Plasma amiodarone concentrations during intravenous infusion.

Amiodarone is a useful antiarrhythmic agent whose pharmacokinetics are incompletely characterised. In order to optimise efficacy of an antiarrhythmic drug, information regarding plasma concentrations achieved during use of the drug is necessary. We report plasma amiodarone and desethylamiodarone concentrations in eight patients following intravenous infusion at a rate of 175 mg h-1 for the first 2 h, followed by infusion at a rate of 50 mg h-1 for a further 46 h a regimen very similar to that recommended by the manufacturers. In at least three of eight patients plasma concentrations were below the suggested therapeutic range of 1.0-2.5 mg l-1 from 3 to 16 h after the infusion was started. Our data suggests that larger doses of intravenous amiodarone than those previously recommended may be necessary to obtain optimal benefit from the drug.     

Pharmacokinetics of rifampin in children. I. Multiple dose intravenous infusion

The pharmacokinetics of intravenous rifampin (280 +/- 78 mg/m2) were investigated during multiple dose administration in 12 pediatric patients aged 3 months to 12.8 years. Serum rifampin concentration data were fit to a linear one-compartment model. There was a significant effect of duration of therapy on rifampin clearance (Cl) and half-life (t1/2) (p = 0.027 and p = 0.048, respectively). A mean increase of 52.0% in Cl (3.10-4.72 L/h/m2) and a mean decrease of 27.0% in t1/2 (2.38-1.73 h) were observed when data collected during the first 2 days of therapy were compared with data collected following 8 or more days of therapy. Peak concentrations extrapolated to the end of infusion were 27.0 +/- 8.2 micrograms/ml, and concentrations at 8 h after the dose were only 1.9 +/- 1.5 micrograms/ml. There was no significant effect of duration of therapy on these concentration values. There was no correlation between Cl and age or administered dose. Intrapatient variation in Cl was great, as evidence by the lack of correlation of initial Cl values with subsequent values in individual patients (r = 0.259). It would appear that dosage intervals may need to be shortened from 12 to 8 h during continuous therapy, and that periodic measurement of rifampin concentration may be required.     

Pharmacokinetic model for procaine in humans during and following intravenous infusion.

A multicompartment pharmacokinetic model is presented to describe procaine distribution in humans during and following intravenous infusion. The model, based on a general perfusion model, relates individual characteristics such as sex, age, weight, height, infusion rate and duration, and hematocrit to general parameters such as drug metabolism, protein binding, ion-trapping effects, and tissue-plasma distribution coefficients to provide an individualized distribution prediction. Experimentally observed kinetics of blood procaine levels collected during intravenous procaine infusion as an adjunct to surgical anesthesia and blood lidocaine levels obtained from the literature compared very well with the model simulation.     

瑞芬太尼和异丙酚全凭静脉麻醉在小儿短小手术中的应用

目的探讨瑞芬太尼复合异丙酚用于小儿短小手术全凭静脉麻醉的有效性、安全性和可控性。方法选择小儿外科择期手术患儿80例,随机分为4组,R1、R2、R3 3组为全凭静脉麻醉组(瑞芬太尼加异丙酚全凭静脉麻醉),C组为对照组,采用静脉吸入复合麻醉。4组均不插管,保留自主呼吸。监测血压、心率、血氧饱和度、手术时间、苏醒时间、听觉诱发电位、血糖。结果4组均达到外科麻醉深度,R2组麻醉效果最好,R1、R2、R3组苏醒快,C组出现1例喉痉挛。结论在小儿短小手术中,选择瑞芬太尼复合异丙酚全凭静脉麻醉,术中血液动力学指标更平稳,术中及术后副作用也相对较少,更安全。     

