特殊药品管理方法探讨

笔者结合单位的做法和体会,对医疗单位等在特殊药品使用管理中存在的问题,提出特殊药品的管理应法制化、职责化、程序化、档案化及提高业务素质、奖优罚劣的管理方法。     

眼科手术表面与球后麻醉比较的临床研究

目的：评价表面麻醉(表麻)下行内眼手术的安全性及可行性。方法：随机抽取表麻下内眼手术300眼与球后麻醉下内眼手术288眼，对两组术中、术后并发症进行对比。结果：表麻下与球后麻醉下内眼手术效果，术中、术后并发症的发生率无显著性差异，但表麻可以最大限度减少因麻醉带来的术中、术后并发症，使内眼手术更加安全快捷。结论：表麻下行内眼手术是可行的、安全的。     

128对不育夫妇血清、精浆抗精浆免疫抑制物抗体与精液检查关系的分析

我们检测了８９对生育夫妇和１２８对不育夫妇血清、精浆中抗精浆免疫抑制物抗体（ＳＰＩ—Ａｂ）的水平。结果表明，不育夫妇血清、精浆ＳＰＩＭ—Ａｂ的水平和检出率均明显高于生育组（Ｐ＜０．０１）；精浆ＳＰＩＭ—Ａｂ水平增高者的精子密度、精子活率、精子运动速度和ＳＰＩＭ活性均明显降低（Ｐ＜０．０１）。提示：ＳＰＩＭ—Ａｂ水平增加可能影响生育。     

99Tcm直接法标记血管抑素

目的: 探索用99Tcm直接标记血管抑素(angiostatin, AS)的方法,并研究标记产物的体外稳定性及其生物活性. 方法:制备的AS经鉴定后,分别用2-巯基乙醇(2-ME)和氯化亚锡(SnCl2)还原法进行标记,并用正交设计筛选最佳合成条件;对标记产物用纸层析法及Sephadex G-50层析柱分离测标记率;产物中分别加入牛血清白蛋白(BSA)、生理盐水及不同摩尔比的半胱氨酸(Cys)以观察其体外稳定性;用人脐静脉内皮细胞系ECV304观察其生物活性. 结果:2-ME法最佳标记条件为AS 100 μg,PB(0.5 mol*L-1, pH 7.3) 1 mL, 2-ME 100 μg, 亚甲基二膦酸盐(MDP)(用1 mL生理盐水溶解) 10 μL,加入99TcmO4- 185 MBq,标记率可达(97.0±1.5)%; SnCl2法为AS 100 μg,硼酸缓冲液(0.1 mol*L-1, pH 9.0) 1 mL, 20 g*L-1 SnCl2 (1 mol*L-1盐酸作为溶剂) 20 μL加入MDP药盒,用去氧水稀释至1 mL, 取20 μL,加入99TcmO4- 185 MBq,标记率可达(90.0±3.0)%. 产物在体外稳定;细胞培养观察其抑制内皮细胞生物活性与AS无显著差异. 结论:用99Tcm直接法标记AS简单高效,且对AS生物活性无明显影响.     

脑血管造影和介入治疗过程中脑动脉痉挛的发生和治疗

目的探索脑血管造影和介入治疗过程中脑血管痉挛(CVS)的发生、表现和治疗效果。方法400例患者经股动脉穿刺对双侧颈内动脉、椎动脉等行数字减影血管造影检查共470例次,其中,52例在造影后接受了介入治疗。造影剂为含碘300mg/mL的非离子型造影剂。对造影和治疗过程中出现重度CVS者经导管注入0.3%罂粟碱10mL解痉。结果造影和介入治疗过程中CVS的发生率为17.7%(83/470),其表现为颈动脉管壁不光整,呈波浪状14例(16.9%),颈动脉管腔轻度变窄36例(43.4%),中度25例(30.1%),重度6例(7.2%),颈内动脉不显影2例(2.4%)。轻至中度CVS未作特殊治疗,无不良反应或后遗症发生;8例重度痉挛者经导管注入罂粟碱后6例明显缓解,1例遗留后遗症,1例病死。结论脑血管造影和介入治疗过程中CVS的发生率不容忽视,造影剂的高渗刺激、导管导丝机械性刺激和血管内压力改变是CVS的高危因素,动脉内注入罂粟碱有良好的解痉作用。     

