术中头孢曲松所致过敏性休克误认为麻醉后体位性低血压

1例43岁男性患者,因脊髓损伤后双下肢痛入院行手术治疗.入院时BP 157/100 mm Hg.术中行麻醉诱导后BP110/70 mm Hg,随后将患者由仰卧变为俯卧,给予头孢曲松2 g入0.9%氯化钠注射液100 ml静脉滴注,几分钟后患者出现血压下降,BP 60/40 mm Hg,HR 100次/min,ECG出现T波倒置.考虑为麻醉后体位性低血压,经处理后情况好转,手术顺利完成.术后生命体征平稳,第2天再次给予头孢曲松静脉滴注,滴入10 ml后患者突然出现全身痒、胸闷、大汗及呼吸困难.BP70/40 mm Hg,HR 130次/min,SpO2 0.80.立即停用头孢曲松,给予抗过敏、扩客及抗休克等治疗,症状逐渐消失,血压平稳.     

呋塞米静脉推注相关过敏性休克

1例44岁女性前庭神经炎患者为改善循环、降低颅压,先后给予银杏叶注射液20 ml/d静滴和呋塞米10 mg/d静推.第3天,在呋塞米开始静推后约1 min,患者出现全身皮疹、头晕、胸闷、心慌、出冷汗、面色苍白、呼吸困难等症状,BP 60/35 mm Hg.立即停用呋塞米,给予吸氧、地塞米松、肾上腺素及异丙嗪治疗,0.5 h后患者呼吸平稳、皮疹消失,BP 110/60 mm Hg.继续使用银杏叶注射液治疗,上述症状未再出现.     

注射用阿奇霉素致过敏性休克1例

1 病例患者,女,25岁,体质量:48 kg.因咳嗽、咯黄脓痰持续3 d来院就诊,初步诊断为急性支气管炎.查体T:36.2℃,R:20次/min,P:70次/min,BP:110/75 mm Hg.给予注射用阿奇霉素0.25 g加入5%GS 250 mL中,40滴/min,静脉滴注.滴入约30 mL时,患者出现眩晕、耳鸣,伴恶心、呕吐,诉心悸.测T:36℃,R:17次/min,P:88次/min,BP:90/60 mm Hg,诊断为过敏性休克.立即停止输液,给氧气3 L/min,进行心电监护,同时给予甲强龙40 mg静脉注射,肾上腺素0.5 mg静脉注射,症状缓解不明显,又给予甲强龙80 mg加入0.9%氯化钠注射液250 mL中静脉滴注,维生素B6 0.2 g加入5%GNS 500 mL中静脉滴注.15 min后,T:36℃,R:19次/min,P:75次/min,BP:100/65 mm Hg,患者生命体征趋于平稳.     

静脉注射氟比洛芬酯致过敏反应2例

1病历摘要例1:男,70岁,体重40kg。因胃癌术后肝转移收住入院,患者入院时BP100/60mm Hg,HR72次/min,消瘦,恶病质状态,腹部疼痛难忍,口服曲马多效果欠佳。应用氟比洛芬酯注射液50mg静脉注射,静脉注射过程中,患者出现胸闷、憋气、呼吸困难,HR120次/min,BP80/40mm Hg,立即通知医生,停用氟比洛芬酯,换输生理盐水,遵医嘱给予氧气吸入,静脉注射地塞米松10mg,肌内注射盐酸异丙嗪50mg,5min后患者症状缓解,BP90/60mm Hg,HR80次/min,呼吸平稳。例2:女,65岁,体重70kg。乳腺癌术后行第六次巩固化疗,患者入院时BP110/70mm Hg,HR76次/min,WBC1.6×109/L,应用瑞白300μg皮下注射,1次/d,2d后出现全身疼痛,遵医嘱给予氟比洛芬酯注射液50mg静脉注射,5min后,患者出现皮肤瘙痒,恶心呕吐,呼吸急促,BP150/100mm Hg,HR110次/min,立即通知医生,遵医嘱给予吸氧,静脉注射地塞米松5mg,肌内注射盐酸异丙嗪25mg,肌内注射甲氧氯普胺20mg。患者10min后症状缓解,BP120/80mm Hg,HR...     

