亚胺培南-西司他丁钠与美罗培南对开颅术后颅内感染患者的临床疗效与安全性比较

目的:评价亚胺培南-西司他丁钠与美罗培南对患者开颅术后颅内感染的临床疗效与安全性。方法:选取2016年12月—2018年2月间收治的行开颅术后颅内感染患者122例资料,按用药方法的不同将其分为观察组(61例)和对照组(61例);对照组患者给予亚胺培南-西司他丁钠治疗,观察组患者给予美罗培南治疗;比较两组患者治疗后的总有效率与用药期间不良反应发生率差异。结果:观察组患者治疗后的总有效率(67.21%)高于对照组(44.26%()P<0.05),用药期间不良反应发生率低于对照组(P<0.05)。结论:采用美罗培南治疗开颅术后颅内感染患者的临床效果与安全性均优于亚胺培南-西司他丁钠,且安全性较高。     

美罗培南与亚胺培南-西司他丁钠治疗老年重度医院获得性肺炎的临床疗效

目的 评价美罗培南与亚胺培南-西司他丁钠治疗老年重度医院获得性肺炎的有效性和安全性。方法 回顾分析132例老年重度医院获得性肺炎使用美罗培南53例或亚胺培南-西司他丁钠79例治疗的临床疗效、细菌清除率、安全性和临床分离菌体外药敏试验。结果 美罗培南与亚胺培南-西司他丁钠治疗老年重度医院获得性肺炎的总有效率分别为94．3％(50／53)和88．6％(70／79)，痊愈率为88．6％(47／53)和75．9％(60／79)。治疗前共分离细菌123株，美罗培南与亚胺培南-西司他丁钠对细菌的总敏感率分别为95．9％(118／123)和93．5％(87／93)，细菌清除率分别为92.3％(48／52)和90．1％(64／71)。药物不良反应发生率分别为9．4％(5／53)和12．6％(10／79)，一过性反应较轻。上述2组结果经统计学处理，P均＞0．05。结论 美罗培南和亚胺培南-西司他丁钠治疗老年重度医院获得性肺炎疗效确切且安全。     

某院呼吸内科50例亚胺培南-西司他丁医嘱合理用药分析

目的:点评医院呼吸内科亚胺培南-西司他丁医嘱,分析其不合理使用的原因,为临床合理用药提供参考。方法:抽取2016年1月—2016年12月间使用过亚胺培南-西司他丁的呼吸内科住院患者50例资料,依据抗菌药物相关文件和权威资料分析用药的合理性。结果:该50例患者亚胺培南-西司他丁的用药频度(DDDs)及药物利用度指数(DUI)分别为476.5和1.40,22例患者存在不合理用药现象,不合理使用率为44.00%,其中无用药指征1例、用药时机不当2例、用法用量不合理15例、未进行细菌学检测2例和越权使用2例。结论:医院呼吸内科亚胺培南-西司他丁的使用属基本合理,但仍存在许多不足之处,应从制度和技术两个层面加强抗菌药物的管理,促进临床合理用药,保障用药的安全、有效和经济。     

亚胺培南-西司他丁钠对急诊重症感染患者抗感染的临床疗效与安全性评价

目的:探究亚胺培南-西司他丁钠对急诊重症感染患者抗感染的临床疗效与安全性。方法:选取2017年5月—2018年5月期间就诊治的急诊重症感染患者60例资料,按治疗方法的不同将其分为治疗组与对照组,每组30例;其中,对照组患者给予头孢哌酮钠抗感染治疗,治疗组患者则给予亚胺培南-西司他丁钠抗感染治疗,比较两组患者治疗后的总有效率与用药期间不良反应的发生率差异。结果:治疗组患者治疗后的总有效率高于对照组(P<0.05),用药期间不良反应发生率低于对照组(P<0.05)。结论:亚胺培南-西司他丁钠用于治疗急诊重症感染患者的疗效优于头孢哌酮钠,且安全性较高。     

亚胺培南西司他丁钠在我院儿科的用药合理性分析

目的了解亚胺培南西司他丁钠在本院儿科的用药合理性,促进特殊管理级抗菌药物的合理应用,减少院内感染和细菌耐药性的发生。方法抽取2011年6月~2012年6月共136份采用亚胺培南西司他丁钠治疗的出院患者的病历资料,进行用药合理性分析。结果 136份病历资料中,用药时间不合理者68份,占50.00%;联合用药不合理者20份,占14.71%;用药时机不合理者9份,占6.62%;病原学送检不合理者11份,占8.09%。结论特殊管理级抗菌药物在本院临床中存在滥用现象,需引起重视。     

