不同抗菌药物治疗新生儿肺炎的临床价值探讨

目的分析不同抗菌药物治疗新生儿肺炎的临床效果。方法 66例新生儿肺炎患儿作为研究对象,对其临床资料进行回顾性分析,研究不同抗菌药物在患儿临床治疗中的应用效果。结果 66例患儿共使用青霉素类药物60次,头孢菌素类药物76次。患儿应用不同抗菌药物治疗方案主要分为3种,分别为单一应用青霉素类,单一应用头孢菌素类以及青霉素类联合头孢菌素类,三组患儿的痊愈时间分别为(4.86±1.30)、(4.80±1.28)、(4.92±1.22)d,两两比较差异无统计学意义(P>0.05)。结论在新生儿肺炎的临床治疗中,应用不同抗菌药物的治愈时间相对一致,因此,需谨慎选择合理的抗菌药物治疗方案,尽可能使用单一药物治疗,进而为患儿的生命安全提供保障。     

头孢吡肟致新生儿剥脱性皮炎

1例出生3 d的新生儿因感染性黄疸给予头孢吡肟0.16 g溶于5%葡萄糖注射液20ml静脉滴注、1次/12h。第6天,患儿左外眼角、颈部皮肤发红,双腋下皮肤发红、糜烂、表皮大片脱落,皮肤脱落面积大约为2.0cm×2.5cm。考虑为头孢吡肟引起的剥脱性皮炎,停用该药,给予小檗碱药浴、红霉素软膏外用。3 d后患儿皮肤糜烂明显好转,无新发皮肤剥脱,黄疸明显消退。1个月后随访,患儿黄疸完全消退,皮损已痊愈。     

Propionibacterium acnes in the cortex of patients with Alzheimer's disease

Propionibacterium acnes was found in the cortex of three patients with Alzheimer's disease and in one frontal cortex of an elderly patient with cardiovascular risk factors and hypoxia due to a large glioblastoma of the right frontal lobe with severely increased intracranial pressure.Propionibacterium acnes is an atypical anaerobic bacterium which is sensitive to cephalosporins, but insensitive to metronidazole. It is concluded that a capillary microangiopathy (in consequence of old age and cardiovascular risk factors such as high blood pressure) leads to cortical hypoxia and reduced resistance of the cortical immune system. Prevention by dietary regimes counteracting microangiopathy and treatment with cephalosporins are recommended.     

利用头孢霉素钯配合物分光光度测定某些一、二代头孢霉素

头孢噻吩、头孢噻啶、头孢呋新和头孢孟多,能与pd~(2+)生成稳定的配合物.头孢霉素Pd~(2+)配合物皆有色,在400nm可进行可见分光光度测定.此法简单、快速、重复性好,ε值为2800～5600 l·mol~(-1)·cm~(-1).也可用偏苯三酚酞—CTAB为试剂的胶束增溶分光光度法,测定头孢霉素与过量pd~(2+)的反应液中未结合的游离钯,间接测定微量的头孢霉素.此法灵敏,有效摩尔“褪色”系数大于1×10~5 l·mol~(-1)·cm~(-1)     

2005～2014年头孢菌素类抗生素致药源性死亡的国内文献分析

目的：汇总近10年国内发表的报道头孢菌素类抗生素致药源性死亡的文献,分析国内头孢菌素类抗生素致药源性死亡的发生情况及特点,为临床用药安全提供科学依据。方法检索中国知网、万方数据和维普网中有关头孢菌素类抗生素致药源性死亡的文献资料,对致死病例的性别、年龄、药品不良反应临床表现及死亡原因等信息进行回顾性分析。结果纳入有效文献55篇,共报道病例76例,男性45例（59．2％）、女性31例（40．8％）,男女性别比为1．45∶1;患者年龄0．5～79岁,平均年龄46．9±17．9。患者原发疾病以上呼吸道感染29例（38.2％）、（支）气管炎12例（15.8％）、肺部感染11例（14．5％）等呼吸系统疾病为主,给药方式以静脉滴注为主,有65例（85.5％）。药品不良反应的发生时间主要集中在10 min 以内,有48例（63．2％）;全部药品不良反应患者中发生过敏性休克患者59例（77．6％）,用药后休克症状发生时间＜5 min 有46例（78．0％）。第三代头孢菌素的使用率最高,有49例（64.5％）。全部患者药品不良反应的临床表现及死亡原因分布中,过敏性休克占比最多,为59例（77．6％）。结论头孢菌素类抗生素临床应用广泛,所引起的药品不良反应临床表现各异,其中致药源性死亡的最主要原因为过敏性休克,第三代头孢菌素的使用率最高。临床用药过程中,用药前应当详细询问病史、过敏史等,密切观察防止药品不良反应致死病例的发生。     

抗生素的回顾,前瞻及其在下呼吸道感染的使用策略（一）

文章总结了我国抗生素发展的历史、临床应用前景及治疗策略。随着青霉素问世后的临床广泛应用，细菌耐药酶逐渐出现，青霉素的治疗枯减退，因此出现了新的不同化学结构的强力抗生素，如：头孢菌素类（第１、２、３、４代）、青霉素＋β－内酰胺类、在环内酯类、喹诺酮类、氨基糖苷类等。但是随着抗生素的使用在达到抗菌效果的同时，出现了许多可行机体损害的毒副作用。作者强调指出要针对病人的病原学诊断。所使用抗生素的毒副作用以     