美罗培南致老年患者急性哮喘

1例84岁男性患者,因肺部感染给予美罗培南抗感染治疗,第3天静脉滴注美罗培南约15min时,患者出现胸闷、呼吸急促、憋喘、轻度呼吸困难、口唇紫绀等喘息症状,并逐渐加重。BP 110/80 mm Hg,P 124次.min-1,R 35次.min-1。立即给予地塞米松、异丙嗪、氨茶碱、氢化可的松治疗,1h后患者喘息症状基本缓解。     

低分子右旋糖酐与呋塞米联用致不良反应1例

1 例41 岁女性患者因肾病综合征给予低分子右旋糖酐注射液250 mL ＋ 呋塞米注射液40 mg,qd,ivgtt.输注至8 min时患者突然出现恶心、呕吐,伴腹痛、全身大汗、精神萎靡,测BP 95/70 mm Hg,HR 90 - 95次·min-1,立即停止输液.给予异丙嗪注射液（12.5 mg,im）、地塞米松注射液（5 mg,iv）以及奥美拉唑注射液（60 mg,iv）,20 min后测BP 120/80 mm Hg,患者继而出现寒战,T 39.5 ℃,给予物理降温,肌注柴胡注射液4 mL.患者仍述腹痛,尤以下腹部明显,给予导尿,1 h 后腹痛缓解,恶心、呕吐消失,3 h 后体温下降,患者病情逐渐平稳.     

苦黄注射液静滴致腮腺肿大

1例56岁男性患者,因全身皮肤黏膜中度黄染,给予苦黄注射液30 mL加入0.9%氯化钠注射液100 mL以30滴.min-1的速度静滴。用药15 min后患者两侧腮腺肿大,BP 150/110 mm Hg。立即停药,更换输液器,输入0.9%氯化钠注射液100 mL,地塞米松磷酸钠注射液5 mg静推,注射用氢化可的松琥珀酸钠100 mg静滴,硝苯地平缓释片20 mg口服,后给予葡萄糖氯化钠注射液缓慢滴注并观察,1 h后上述症状和体征消失。     

参麦注射液致呼吸困难一例

<正>患者,女性,32岁。诊断为"乳腺癌术后化疗"。既往有磺胺药过敏史。于2012年6月7日行乳腺癌切除术后抗肿瘤治疗。遵医嘱静脉滴注参麦注射液(四川升和药业生产,批号Z20053254)5min后,患者突然感觉呼吸困难、胸闷憋气,立即更换输液器,停止输入参麦注射液,更换为0.9%氯化钠溶液100mL,给予持续低流量吸氧,测血压140/80mm Hg(1mm Hg=0.133kPa)、心率110次/min,10min后患者自觉症状缓解,血压恢复平稳110/70mm Hg,脉搏82次/min。     

头孢美唑钠停用1个月后再次使用出现过敏反应

1例57岁肝炎后肝硬化男性患者因腹腔感染给予头孢美唑钠2 g溶于5%葡萄糖100 ml中静脉滴注.滴注结束后约5 min,患者突然出现寒颤、胸闷.查体:P 130次/min,R 24次/min,BP 130/70 mm Hg,血氧饱和度0.95,双肺呼吸音粗.立即给予吸氧,静脉给予地塞米松2 mg和10%葡萄糖酸钙.40 min后患者症状缓解.2.5 h后,患者P 96次/min,R 22次/min,BP 110/70 mm Hg.追踪病史示患者在1个月前曾静脉滴注头孢美唑钠2 g,2次/d,共15 d,未见不良反应.     

