洗涤红细胞临床应用100例效果观察

目的 了解洗涤红细胞输注效果.方法 对2003年6月～2005年5月间输注100例洗涤红细胞及102例全血的临床资料进行回顾分析,计算输注1U血液提升的Hb值、RBC值,并记录发生输血反应的情况.结果 洗涤红细胞组每输注1U洗涤红细胞提高Hb(34.8±9.75)g/L,RBC(1.035×1012±0.43×1012)/L,全血组每输注1U全血提高Hb(35.2±9.34)g/L,RBC(1.042×1012±0.41×1012)/L.两组治疗效果显著性差异(P＞0.05).结论 洗涤红细胞具备纯度高、疗效好、输用安全、输血反应少、针对性强等优点,适宜在临床推广.     

琥珀酸亚铁片治疗妊娠合并缺铁性贫血的疗效和安全性分析

目的分析琥珀酸亚铁片治疗妊娠合并缺铁性贫血的疗效和安全性。方法选择本院2010年2月～2013年1月收治的106例妊娠合并缺铁性贫血患者,将采用琥珀酸亚铁片治疗的55例作为观察组,采用硫酸亚铁片治疗的51例作为对照组,观察两组患者的疗效和安全性。结果治疗后,观察组的红细胞计数（RBC）为（3.96±0.66）×1012/L,血红蛋白浓度（Hb）为（122.22±14.31）g/L,治疗总有效率为89.09%;对照组的RBC为（3.54±1.75）×1012/L,Hb为（110.24±13.34）g/L,治疗总有效率为74.51%;观察组的RBC、Hb和疗效均显著优于对照组患者,且观察组无明显并发症发生。结论琥珀酸亚铁片治疗妊娠合并缺铁性贫血疗效确切,安全,值得临床推广应用。     

头孢哌酮钠/舒巴坦钠致急性造血停滞

患者女,71岁。因“肝功能异常1年,乏力尿黄1周”,于2004年10月15日入院。诊断为自身免疫性肝病,给予保肝、降酶、退黄、支持治疗,病情好转。入院时检查血象3系均正常:WBC9.30×109/L、N0.566;RBC3.54×1012/L,HGB127g/L;PLT131×109/L。B超示:脾不大。入院后2周(10月27日)发现双下肺炎症,即加用头孢哌酮钠/舒巴坦钠(优普酮)4g,1次/12h抗感染治疗。4d后检测血常规:WBC4.27×109/L,RBC2.36×1012/L,HGB81g/L,PLT32×109/L。1周后复查:WBC3.10×109/L,RBC2.15×1012/L,HGB74g/L,PLT20×109/L。行骨穿检查,骨髓片检查示增生…     

预存式自体输血对前置胎盘患者血常规的影响分析

目的:探讨采用预存式自体输血对有前置胎盘患者血常规结果的影响,同时预估对产后出血情况。方法:筛选自2010年9月至2013年7月在笔者单位实施分娩的本市前置胎盘产妇78例,78例产妇在经过医护人员解释后同意采用预存式自体输血,观察78例患者在预存自体血后24h、72h时的血常规和预存血之前血常规结果,同时和分娩后血常规结果对比。结果:预存血之前RBC(3.75±0.46)×1012,Hb(108.31±6.45)g/L,Hct(0.32±0.21),Plt(183.22±40.37)×109/L;采血后48hRBC(3.34±0.28)×1012,Hb(100.75±5.94)g/L,Hct(0.28±0.14),Plt(202.36±41.16)×109/L;采血后96hRBC(3.59±0.36)×1012,Hb(104.17±4.78)g/L,Hct(0.31±0.19),Plt(190.71±43.02)×109/L;分娩后RBC(3.36±0.41)×1012,Hb(99.89±7.63)g/L,Hct(0.30±0.27),Plt(209.55±48.47)×109/L,各时间段对比血常规结果无明显差异。结论:预存式自体输血是一种经济安全的输血方式,对有前置胎盘的产妇在实施预存式自体输血血常规各指标变化不明显,因此值得推广。     

阿维A引起白细胞和血小板增多

1例42岁男性患者,因脓疱型银屑病服用阿维A胶囊30 mg/d治疗.治疗前血常规基本正常:RBC 3.65×1012/L,WBC9.5×108/L,PLT 246×109/L.治疗1周后,RBC 3.67×1012/L,WBC 16.5×109/L,PLT412×109/L.病理学检查示:血小板增多,骨髓增生;B超示脾肿大.将阿维A减量至15 mg/d.3周后复查血象:RBC 3.72×1012/L,WBC 14.3×109/L,PLT446×109/L.阿维A继续减量至10 mg/d,2周后复查血象RBC 3.48×1012/L,WBC 10.3×109/L,PLIT 385×109/L;腹部B超检查未见异常.     

