著意义（P〈0.05）。A组在术后1h、3h的胸腔和心包引流量与S组相比较差异均有显著意义（P均〈0.05）。结论氨甲环酸与抑肽酶相似，均能明显抑制CPB对GMP-140的激活．保护血小板功能，并可显著减少术后失血。     

Efficacy and tolerance of a hydrocolloid dressing containing hyaluronic acid for the treatment of leg ulcers of venous or mixed origin

ABSTRACT

Objective: This study was aimed at comparing efficacy and tolerance of a new hydrocolloid dressing containing hyaluronic acid (HC?+?HA) to a reference hydrocolloid not containing hyaluronic acid (HC) in the treatment of leg ulcers of venous or mixed origin.

Research design and methods: This was an open, prospective study, randomized in parallel groups, in which 125 patients were enrolled and treated for up to 42 days. The primary efficacy criterion was the reduction of the wound area; other efficacy criteria were the condition of the wound bed, and of the surrounding skin, and presence and severity of symptoms such as pain and itching.

Results: After 42 days of treatment the median reduction of ulcer area was ?42.6% (95% confidence interval [CI]: ?66.6; ?5.7) and ?31.0% (95% CI: ?51.6; ?8.8) in the HC?+?HA group and in the reference HC group, respectively. The difference between treatments was not statistically significant. A reduction ≥?90% of the initial ulcer area was seen in 15 patients in the HC?+?HA dressing group and in only seven patients in the HC dressing group. Changes in wound bed condition in the two groups were not significantly different, except for a more marked reduction of fibrinous tissue in the HC?+?HA dressing group (?p?=?0.04), at Day 28. Both treatments were well tolerated.

Conclusions: The HC?+?HA dressing was equally well tolerated and with a trend to be more effective than the reference HC dressing in the treatment of leg ulcers of venous or mixed origin. Further research is needed to confirm these findings.     

Determination of tranexamic acid in cosmetic products by high-performance liquid chromatography coupled with barrel plating nickel electrode

Tranexamic acid (TA) is an important reagent in cosmetic skin-whitening formulation and a drug for the inhibition of plasminogen to plasmin in blood. Since there is no chromophore in tranexamic acid molecule to enable direct analysis by UV–visible absorption spectrophotometry, derivatization is thus required by excluding use of UV or fluorescence detection. We report here a relatively simple electrochemical TA detection method by using a barrel plating nickel electrode. Chromatographic separation was performed on a Hamilton PRP-X100 anion-exchange column (150 mm × 4.1 mm i.d., 10 μm particle size) with a (85:15, v/v) mixture of 0.1 mol l⁻¹ NaOH and acetonitrile as mobile phase and pumped at a flow rate of 0.9 ml min⁻¹. By detecting at +0.55 V vs. Ag/AgCl, the calibration plot was linear in the concentration window of 3–1000 ppm with regression coefficient and detection limit (S/N = 3) of 0.9993 and 0.13 ppm (0.84 μmol l⁻¹), respectively. Successive injections (n = 10) of 50 ppm tranexamic acid showed a R.S.D. value of only 0.3% indicating good reproducibility of the proposed system. The method was successfully applied to the analysis of the content of tranexamic acid in cosmetic products and proved to be suitable for rapid and reliable quality control.     

氨甲环酸对老年患者股骨转子间骨折手术后凝血及纤溶功能的影响

目的 探讨氨甲环酸对老年患者股骨转子间骨折手术后凝血及纤溶功能的影响.方法 123例老年股骨转子间骨折患者,随机分为对照组(60例)及观察组(63例).对照组患者术后切口内注射氯化钠注射液,观察组患者术后切口处应用1％ 氨甲环酸注射液与0.9％ 氯化钠注射液.对比两组患者总失血量、隐性失血量及手术前后凝血功能及纤溶功能...     

氨甲环酸注射液联合谷胱甘肽及维生素C治疗黄褐斑的近期临床观察

目的：对氨甲环酸注射液联合谷胱甘肽及维生素C静滴治疗黄褐斑的临床疗效进行评价。方法将100例面部黄褐斑的患者分为两组。治疗组使用氨甲环酸0.25g注射液＋谷胱甘肽1.2g＋维生素C 5g静脉滴注8周。对照组仅用谷胱甘肽1.2g＋维生素C 5g静脉滴注8周。结果治疗组总有效率为92%,对照组总有效率62%。两组疗效比较,差异有统计学意义（P＜0.05）。结论氨甲环酸注射液联合谷胱甘肽及维生素C静滴治疗黄褐斑比单用谷胱甘肽1.2g＋维生素C的疗效更好。     

氨甲环酸在治疗黄褐斑领域中的应用进展

黄褐斑是一种常发于面部的难治性皮肤疾病,以不规则的色素沉着斑为特征。目前主要治疗药物有对苯二酚、维A酸等,但其副作用较大。氨甲环酸是一种人工合成的赖氨酸衍生物,属于抗纤维蛋白溶解剂,经FDA批准用于治疗月经过多和预防出血。另外,氨甲环酸具有治疗黄褐斑功效,它通过对纤溶酶原激活途径的抑制作用,从而减轻色素沉着症状。本文在PubMed、Web of Science、CNKI、ScienceDirect等数据库进行了广泛的文献检索,对氨甲环酸在治疗黄褐斑领域的制剂学研究和临床有效性研究进行了资料归纳与分析,为临床上应用氨甲环酸治疗黄褐斑提供参考。     