脉络宁注射剂致过敏反应2例

患者,男,72岁,因言语不清伴右侧上下肢活动受限2 d就诊。查体:T 37℃,BP140/80 mm Hg(1 mm Hg=0.13kPa)。诊断:缺血型脑血管病;脑动脉硬化症。给予脉络宁2mL加入10%葡萄糖250 mL静脉滴注,约10 min后患者烦躁不安,胸闷,气憋,呼吸困难。立即给予停药,静脉注射10%葡萄糖酸钙及皮下     

基于属性AHM的Topsis综合评价促透剂的促透效果

目的运用基于属性AHM的Topsis,对几种促透剂的促透效果进行综合评价。方法以延胡索乙素为模型药物,以氮酮、薄荷醇、丁香油、广藿香挥发油为促透剂,在离体透皮吸收装置上进行透皮吸收实验,计算渗透系数、稳态流量、滞后时间、增渗倍数,运用基于属性AHM的Topsis对促透效果进行综合评价。结果对延胡索乙素的促渗作用,优劣顺序为:10mL.L-1氮酮、10mL.L-1氮酮和10mL.L-1丁香油、10mL.L-1丁香油、10mL.L-1氮酮和10mL.L-1薄荷醇、10mL.L-1薄荷醇和10mL.L-1丁香油、10mL.L-1薄荷醇、10mL.L-1氮酮和10mL.L-1广藿香挥发油、10mL.L-1丁香油和10mL.L-1广藿香挥发油、10mL.L-1薄荷醇和10mL.L-1广藿香挥发油、10mL.L-1广藿香挥发油。结论基于属性AHM的Topsis使主观与客观相结合,能公正地评价中药挥发油促渗剂的促渗效果。     

Compatibility of verapamil hydrochloride with penicillin admixtures during simulated Y-site injection

The compatibility of verapamil hydrochloride during simulated Y-site injection with i.v. admixtures containing 11 different penicillins was studied. Admixtures of penicillin G potassium (62.5 mg/mL), nafcillin sodium (40 mg/mL), oxacillin sodium (40 mg/mL), ampicillin sodium (40 mg/mL), carbenicillin disodium (40 mg/mL), methicillin sodium (40 mg/mL), ticarcillin sodium (40 mg/mL), azlocillin sodium (40 mg/mL), mezlocillin sodium (40 mg/mL), piperacillin sodium (40 mg/mL), and amdinocillin (20 mg/mL) were prepared in both 5% dextrose injection and 0.9% sodium chloride injection in minibags. Verapamil hydrochloride injection 4 mL (10 mg) was then added to each admixture, and the admixtures were examined macroscopically and microscopically for precipitate immediately and at 15 minutes and 24 hours after mixing. To simulate Y-site injection of verapamil, verapamil hydrochloride injection 1 mL (2.5 mg) was added to 1 mL of each penicillin admixture in a test tube. For admixtures in which precipitates formed, the pH was recorded before and after verapamil was added to the admixtures. Loss of verapamil hydrochloride when mixed with the penicillin admixtures was determined using reverse-phase high-performance liquid chromatography. Addition of verapamil hydrochloride to admixtures containing nafcillin sodium, oxacillin sodium, ampicillin sodium, and mezlocillin sodium resulted in substantial loss of verapamil hydrochloride. The results for the Y-site injection study showed visible precipitation with the same penicillin admixtures. Because a precipitate formed when verapamil hydrochloride was added to nafcillin sodium, oxacillin sodium, ampicillin sodium, or mezlocillin sodium in the diluents studied, we recommended that verapamil hydrochloride be administered separately or that the i.v. tubing be flushed thoroughly before and after this drug is administered through a Y-injection site with these penicillin admixtures.     