术中静脉使用胰岛素对女性肥胖伴胰岛素抵抗患者糖代谢的影响

目的 了解女性肥胖伴胰岛素抵抗患者麻醉和手术中血糖和血浆胰岛素水平的变化,以及术中静脉滴注胰岛素对其影响.方法 20例女性肥胖伴胰岛素抵抗的择期手术患者,ASAI—Ⅱ级,随机分成2组,B组术中静脉滴注无糖溶液;C组使用含糖溶液加胰岛素静脉滴注,每4g葡萄糖用1U胰岛素,胰岛素总量控制在20U,其余液体使用无糖溶液;另设10例无胰岛素抵抗患者作为对照组(A组),分别于麻醉前、麻醉后、术中(手术进行30min)和未毕测定血糖和血浆胰岛素水平.结果 女性肥胖患者均存在胰岛素抵抗现象,表现为空腹血糖水平和血浆胰岛素水平较对照组明显升高,麻醉和手术应激均使血糖和血浆胰岛素水平升高,术中静脉滴注胰岛素可防止血糖升高.结论 女性肥胖患者存在胰岛素抵抗现象,术中适当使用胰岛素可纠正手术应激对其糖代谢的影响.     

环丙沙星静滴致过敏性休克

患者男,20岁。因发热3d,于2002年12月20日来我院门诊就诊。查体:T37.8℃,咽充血,双侧扁桃体Ⅱ度肿大,可见脓性分泌物,双肺呼吸音清,HR88次·min-1,律齐,腹软,无压痛。诊断:急性化脓性扁桃体炎。给予环丙沙星0.2g静滴。当静滴约5min时,患者突然出现心慌、憋气、大汗、面色苍白,随后意识丧失,BP0/0mmHg。考虑为过敏性休克,立即更换输液器,给予地塞米松5mg静脉注射,吸氧。5min后测血压为45/30mmHg(1mmHg=0.133kPa);10min后,患者神志恢复,BP90/60mmHg,HR80次·min-1,律齐;30min后,BP95/60mmHg,HR76次·min-1。留观2h后平安离院。患者在…     

Pharmacokinetics of cephapirin sodium during intravenous infusion

Studies on absorption and excretion of cephapirin (CEPR) are described. CEPR was administered by intravenous drip infusion to 4 healthy volunteers weighing 53 kg to 61 kg, and the serum levels were measured. Pharmacokinetic parameters were calculated by one-compartment model and two-compartment model. Each model was comparatively applied to every founds. Most appropriate administration rate of intravenous drip infusion was discussed due to calculated serum levels, therapeutic AUC and effective time.     

静脉滴注艾迪注射液致严重过敏性反应

患者男,42岁,有青霉素过敏史。因肺癌术后50余天,第2次化疗后1个月,于2005年5月8日10:15再入我院。CT示:右上肺叶后段及下叶背段占位并纵隔淋巴结转移,病理示:低分化鳞癌。术后曾给予顺铂(DDP)联合丝裂霉素(MMC)化疗2次。本次入院拟行化疗。入院检查:T36.2℃,P98次/min,R20次/min,BP120/90mm Hg(1mm Hg=0.133kPa),心腹(-),右肺呼吸音稍弱,叩诊音浊,未闻及湿罗音,浅表淋巴结不大。血常规:RBC3.85×1012/L,WBC8.15×109/L,Hb122g/L;肝功:ALT49U/L,AST41U/L,肾功能正常,二便(-),心电图示:窦性心律,心电轴轻度左偏。X线胸片:两肺…     

小儿静滴双黄连粉针剂不良反应观察

目的:了解小儿静脉滴注双黄连粉针剂不良反应(ADR)发生情况,并探讨其相关因素。方法:对因急性呼吸道感染(ARI)住院应用双黄连治疗的患儿进行观察,并对其不良反应进行归纳统计和分析。结果:应用双黄连粉针剂治疗急性呼吸道感染患儿1204例,发生ADR共101例,发生率8.39%,其中与抗生素配伍给药发生率9.48%,单独给药发生率6.04%,两者相比具有差异性(P<0.05)。ADR类型主要为皮疹,其次为胃肠道症状。结论:小儿静脉滴注双黄连粉针剂发生ADR频数较高,不容忽视,若须与抗生素合用,宜单独给药,可减少ADR发生。     

Pharmacokinetic modeling of plasma and cerebrospinal fluid methotrexate after high-dose intravenous infusion in children.