氨甲环酸腔内注射对股骨粗隆间骨折闭合髓内钉内固定潜在失血量的影响

目的 探究氨甲环酸对于股骨粗隆间骨折闭合髓内钉(InterTan)内固定潜在失血的临床疗效和安全性.方法 选择2014年6月至2016年6月安徽医科大学附属巢湖医院接受股骨粗隆间骨折髓内钉内固定手术治疗的100例患者为研究对象,分层随机分为对照组和观察组(各50例).其中对照组在手术扩髓后给予0.9%氯化钠溶液250 mL腔内注射;观察组则以250 mL的氨甲环酸溶液腔内注射.比较两组患者手术前后的血红蛋白变化以及输血情况;手术过程中的可见失血量、潜在失血量和总失血量;并在术后利用超声检查下肢深静脉血栓形成情况.结果 两组患者术前血红蛋白差异无统计学意义(P>0.05);观察组患者术后连续3 d的血红蛋白含量均高于对照组;观察组19例患者需行输血,而对照组32例需要输血;观察组输血量为(228.95±60.82)mL,明显少于对照组(P<0.01);两组患者在可见失血量方面差异无统计学意义[(155.20±17.87)mL比(156.80±10.39)mL,P>0.05],但观察组患者的潜在失血量[(794.09±234.19)mL比(1094.7±269.3)mL]和总失血量[(950.89±237.54)mL比(1249.9±270.03)mL]均明显少于对照组(P<0.01);术后两组均未出现下肢深静脉血栓.结论 临床上使用氨甲环酸对髓内钉内固定潜在失血的临床疗效明显,显著降低患者的失血量,并且具有较高的安全性,因此值得应用和推广.     

荟萃分析氨甲环酸治疗特发性月经过多的疗效

目的系统评价氨甲环酸治疗特发性月经过多文献的质量,荟萃分析氨甲环酸治疗特发性月经过多的疗效。方法全面收集关于氨甲环酸治疗月经过多的相关文献,并根据改良Jadad量表严格评价文献质量,用Rev Man 4.2荟萃分析软件分析比较氨甲环酸与安慰剂、孕激素类药物及非甾体类药物治疗月经过多的有效性与安全性。结果根据纳入与排除标准对收集到的文献进行筛选,共有8篇文献纳入本次研究,其中英文文献7篇,中文文献1篇。优质文献的比例为87.5%。氨甲环酸与孕激素、非甾体类等止血药物均可在某种程度上减少特发性月经过多患者的月经量。但在月经量减少程度、治疗有效率、患者自我感觉改善的比例上,氨甲环酸的效果均显著高于安慰剂及其他药物组。氨甲环酸并不改变患者的经期长度,且引起不良反应的比例显著低于孕激素类药物。结论氨甲环酸是一种用于治疗特发性月经过多的安全有效的药物,值得临床推广。但由于纳入本次研究的文献数量偏少,且中文只有1篇,结论存在一定的偏倚,有待更大样本量研究的验证。     

Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements after cardiopulmonary bypass: a prospective,randomised, double-blind trial

Summary

Introduction: Aprotinin (AP) reduces blood loss and transfusions after cardiopulmonary bypass (CPB), but may sensitise patients and is expensive. Tranexamic acid (TA) has less side-effects, but data regarding its efficacy are controversial. The aim of our prospective, randomised, double-blind study was to compare the impact of AP vs. TA on drainage blood loss and transfusion requirements in patients undergoing first time CABG on CPB.

Materials and Methods: One hundred and twenty adult patients were randomised to receive either high-dose AP according to Hammersmith or a total of 2 g TA. Perioperative blood products were transfused in a standardised fashion. Blood loss was measured up to 24 h. Demographic and clinical patient data were collected until hospital discharge.

Results: The data from 118 patients (TA: n = 58, TA appears to be a cost-effective alternative to AP AP: n = 60) who completed the study according to protocol were analysed. Blood loss at 24 h postoperation in TA patients was significantly higher (896 ± 354 ml) as compared to AP patients (756 ± 347ml; p = 0.03). TA patients received 1.5 ± 1.5 units of red blood cells (AP: 1.5 ± 1.7, p = 1.0), 1.3 ± 2.0 units of fresh frozen plasma (AP: 1.0 ± 2.0, p = 0.38) and 0.5 ± 1.4 units of platelets (AP: 0.2 ± 0.7, p = 0.15). Clinical data, including perioperative myocardial infarction rate, acute renal failure, mechanical ventilation, hospital stay and mortality, were not significantly different between either group.

Conclusion: Our data show a difference in blood loss between TA and high-dose AP. Although statistically significant, it has little clinical relevance, because perioperative transfusion requirements were similar for both groups. Thus, TA appears to be a cost-effective alternative to AP in primary CABG patients.     