Liquid chromatography-tandem mass spectrometry for the determination of colchicine in postmortem body fluids. Case report of two fatalities and review of the literature

Poisoning by colchicine may occur following ingestion of this alkaloid used for the treatment of acute gouty arthritis. The authors report two fatalities and describe a liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS-MS) triple-quadrupole method for the determination of colchicine in autopsy samples. One milliliter of heart blood, femoral blood, urine, bile, gastric, and vitreous each were extracted with saturated NH4Cl at pH 9.6 and dichloromethane/5% isopropanol. Separation was achieved on a C18-Xterra column with a mobile phase consisting of 2 mM ammonium formate buffer (pH 3)/acetonitrile in a gradient mode. Four product ions of the protonated molecule were monitored. The method was fully validated in whole blood (1 mL) and was linear in the range of 0.5-50 ng/mL (r2>0.99). The limit of detection was 0.1 ng/mL (50 times S/N), and the limit of quantitation was 0.5 ng/mL with RSDs<11.8% intraday (n=6), <18.7% interday (n=18), and accuracy<3% (n=18). Case #1: a 33-year-old nurse committed suicide by the ingestion of 80 colchicine 1-mg tablets. She died 61 h later after resuscitation procedures. Colchicine was found in heart blood at 5.2 ng/mL, femoral blood at 17.4 ng/mL, urine at 19.4 ng/mL, bile at 42.8 ng/mL, gastric at 348 ng/mL, and vitreous at 3 ng/mL. Case #2: a 57-year-old man with gout was found dead at home. Colchicine was found in heart blood at 22.8 ng/mL, femoral blood at 21.9 ng/mL, lung blood at 45.2 ng/mL, urine at 148.5 ng/mL, bile at 1818.5 ng/mL, gastric at 219.8 ng/mL, and vitreous at 0.5 ng/mL. These results were consistent with death. Because of its good sensitivity, this LC-ESI-MS-MS triple-quadrupole method is suitable for the determination of colchicine not only in fatalities but also for pharmacokinetic studies.     

黄芪注射液改善脑梗死病人红细胞流变性剂量效应的观察

目的 :探讨黄芪对脑梗死病人红细胞流变行为影响的剂量 效应关系。方法 :脑梗死病人 60例 ,分为 4组 (各 15例 )。在常规治疗的基础上 ,各组每日分别加用黄芪注射液 10 ,2 0 ,3 0 ,40mL ,iv ,gtt× 10d。测定治疗前后病人红细胞变形、聚集指数的变化及病情变化。结果 :与 10mL组比较 ,2 0mL组各项指数P >0 .0 5 ,3 0 ,40mL组红细胞变形指数分别为 0 .9± 0 .3 ,0 .9± 0 .3 ,较治疗前显著升高 (P <0 .0 1)、聚集指数分别为 (2 .0± 0 .3 ,2 .0±0 .4) ,较治疗前显著下降 (P <0 .0 1) ,临床总有效率均为 93 %较 10 ,2 0mL组 (分别为 60 % ,67% )显著升高 (P <0 .0 5 )。 3 0mL组和 40mL组间各项指标均无显著差异。结论 :黄芪对脑梗死病人红细胞流变性的影响存在着剂量 效应关系 ,每日静脉滴注黄芪注射液 3 0mL最为适宜。     

高效液相色谱法测定兔血浆中盐酸氯胺酮质量浓度

目的 建立测定兔血浆中盐酸氯胺酮质量浓度的高效液相色谱法.方法 采用安捷伦1200型液相色谱仪,色谱柱为Hypersil ODSC18柱(250 mm×4.6 mm,5μm),流动相为甲醇-乙腈-磷酸盐缓冲液(50:15:35),流速为1.0 mL/min,柱温为30℃,检测波长为220 nm.以布比卡因为内标检测血浆中盐酸氯胺酮的质量浓度.结果 盐酸氯胺酮的质量浓度在0.25～25 μg/mL范围内与峰面积线性关系良好(R2=0.999 5),盐酸氯胺酮和布比卡因的保留时间分别为5.868 min和10.776 min,最低检测浓度为0.1 μg/mL,日内日间RSD均小于5%,其中低、中、高(0.5,2.5,25μg/mL)质量浓度的提取回收率分别为84.91%,79.80%,80.63%,方法回收率分别为97.19%,100.97%,99.62%.结论 提取方法可靠、专属性理想、稳定性好,适用于盐酸氯胺酮血药浓度的测定.     