A pharmacokinetic study was performed in plasma and cerebrospinal fluid (CSF) of patients suffering from brain tumors to describe the disposition of methotrexate. An open three-compartment model was developed to fit together the data obtained in plasma and CSF. The pharmacokinetic parameters obtained by the model agreed with those obtained with classical analysis and the fitting correctly depicted the plasma and CSF concentration decays. According to the results, such a model could be applied to other anticancer drugs.     

阿昔洛韦静脉滴注致急性肾功能衰竭

患者男,34岁。因纳差,乏力伴尿量减少2d,于2006年8月21日入院。4d前因生殖器疱疹在当地诊所予以阿昔洛韦0.75g+5%葡萄糖注射液250ml静脉滴注,次日下午出现双侧腰部疼痛、查尿蛋白(+),疑为药物所致遂停止使用阿昔洛韦。继而出现恶心、呕吐,尿量约为400ml。第4天来我院就诊,入院时查体:T36.7℃,P80次/min,R20次/min,BP130/100mmHg。双肾区有叩击痛,双下肢无水肿。患者平素体健,否认肾炎、高血压、糖尿病史。Cr424μmol/L,BUN11.54mmol/L,尿酸(UA)445μmol/L,CO2CP22mmol/L;尿沉渣:RBC1.2×105个/ml,均一型,WBC4～5个/HP。血、大便…     

阿昔洛韦静脉滴注致急性肾功能损害

患者男,35岁。因左颈部、肩部水疱,疼痛1周,腰痛3d,于2003年2月10日来院就诊。患者1周前劳累后左颈部、肩部突发米粒至绿豆大小丘疹、丘疱疹、水疱,皮疹渐增多,伴阵发性刺痛。发病第4天在当地医院诊断为“带状疱疹”,给予阿昔洛韦0.5g 5%葡萄糖注射液500mL静滴,1次/d。次日,当输入液体约150mL时,患者突感腰部疼痛,活动受限,立即终止输液,经卧床休息后,疼痛稍缓解。2d后,症状仍无明显改善,遂来我科就诊,门诊以“带状疱疹,腰痛待查”收入院。发病以来,无发热、畏寒,心悸、气促,腹痛、腹泻、头痛、呕吐、少尿、血尿等症状。精神尚可,食欲、睡…     

头孢曲松钠静滴致双硫仑样反应

患者男,46岁。因尿频、尿急、尿痛3d,于2004年2月16日来我院就诊。查体:体温37.4℃,下腹部压痛。实验室检查:尿常规:WBC20-30/HP、RBC1-4/HP、BLD( ),其它正常。诊断:尿路感染。拟给予头孢曲松钠2.0g/d静滴,并嘱用药期间不能饮酒。患者因当晚有酒宴未用药,故于次日下午5:00左右,给予头孢曲松钠2.0g 0.9%氯化钠注射液100mL静滴,1次/d。输入药液约50mL时,患者自觉周身奇痒,继续用药后,出现头晕、心慌、呼吸困难、恶心、嗜睡等症状。查体可见患者颜面潮红呈醉酒状,眼结膜充血,皮肤潮红并伴片状丘疹。即刻测血压130/90mmHg(1mmHg=0.133k…     

儿童静脉输液安全问题的调查与干预模式探讨

目的:探讨药师与临床合作,参与静脉输液安全的管理的模式。方法:采用WHO推荐的监测-培训-计划(monitoring-training-planning,MTP)模式,设计调查问卷,了解临床医生、护士对静脉输液安全用药相关知识认知现况和需求;药师针对调查反馈的信息,对临床医护人员开展相应的培训、编写《静脉输液手册》和搭建静脉输液信息共享平台。结果:通过MTP循环,临床医护人员对静脉输液安全用药相关知识的认知有了显著的提高,药师亦更多地参与静脉输液安全的管理。结论:药师在静脉输液安全管理中可发挥重要的作用。     