住院患者亚胺培南西司他丁钠使用情况分析

目的评价亚胺培南西司他丁钠用药合理性,为临床合理用药提供参考。方法调阅我院2012年1—9月使用亚胺培南西司他丁钠的45例患者的住院病历,分析亚胺培南西司他丁钠的用药情况。结果 4例痊愈,41例显效,临床有效率为100%。药物利用指数DUI为0.77,微生物样本送检率为100.00%。部分病例在抗菌药物品种选用,给药剂量等方面存在缺陷。结论高质量的专项处方点评可以全面揭示亚胺培南西司他丁钠用药现状,促进合理用药。     

亚胺培南-西司他丁钠不同输注时间对重症监护病房患者严重病原菌感染病的疗效和安全性评价

目的:比较亚胺培南-西司他丁钠不同输注时间对重症监护病房(ICU)严重病原菌感染病患者的疗效和安全性。方法:选取2015年10月—2017年5月间ICU收治的严重病原菌感染病患者90例资料,采用电脑随机双盲法将其分成治疗组和对照组,每组45例;治疗组患者给予亚胺培南-西司他丁钠微量泵输注3 h,每隔8 h用药1次,抗感染治疗;而对照组患者则给予亚胺培南-西司他丁钠微量泵输注0.5 h,每隔8 h用药1次,抗感染治疗;比较两组患者用药后的总有效率,以及用药期间不良反应发生率的差异。结果:治疗组患者治疗后的总有效率为97.78%高于对照组为82.22%(P<0.05);两组患者用药期间不良反应的发生率经比较其其差异无统计学意义(P>0.05)。结论:采取亚胺培南-西司他丁钠延长泵输时间治疗ICU严重病原菌感染病患者的抗感染病疗效较为确切,安全性高。     

鲎试剂法检测注射用亚胺培南-西司他丁钠的细菌内毒素

目的：探讨注射用亚胺培南-西司他丁钠细菌内毒素的检测方法。方法：参照中国药典2005年版二部细菌内毒素检查法中干扰试验的基本原理及检查方法。结果：将注射用亚胺培南-西司他丁钠细菌内毒素稀释成1．470ml浓度以下时可消除干扰。结论：本法快速、简便,可用于注射用亚胺培南西司他丁钠细菌内毒素检查。     

亚胺培南-西司他丁钠相同浓度不同输注时间对重症监护室患者严重病原菌感染的疗效及安全性的比较

目的:比较亚胺培南-西司他丁钠相同浓度不同输注时间对重症监护室(ICU)患者严重病原菌感染的疗效及安全性。方法:选取2018年1月—2019年1月期间收治的ICU严重病原菌感染患者80例资料,按不同输液时间将其分为对照组40例和观察组40例;对照组患者给予常规亚胺培南-西司他丁钠输注时间为30 min,而观察组患者给予延长亚胺培南-西司他丁钠输注时间为3 h;比较两组患者治疗后的总有效率、重症监护时间和用药期间不良反应发生率差异。结果:观察组患者治疗后的总有效率(97.50%)高于对照组(80.00%()P<0.05),重症监护时间(4.05±1.15)d短于对照组(5.64±1.02)d(P<0.05),用药期间不良反应发生率(10.00%)稍低于对照组(17.50%)但经组间比较其差异无统计学意义(P>0.05)。结论:相同浓度的亚胺培南-西司他丁钠采用适当延长输注时间治疗ICU严重病原菌感染患者有效提高了总有效率,缩短治疗时间,且不良反应较少,安全性较高。     

美罗培南与亚胺培南-西司他丁钠治疗下呼吸道感染的疗效研究

目的比较美罗培南与亚胺培南-西司他丁钠治疗下呼吸道感染的疗效。方法 2010年8月—2012年8月我院治疗下呼吸道感染患者90例,根据治疗方法不同分为两组：美罗培南组48例,亚胺培南-西司他丁钠组42例。观察两组治疗效果及不良反应发生情况。结果美罗培南组痊愈30例,显效14例,无效4例;出现恶心呕吐1例,皮疹2例,不良反应发生率为6.25%。亚胺培南-西司他丁钠组痊愈32例,显效7例,无效3例;出现恶心呕吐2例,精神症状者1例,不良反应发生率为7.14%。两组治疗效果比较,差异无统计学意义（P〉0.05）;两组不良反应发生率比较,差异无统计学意义（P〉0.05）。结论美罗培南与亚胺培南-西司他丁钠治疗下呼吸道感染具有满意的临床疗效和较高的临床应用价值。     

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.