Salvianolic acid B dry powder inhaler for the treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis(IPF) is a serious and fatal pulmonary inflammatory disease with an increasing incidence worldwide. The drugs nintedanib and pirfenidone, are listed as conditionally recommended drugs in the “Evidence-Based Guidelines for the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis”. However, these two drugs have many adverse reactions in clinical application. Salvianolic acid B(Sal B), a water-soluble component of Salvia miltiorrhiza, could alleviate bleomycin-induc...     

氨甲环酸关节腔内给药对单侧人工全膝关节置换术患者术后引流量的影响分析

目的 分析单侧人工全膝关节置换术患者给予氨甲环酸关节腔内给药对其术后引流量的影响。方法 将该院确诊并收治的94例膝关节骨性关节炎患者按照随机数字法分为对照组和研究组,每组47例。两组均实施单侧人工全膝关节置换术,对照组在关节囊缝合后单纯向囊内注射生理盐水混合液,研究组在关节囊缝合后向囊内注射氨甲环酸注射液与生理盐水混合液。术后常规实施抗血栓生成及康复锻炼,对失血量大的患者结合临床进行异体红细胞输注。对比两组术中出血量和术后引流量。对比两组术后24 h及72 h的血红蛋白(haemoglobin,Hb)、红细胞比容(hematocrit,Hct)、D-二聚体水平变化幅度。统计两组术后并发症及输血情况。结果 两组术中出血量差异无统计学意义(P＞0.05)。研究组术后24 h引流量及合计总引流量均显著低于对照组(P＜0.05)。两组术后24 h血红蛋白变化幅度,术后24 h及术后72 h D-二聚体变化幅度无显著差异(P＞0.05)。研究组术后72 h血红蛋白变化幅度、术后24 h及术后72 h红细胞比容变化幅度显著低于对照组(P＜0.05)。两组均无严重不良反应发生。两组输血率差异无统计学意义,但对照组中6例输血,研究组无输血病例。结论 单侧人工全膝关节置换术患者给予氨甲环酸关节腔内给药可显著减少术后引流量,遏制术后出血,从而避免引发贫血相关的并发症发生、避免输血治疗,有助于患者术后的恢复,同时不会增加下肢静脉血栓风险。     

Synthesis and characterization of membranes obtained by graft copolymerization of 2-hydroxyethyl methacrylate and acrylic acid onto chitosan

Chitosan based membranes to be applied on wound healing as topical drug delivery systems were developed by graft copolymerization of acrylic acid (AA) and 2-hydroxyethyl methacrylate (HEMA) onto chitosan using cerium ammonium nitrate as chemical initiator. Evidence for graft copolymerization of the vinyl monomers onto chitosan was obtained by FTIR and DMTA. Swelling degree, cytotoxicity, thrombogenicity and haemolytic activity of these membranes were evaluated. Chitosan-graft-AA-graft-HEMA showed to be the best matrix for drug delivery systems than chitosan-graft-AA because it retains good swelling properties, but the content in HEMA has improved cytocompatibility, hemocompatibility and thrombogenic character.     

关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术疗效及出血量的影响

目的 研究关节腔和静脉联合应用氨甲环酸对人工全膝关节置换术(TKA)疗效及出血量的影响。 方法 2015年5月至2017年5月,陕西省中医医院共收治86例行TKA患者,以随机数字表法分成观察组43例,对照组43例。观察组患者在止血带松动前20 min行静脉滴注氨甲环酸(10 mg·kg-1)溶液100 mL,术后经引流管向关节腔直接注射1.0 g氨甲环酸,引流管夹闭1 h后行负压吸引;对照组患者在止血带松动前20 min行静脉滴注生理盐水100 mL,术后经引流管向关节腔直接注射1.0 g氨甲环酸,引流管夹闭2 h后行负压吸引。对比观察两组治疗后失血量、凝血功能、临床资料及输血率与深静脉血栓形成(DVT)发生率。 结果 术后观察组在显性失血量与阴性失血量及总失血量方面均明显低于对照组(t=5.674,6.519,7.767;P＜0.001,＜0.001,＜0.001);术后两组患者在凝血酶原时间(PT)与活化部分凝血活酶时间(APPT)及D-二聚体(D-D)等指标均差异无统计学意义(t=0.258,0.786,1.537;P=0.797,0.434,0.128);手术后观察组患者血红蛋白与红细胞比容及血体积改变等方面明显不同(t=2.128,3.637,14.604;P=0.036,0.001,＜0.001);术后两组患者DVT发生率(观察组为13.95%,对照组为18.60%)差异无统计学意义,但输血率观察组(13.95%)明显低于对照组(39.53%)(χ²=7.182,P=0.007)。 结论 关节腔和静脉联合应用TXA对人工膝关节手术患者治疗中,有效降低了术后患者出血量,改善了患者血红蛋白与红细胞比容及血体积,同时还有效降低了患者术中及术后输血率,且不增加DVT发生率,值得临床借鉴。