Clinical and pharmacokinetic studies of gentamicin in intravenous drip infusion to children

Eighteen children with urinary tract infection were treated with intravenous drip infusion of gentamicin (GM), and clinical efficacy and pharmacokinetics were studied. Ages of the patients ranged from 2 months to 12 years. Doses of GM ranged 1.0 to 2.5 mg/kg every 8 to 12 hours, and treatment continued for 4 to 10 days. Among 18 patients treated, clinical results were excellent in 12, and good in 6. Values of BUN and creatinine remained within normal range in all patients during and after the GM treatment. One child had an eosinophilia. There were no cases that showed signs and symptoms of oto- and nephrotoxicity. Twenty eight time-serum level curves were studied in 16 patients during and after intravenous infusion of GM over 30 minutes. Doses were 1.0 mg/kg in 4, 1.9-2.0 mg/kg in 14, and 2.2-2.5 mg/kg in 10. Peak serum levels at 30 minutes after the start of infusion were 2.66-7.38 micrograms/ml (average 5.45 micrograms/ml) in cases receiving 1.0 mg/kg, 4.67-10.8 micrograms/ml (7.26 micrograms/ml) in 1.9-2.0 mg/kg, and 6.16-16.5 micrograms/ml (8.86 micrograms/ml) in 2.2-2.5 mg/kg. Elimination half-lives were 1.75-2.48 hours (average 2.10 hours) in cases with ages less than 1 year, 1.58-2.58 hours (2.01 hours) with 1 to 6 years, and 1.20-3.07 hours (1.66 hours) with 7 to 12 years who were given doses of 1.9-2.5 mg/kg. There were no significant differences in pharmacokinetic parameters between first and last administration in these patients, suggesting that no accumulation occurred with above mentioned doses. Urinary recovery of GM ranged from 21.9 to 99.2 percent (average 62.48%) within 6.5 hours after the initiation of drip infusion.     

莪术油葡萄糖注射液静滴致过敏性休克

患儿男,2岁4个月。因发热、咳嗽1d,于2004年4月25日上午到开县妇幼保健院就诊。查体:T38.5℃,听诊,双肺闻及湿啰音，白细胞总数和中性罯赴龈?诊断为肺炎。给予退热、抗感染、抗病毒、支持等治疗。当日中午12h开始静滴莪术油葡萄糖注射液,5min后患儿出现面色苍白、牙关紧闭、呼吸困难、神志不清等症状。立即停药、平卧、吸氧,给予地塞米松等抗过敏治疗。2h后,患儿病情好转,住院观察2d,病情稳定,门诊继续抗感染治疗。追问病史,无其它药物过敏史和家族史。莪术油葡萄糖注射液是莪术油、葡萄糖与适宜的助溶剂制成的灭菌水溶液,莪术油中含有莪…     

Vagal activity is increased during intravenous isoprenaline infusion in man

Eight healthy normal subjects (19-23 years) received graded intravenous isoprenaline infusions PRE- and POST-atropine, 0.04 mg/kg i.v. The adequacy of atropinization was tested with bolus intravenous injections of phenylephrine. PRE-atropine, isoprenaline caused an increase in heart rate and systolic pressure, but a decrease in diastolic pressure with little change in mean pressure (+32.8 +/- 3.0 beats/min, +18.9 +/- 3.0 mm Hg, -13.5 +/- 1.9 mm Hg, -2.7 +/- 1.9 mg Hg respectively at isoprenaline 2 micrograms/min). POST-atropine, the increase in heart rate was enhanced, the rise in systolic pressure abolished and the falls in diastolic and mean pressures exaggerated (+47.0 +/- 2.8 beats/min, -8.9 +/- 2.9 mm Hg, -27.3 +/- 2.1 mm Hg, -21.1 +/- 1.9 mm Hg, respectively at isoprenaline 2 micrograms/min). During an isoprenaline infusion, when the heart rate and blood pressure changes are stable, there is an increase rather than a decrease in cardiac vagal tone.