尿药法研究头孢硫脒在腰-硬联合麻醉状态下行子宫全切术患者体内药代动力学

[目的]探讨头孢硫脒在腰-硬联合麻醉状态下行子宫全切术患者体内的排泄情况.[方法]选择本院收治的13例腰-硬联合麻醉下行子宫全切术的女性患者为研究对象,ASA分级为Ⅰ～Ⅲ级,在腰-硬联合麻醉后静脉滴注头孢硫脒,1h给药结束;给药完成后分别收集患者0～1 h、1～2 h、2～3 h、3～4 h、4～5 h时间段给药过程的尿样,采用HPLC-UV法测定尿样中头孢硫脒含量.利用Win Nonlin6.1软件计算头孢硫脒的相关药动学参数.[结果]13例患者麻醉状态头孢硫脒的t1/2β为(1.953士0.9732)h显著高于非麻醉状态下的(1.126±0.4496)h,差异具有统计学意义(P＜0.05).各受试者麻醉、非麻醉状态下0～6 h头孢硫脒在尿液中的平均排泄率于给药1.5 h后达到峰值,非麻醉状态下的头孢硫脒在尿液中平均排泄速率大于麻醉状态下的平均排泄速率.非麻醉状态下的头孢硫脒在尿液中的平均累积排泄率显著快于麻醉状态下的累积排泄率.[结论]头孢硫脒在腰-硬联合麻醉下的t1/2β明显长于非麻醉状态下,提示麻醉药物或围麻醉期用药、手术创伤等带来的机体应激反应可能影响到药物在体内的清除,进而延长药物的半衰期.     

Bacterial eradication rates with shortened courses of 2nd- and 3rd-generation cephalosporins versus 10 days of penicillin for treatment of group A streptococcal tonsillopharyngitis in adults

In a meta-analysis of 5 randomized controlled trials involving 1030 adults, the likelihood of bacteriologic eradication in the treatment of group A beta-hemolytic streptococcal (GAS) tonsillopharyngitis with 5 days of select cephalosporins (cefpodoxime, cefuroxime, cefotiam, and cefdinir) was noninferior to 10 days of penicillin (odds ratio, 1.46; 95% confidence interval, 0.96-2.22, P = 0.08).     

Antibiotic-mediated release of tumour necrosis factor alpha and norharman in patients with hospital-acquired pneumonia and septic encephalopathy

Objective To investigate antibiotic-mediated release of tumour necrosis factor (TNF)- and norharman in patients with hospital-acquired pneumonia with and without additional septic encephalopathy.Design Prospective observational study with a retrospective post hoc analysis.Setting Surgical intensive care unit (ICU) at a university hospital.Patients Thirty-seven patients were consecutively included (9 patients with hospital-acquired pneumonia, 11 patients with hospital-acquired pneumonia and septic encephalopathy, 17 control patients) in the study. Pneumonia was defined according to the criteria of the American Thoracic Society.Interventions Patients received cephalosporins for antibiotic treatment of hospital-acquired pneumonia. Blood samples were taken before, immediately after and 4 h after application of cephalosporins.Measurements and results Of the pneumonia patients, 55% developed septic encephalopathy. ICU stay, complications and mortality were significantly increased. An increased release of TNF- was immediately seen in all pneumonia patients after antibiotics compared to controls, whereas the level did not differ between patients with and without septic encephalopathy. Norharman was significantly increased in pneumonia patients 4 h after antibiotic treatment, in tendency more enhanced in the pneumonia patients without encephalopathy.Conclusions Patients with hospital-acquired pneumonia and septic encephalopathy had a significantly longer ICU stay with higher mortality rate compared to patients with hospital-acquired pneumonia alone. Antibiotic-mediated TNF- release may induce the kynurenine pathway. TNF- activates indolamine-2,3-dioxygenase with neurotoxic quinolinic acid as the end product. Norharman seems to counteract this mechanism and seems to play a role in neuroprotection. The worse outcome of patients with encephalopathy expresses the need to investigate protective factors and mechanisms.     

头孢菌素类药致药源性死亡文献分析

摘 要为了解头孢菌菌素类药致药源性死亡的发生情况及特点,检索中国生物医学文献数据库、中国知网、万方数据库和维普网中有关头孢菌素类药致药源性死亡的文献资料,对致死病例的性别、年龄、药物不良反应临床表现及死亡原因等信息进行回顾性分析。结果发现,检索到有效文献52篇,报道病例73例;死者平均年龄（47.12±13.05）岁,男女性别比为1.43∶1;原发疾病以呼吸系统感染为主（52例,71.24%）;给药方式以静脉滴注为主（63例,86.30%）;ADR的发生时间主要集中在10 min以内（47例,64.38%）;使用第三代头孢菌素药患者最多（48例,65.75%）,使用频率最高的前3位头孢菌素类药依次为：头孢曲松钠24例（32.88%）、头孢唑林钠11例（15.07%）、头孢哌酮钠10例（13.70%）;过敏性休克是导致药源性死亡的主要原因（56例,76.71%）。