局部放射治疗对鼻咽癌患者血象的影响

目的:探讨局部放射治疗对鼻咽癌患者血象的影响.方法:对50例鼻咽癌患者予以SEMENT医用加速器外照射治疗,放疗期间每周行血常规检查并记录放疗剂量进行统计分析.结果:(1)白细胞平均值为6.0×109/L,中性粒细胞平均值为4.5×109/L,淋巴细胞平均值为0.72×109/L,红细胞平均值为4.4×1012/L,血红蛋白平均值为129.2 g/L,血小板平均值为210.1×109/L.白细胞第六周(约50Gy)开始下降明显达18.2%(P=0.000),淋巴细胞第一周明显下降达44.4%(P=0.000);血小板的变化以第四周(约30Gy)下降达低值,较放疗前减少12.4%(P=0.005),随后缓慢回升但无明显差异.结论:单纯局部放疗对鼻咽癌患者血象影响不大,但淋巴细胞对放射治疗较为敏感.     

PVA颗粒栓塞脾脏红髓小动脉治疗脾亢的临床研究

目的 探讨PVA颗粒栓塞脾脏红髓小动脉治疗脾亢的临床应用价值.方法 脾亢患者21例,男13例,女8例.11例并发原发性肝癌,同时行肝动脉栓塞及脾动脉部分栓塞术.并观察术前术后外周血象的变化.其中8例行2次以上脾动脉部分栓塞术.结果 21例患者术前WBC平均值为 2.80×109/L,RBC平均值为 3.22×1012,PLT平均值为 56.60×109/L,术后1个月平均值分别为WBC 6.25×109/L,RBC 3.32×1012/L,PLT 132.60×109/L,术后半年的平均值分别为WBC 5.30×109/L,RRBC3.38×1012/L,PLT 102.60×109/L,21例中1例出现较严重的并发症,经抗炎对症治疗治愈出院.结论 应用PVA颗粒栓塞脾脏红髓小动脉治疗脾亢是安全有效的,可作为外科切脾的替代方法.     

静脉用蔗糖铁治疗血透患者肾性贫血的临床观察

目的观察静脉用蔗糖铁与口服琥珀酸亚铁治疗血液透析患者肾性贫血的疗效。方法将64例患者随机分为静脉组和口服组,分别用静脉推注蔗糖铁和口服琥珀酸亚铁进行治疗8周。监测治疗前后血红蛋白(HGB)、红细胞数量(RBC)、血细胞压积(HCT)、血清铁蛋白(SF)的变化。结果治疗后与治疗前比较,口服组:HGB上升(10.2±1.3)g/L,RBC上升(1.1±0.24)×1012,HCT上升(3.6±0.67)%,SF上升(130.5±31.5)μg/L;静脉组:HGB上升(18.2±3.8)g/L,RBC上升(1.4±0.37)×1012,HCT上升(5.9±0.83)%,SF上升(421.6±64.8)μg/L。静脉组各项上升幅度与口服组上升幅度经统计学处理有显著差异。结论静脉推注蔗糖铁较口服琥珀酸亚铁疗效显著。     

冷凝集引起交叉配血困难1例

1 病历资料 徐某,男,46 岁,2011 年3 月于我院诊断为糖尿病、再生障碍性贫血,既往有多次输血史.急查血常规:白细胞(WBC)1.2 × 109/L,红细胞(RBC)0.59 × 1012/L,血红蛋白(HGB)19g/L,血细胞比容(HCT)0.06,血小板(PLT)13 × 109/L.     

血液检验在贫血患者中的诊断价值分析

目的研究血液检验在贫血诊断中的价值。方法纳入25例健康者作为健康组,25例地中海贫血患者作为地中海组,25例缺铁性贫血患者作为缺铁组。三组均行血液检验,对比三组的红细胞计数(RBC)、血红蛋白(Hb)、平均红细胞体积(MCV)、红细胞体积分布宽度(RDW)、平均红细胞血红蛋白含量(MCH)以及血液检验对贫血患者的诊断准确率。结果地中海组RBC(5.71±0.38)×10^9/L、RDW(16.90±2.05)%高于健康组的(4.23±0.42)×10^9/L、(14.04±1.32)%,Hb(100.58±8.33)g/L、MCV(73.55±6.20)fl、MCH(7.59±1.38)pg低于健康组的(121.75±9.46)g/L、(90.38±7.62)fl、(21.87±1.84)pg,差异有统计学意义(P<0.05)。缺铁组RBC(3.05±0.66)×10^9/L、Hb(84.05±5.91)g/L、MCV(75.04±5.98)fl低于健康组,RDW(21.94±1.51)%高于健康组,差异有统计学意义(P<0.05)。缺铁组RBC、Hb低于地中海组,RDW、MCH高于地中海组,差异有统计学意义(P<0.05)。血液指标综合检验对贫血患者的诊断准确率为100.00%,高于RBC、Hb、RDW、MCV、MCH检验的84.00%、88.00%、88.00%、92.00%、92.00%,差异有统计学意义(P<0.05)。结论血液检验不仅能对贫血做出鉴别诊断,且能准确区分不同贫血类型,使贫血治疗针对性得到增强。     

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.