益母草注射液联合缩宫素预防产后出血的临床分析

目的探讨益母草注射液与缩宫素联合应用预防产后出血的疗效。方法选取笔者所在医院200例产妇,随机分为对照组和研究组。研究组产后肌注或宫体注射益母草注射液2mL和缩宫素注射液20U;对照组单独给缩宫素注射液20U,肌肉注射或宫体注射。分别观察产后2h的出血量进行比较。结果研究组产后2h出血量100～200mL的51例、200～300mL的32例、300～400mL的12例、400～500mL的4例、>500mL的1例;对照组产后2h出血量100～200mL的32例、200～300mL的37例、300～400mL的19例、40～500mL的7例、>500mL的5例;研究组与对照组产后出血比较,差异有统计学意义(P<0.05),不良反应发生率比较无统计学意义(P>0.05)。结论益母草注射液与缩宫素联合应用可减少产后2h出血,且不增加不良反应发生。     

Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2001). I. Susceptibility distribution

The bacterial strains isolated from patients diagnosed as having urinary tract infections (UTIs) in 10 institutions in Japan were supplied between the period of September and December 2001. Then, the susceptibilities of them to a variety of antimicrobial agents were investigated. The number of them were 496 strains. The breakdown of these strains was Gram-positive bacteria as 29.6% and Gram-negative bacteria as 70.4%. Susceptibilities of these bacteria to antimicrobial agents were as follows; against Staphylococcus aureus, vancomycin (VCM) showed a strong activity, and this drug also had a strong activity against MRSA in preventing growth of all strains at 1 microgram/mL. In addition, arbekacin (ABK) showed strong activity with the MIC90 of 2 micrograms/mL against MRSA and prevented growth of all strains at 4 micrograms/mL. ABK also showed a strong activity against Staphylococcus epidermidis in preventing growth of all strains at 0.5 microgram/mL. Ampicillin (ABPC) and cefozopran (CZOP) showed a relatively strong activity against S. epidermidis (MIC90: 8 micrograms/mL). ABPC, imipenem (IPM), and VCM showed strong activities against Enterococcus faecalis. No increase of low-susceptible strains in E. faecalis was observed against these antimicrobial agents. Against Escherichia coli, carbapenems showed the highest activities: meropenem (MEPM) prevented growth of all strains at 0.25 microgram/mL; IPM prevented growth of all strains at 0.5 microgram/mL. CZOP and cefotiam (CTM) also showed strong activities against E. coli: MIC90 of CZOP was within 0.125 microgram/mL; MIC90 of CTM was within 0.5 microgram/mL. Quinolone-resistant E. coli was detected at frequency of 9.3%, which was lower than that in the last year, and was higher level than those in up to 1999. MEPM showed the strongest activity against Citrobacter freundii in preventing growth of all strains at 0.125 microgram/mL. Almost all drugs showed strong activities against Klebsiella pneumoniae and Proteus mirabilis, and MEPM prevented growth of all strains within 0.125 microgram/mL. Against Serratia marcescens, the MIC90 of gentamicin (GM) was the lowest value being 2 micrograms/mL, and those of IPM and carumonam were 8 and 16 micrograms/mL, respectively. Against Pseudomonas aeruginosa, almost all drugs were not so active. The MIC90 of GM was 8 micrograms/mL, those of IPM and amikacin were 16 micrograms/mL, and those of all other drugs were over than 32 micrograms/mL.     