Preparation and identification of monoclonal antibodies against Penicillium marneffei]

OBJECTIVE: To prepare and identify monoclonal antibodies (mAbs) against Penicillium marneffei. METHODS: Recombinant mannoprotein1 (MP1) of Penicillium marneffei was used to immunize BALB/c mice, and anti-MP1 mAbs were obtained by means of hybridoma. Screening and identification of the mAbs were subsequently performed with indirect enzyme-linked immunosorbent assay and Western blotting, respectively. RESULTS: Four hybridomas producing antibodies against Penicillium marneffei were obtained, and the IgG isotypes of the 4 mAbs were identified as IgG1 with affinity constants (K) of 8.2x10(-9), 4.7x10(-9), 6.5x10(-9) and 2.7x10(-9), respectively. Western blotting demonstrated specific recognition of Aspergillus fumigatus MP1 by the obtained mAbs. CONCLUSION: The 4 hybridomas producing anti-MP1 mAbs with high specificity and affinity can be of significant value in the diagnosis of Penicilliosis marneffei infections.     

经喉内镜手术治疗喉部疾病的并发症分析

目的：分析经喉内镜手术后并发症的发生原冈及其防治措施。方法：使用从德国STORZ公司引进的国内首套喉内镜手术系统，治疗包括声带小结、声带息肉、喉乳头状瘤、声带囊肿、会厌囊肿、喉部炎性假瘤、喉部血管瘤等58例患者，并随访2～36个月，观察主要并发症并作相应处理。结果：58例患者中发音正常者54例，发音功能明显好转者4例。主要并发症有：牙齿松动2例，牙齿脱落1例，声带粘连1例，舌体麻木1例，舌运动障碍1例，术后拔管时喉痉挛1例。结论：经喉内镜手术可住微创的前提下彻底清除病灶，并最大限度地保留发音功能，只要术前严格掌握适应证，术中精细操作，其并发症是可以避免的。     

Comparing diffusion-weighted and T2-weighted MR imaging for the quantification of infarct size in a neonatal rat hypoxic–ischemic model at 24 h post-injury

PURPOSE: In a neonatal rat model of hypoxic-ischemic (HI) brain injury, using T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), we aim to determine the best MRI method of lesion quantification that reflects infarct size. MATERIALS AND METHODS: Twenty 7-day-old rats underwent MRI 24h after HI brain injury was induced. Lesion size relative to whole brain was measured using T2WI and apparent diffusion coefficient (ADC) maps, applying thresholds of 60%, 70% and 80% contralateral control hemisphere mean ADC, and at day 10 post-HI on pathology with TTC staining. Multiple linear regression analysis was used to study the relationships between lesion size at MRI and pathology. RESULTS: Lesion size measurement using all MRI methods significantly correlated with infarct size at pathology; using T2WI, r=0.808 (p<0.001), using 80% ADC, 70% ADC and 60% ADC thresholds, r=0.888 (p<0.001), 0.761, (p<0.001) and 0.569 (p=0.014), respectively. Eighty percent ADC threshold was found to be the only significant independent predictor of final infarct volume (adjusted R(2)=0.775). CONCLUSION: At 24h post-HI, lesion size on DWI, using 80% ADC threshold is the best predictor of final infarct volume. Although T2WI performed less well, it has the advantage of superior spatial resolution and is technically less demanding. These are important considerations for experiments which utilize MRI as a surrogate method for lesion quantification in the neonatal rat HI model.