胸腰椎骨折应用短节段钉棒内固定治疗临床体会

目的 为了近一步观察短节段钉棒内固定治疗胸腰椎骨折的临床疗效.方法 总结2008年10月～2012年10月期间在本院治疗的胸腰椎骨折患者120例资料,所有患者在按照ASIA分级方法进行分级后,均采取短节段钉棒内固定方法进行治疗,治疗后根据患者病情恢复情况再次根据ASIA分级方法进行分级,最后统计短节段钉棒内固定治疗胸腰椎骨折的有效性.结果 120例统计资料中,B级12例,C级28例,D级80例,治疗后B级患者有3例恢复至D级,C级中有10例恢复至D级,其余107例资料均恢复至E级.结论 短节段钉棒内固定治疗胸腰椎骨折具有比较满意的临床疗效.     

经皮椎体成形术治疗老年骨质疏松性胸腰椎骨折86例临床疗效分析

目的通过观察分析86例接受经皮椎体成形术(PVP)治疗骨质疏松性胸腰椎骨折的老年患者的临床治疗效果,评估经皮椎体成形术的疗效。方法选取我院2011年2月至2013年12月期间接受经皮椎体成形术治疗骨质疏松性胸腰椎骨折的86例老年患者作为研究对象,对患者临床治疗资料进行回顾性分析考察,对比治疗前后疼痛视觉类比评分(VAS评分),探讨治疗效果。结果 86例老年骨质疏松性胸腰椎骨折患者临床疼痛症状明显改善,所有患者腰腹部疼痛症状均在两天以内明显减轻和消失,VAS评分手术治疗后明显比治疗前有明显下降,治疗前后的差异具有可比性(P<0.05)具有统计学意义。结论经皮椎体成形术治疗老年患者骨质疏松性胸腰椎骨折能有效缓解疼痛症状,手术操作比较简单,安全性高,是治疗老年骨质疏松性胸腰椎骨折的有效手术方法,值得临床推广应用。     

椎体成形术治疗胸腰椎骨折的临床效果观察

目的探讨椎体成形术治疗胸腰椎骨折的临床效果。方法选取本院收治的88例胸腰椎骨折患者,随机将这些患者分成观察组44例,对照组44例,比较两组患者治疗后的临床效果。结果观察组经椎体成形术治疗,效果优良率为90.91%,对照组经传统保守治疗,效果优良率为54.55%,观察组临床效果明显优于对照组。结论椎体成形术在治疗胸腰椎骨折方面具有确切的临床效果,值得临床推广使用。     

临床护理路径在胸腰椎骨折围手术期患者中的应用

目的 制定适合胸腰椎骨折围手术期患者的临床护理路径表,并观察其应用效果.方法 将60例胸腰椎骨折围手术期患者随机分成2组,实验组和对照组,每组各30例,实验组按临床路径表方式进行护理.对照组采用传统护理方式护理.结果 实验组住院天数减少,医疗费用和并发症发生率均降低,患者满意度有较大提高,与对照组相比差异有统计学意义(P＜0.05).结论 临床护理路径应用于胸腰椎骨折围手术期患者中,可促进患者早日康复,提高护理质量.     

健脊复髓汤治疗胸腰椎骨折的疗效观察

目的研究中医健脊复髓汤对胸腰椎骨折治疗的临床效果。方法选取郑州市骨科医院自2010年1月至2012年1月治疗的胸腰椎骨折患者100为研究对象,随机分为中医组和对照组,每组患者50例,对两组患者手术治疗后,对照组采用常规手段进行治疗,中医组在对照组基础之上,给予健脊复髓汤内服治疗,对比观察两组患者治疗疗效。结果中医组治疗后腹胀有效率达到95％,和对照组比较差别具有统计学意义（P〈0．05）;中医组对下肢感觉和肌力影响以及改善血钾离子情况优于对照组（P〈0．05）。结论健脊复髓汤对手术后的胸腰椎骨折患者进行的治疗,起到了缓解低血钾并减轻患者的腹痛和便秘等优点,具有很强临床应用价值。     

中西医结合治疗胸腰椎骨折的临床分析

目的探讨中西医结合治疗胸腰椎骨折的临床效果。方法将78例胸腰椎骨折行椎弓根螺钉内固定的患者随机分为两组,对照组39例给予常规手术治疗,观察组39例在对照组基础上加用中药内服与针灸治疗。比较两组的治疗效果。结果观察组总有效率为94．87％,明显高于对照组的69．23％（P〈0．05）。结论中西医结合治疗胸腰椎骨折疗效确切,值得临床推广应用。     

中医综合疗法治疗无神经损伤胸腰椎骨折的临床观察

目的 探讨中医综合疗法治疗无神经损伤胸腰椎骨折的临床效果.方法 124例无神经损伤胸腰椎骨折根据随机数字表法将其分为治疗组与对照组,每组各62例.治疗组采用中医综合疗法治疗,对照组采用中成药、西药及功能锻炼治疗.比较两组患者的疗效.结果 治疗组总有效率高于对照组（P＜0.05）;两组患者治疗3个月后与治疗前比较,疼痛明显缓解（P＜0.05）,治疗组缓解情况优于对照组（P＜0.05）;两组患者治疗3个月后Cobb角度较治疗前改善（P＜0.05）,治疗组改善情况优于对照组（P＜0.05）;24个月时,治疗组Cobb角度小于对照组（P＜0.05）.结论 中医综合疗法疗效确切,安全性高,可作为无神经损伤胸腰椎骨折的首选治疗.     

脊柱通用系统治疗下腰椎骨折

脊柱骨折以胸腰段多见,下腰椎骨折在胸腰椎骨折中仅占4%[1].对于需要手术治疗的不稳定型及合并神经损伤的严重下腰椎骨折脱位,治疗上不完全等同于胸腰段骨折.我院于2000-2007年间采用脊柱通用系统(universal spine system,USS)椎弓根螺钉系统经后路进行减压和固定治疗严重下腰椎骨折23例,临床疗效满意.     

椎体成形术治疗胸腰椎骨折的临床效果观察

目的:观察椎体成形术治疗胸腰椎骨折的临床效果,为临床治疗提供依据。方法:选择我院2010年2月-2012年2月收治的70例胸腰椎骨折患者为研究对象,随机分为观察组和对照组各35例,观察组35例患者共计41个椎体,应用椎体成形术治疗,对照组35例患者卧床休息、腰围固定及相应药物治疗,对比观察两组患者的疼痛视觉模拟评分,止痛药使用评分,活动能力及并发症。结果:实施椎体成形术的观察组患者观察术后,对照组患者观察入院后1周,2周,1月时VAS评分,止痛药使用评分及活动能力评分均有显著性差异。观察组显著优于对照组(P<0.05)。6个月及1年时各项评分均无显著性差异。结论:椎体成形术治疗胸腰椎骨折操作简便、安全有效,能够有效缓解患者的疼痛、改善患者功能,患者临床疗效满意,可在临床推广应用。     

椎体成形术治疗胸腰椎骨折的临床效果观察

目的观察椎体成形术治疗胸腰椎骨折的临床效果,以供临床参考。方法选择2011年8月至2012年7月我院胸腰椎骨折患者78例为研究对象,均接受椎体成形术治疗。对比治疗前后患者疼痛程度、伤椎前缘、中央高度值、后缘压缩率等差异性。结果与治疗前对比发现,治疗后患者VAS评分、伤椎前缘、中央高度值、后缘压缩率等指标明显下降,差异具有统计学意义(P<0.05)。结论椎体成形术在胸腰椎骨折的临床治疗中疗效确切,值得临床推广应用。     

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.