Rapid colorimetric assay for gentamicin injection

A rapid colorimetric method for determining gentamicin concentration in commercial preparations of gentamicin sulfate injection was developed. Methods currently available for measuring gentamicin concentration via its colored complex with cupric ions in alkaline solution were modified to reduce the time required for a single analysis. The alkaline copper tartrate (ACT) reagent solution was prepared such that each milliliter contained 100 mumol cupric sulfate, 210 mumol potassium sodium tartrate, and 1.25 mmol sodium hydroxide. The assay involves mixing 0.3 mL gentamicin sulfate injection 40 mg/mL (of gentamicin), 1.0 mL ACT reagent, and 0.7 mL water; the absorbance of the resulting solution at 560 nm was used to calculate the gentamicin concentration in the sample. For injections containing 10 mg/mL of gentamicin, the amount of the injection was increased to 0.5 mL and water decreased to 0.5 mL. The concentration of gentamicin in samples representing 11 lots of gentamicin sulfate injection 40 mg/mL and 8 lots of gentamicin sulfate injection 10 mg/mL was determined. The specificity, reproducibility, and accuracy of the assay were assessed. The colored complex was stable for at least two hours. Gentamicin concentration ranged from 93.7 to 108% and from 95 to 109% of the stated label value of the 40 mg/mL and the 10 mg/mL injections, respectively. No components of the preservative system present in the injections interfered with the assay. Since other aminoglycosides produced a colored complex, the assay is not specific for gentamicin. The assay was accurate and reproducible over the range of 4-20 mg of gentamicin. This rapid and accurate assay can be easily applied in the hospital pharmacy setting.     

硫酸镁联合依达拉奉治疗急性脑梗死的疗效观察

目的:探讨依达拉奉联合应用硫酸镁静脉给药治疗急性脑梗死的疗效和最佳剂量.方法:联合治疗组患者在依达拉奉治疗的基础上给以3种负荷量的硫酸镁(0mL,10mL,20mL)加24h内60mL硫酸镁维持以及每日20mL,14d的硫酸镁维持治疗,监测患者的血压、腱反射等镁的副作用,动态观察了血清镁浓度,在30d和90d对患者进行ESS评分.结果:10mL 、20mL硫酸镁联合治疗组患者的血清镁能够迅速提升,明显增加患者远期的ESS评分,其中20mL组更为有效.未见明显的不能耐受的不良反应.结论:依达拉奉联合应用硫酸镁,负荷应用硫酸镁10mL、20mL对脑梗死患者具有良好的治疗作用,其中20mL负荷量效果最佳.     

Application of derivative spectrophotometry for determination of enalapril, hydrochlorothiazide and walsartan in complex pharmaceutical preparations

A derivative spectrophotometry method was developed to determine enalapril, hydrochlorothiazide, candesartan and walsartan in complex antihypertensive drugs. The pharmaceutical preparations containing hydrochlorothiazide and one of the angiotensin convertase inhibitors were investigated. It was found that the developed method enables the constituents of the investigated drugs to be determined directly despite evident interference of the zero order absorption spectra. For determination of enalapril and hydrochlorothiazide as well as candesartan and hydrochlorothiazide the first derivative was used, while for walsartan and hydrochlorothiazide the second derivative was employed. The method was of high sensitivity; the LOD accuracy for enalapril was 2.81 microg x mL(-1), 0.56 microg x mL(-1) for candesartan, 4.02 microg x mL(-1) for walsartan and ranged from 0.31 microg x mL(-1) to 1.78 microgxmL(-1) for hydrochlorothiazide, depending on preparation under investigation. The recovery of individual constituents was within the limit of 100% +/- 5%, RSD varied from 1.11% to 2.94%, and the linearity range was from 4.1 microg x mL(-1) to 20.5 microg x mL(-1) for enalapril, from 6.45 microg x mL(-1) to 32.25 microg x mL(-1) for walsartan, from 2.36 microg x mL(-1) to 11.80 microg x mL(-1) for candesartan, and from 0.96 microg x mL(-1) to 26.00 microg x mL(-1) for hydrochlorothiazide.