Flunitrazepam (Ro 5-4200) and sleep cycle in insomniac patients

The action of flunitrazepam (Ro 5-4200), a benzodiazepine derivative, was assessed on the sleep cycle of insomniac patients by means of all-night reeordings. Baseline placebo nights were compared with the drug (2–8 mg p.o.) and with the placebo post-drug nights.Flunitrazepam induced a shift to faster frequencies of the EEG and a disappearance of sleep stages 3 and 4 while stage 2 was increased. In 10 out of 12 studied insomniacs the compound was effective in inducing and maintaining sleep (decrease in NREM sleep latency, wake time and number of wakes) throughout the drug administration period. Both NREM and REM sleep were increased, the latter most likely in relation to a blockade of processes precluding NREM emergence.The hypnotic action of flunitrazepam was still present during the first withdrawal night, pointing out to a carry over effect.Supported by a grant from Hoffman-La Roche.     

合理选用红细胞流变性指标是诊断血液高黏滞的需要

目的：针对目前国内临床血液流变学指标检测报告单存在指标项目过多的现状,通过分析某医院现行的临床血液流变学指标检测报告单,揭示红细胞流变性检测中报告单所反映的各种存在问题,指出指标设置的不合理之处,从而提供临床血液流变学指标检测规范化建设的原则。方法：通过对现行由厂家提供的某医院的临床血液流变学指标检测报告单的分析,列举报告单中指标设置及其检测结果的各种存在问题,揭示红细胞流变性检测指标设置的混乱性。结果：通过对临床血液流变学指标检测报告单的分析,发现临床血液流变学指标检测报告单的红细胞流变性存在指标过多．指标优劣混杂、指标定义不清的混乱状况。结论：目前临床血液流变学检测报告指标设置混乱的状况．已经对临床医生准确判断血液高黏滞造成严重影响。文章提出改进的必要,并强调指出,有关专家、学者应对临床血液流变学检测报告指标设置加强研究,有关主管部门、学术机构应组织专门的研讨,有针对性地提出切实可行的临床血液流变学指标检测报告的规范化方案,尽早改变临床血液流变学指标检测的混乱状况。     

Effects of quazepam as a preoperative night hypnotic: comparison with brotizolam

Purpose The purpose of this study was to evaluate the effects of quazepam, a long-acting hypnotic, as a preoperative night medication in comparison with brotizolam, a shortacting hypnotic. Methods Two hundred patients (aged 30 to 70 years) admitted for elective general anesthesia at various hospitals were enrolled. Quazepam 15 mg, 30 mg, or 45 mg, or brotizolam 0.25 mg (40 patients each), was administered orally at 9 p.m. in the evening of the day before surgery. The control group (40 patients) did not receive any drugs. The quality of night sleep between the night during hospitalization and the night before surgery was compared by using a questionnaire. In the first 8 patients who received quazepam 15 mg, 30 mg, and 45 mg, the plasma concentrations of quazepam and its metabolites were measured 12 h after the drug administration, when the patients were brought into the operating room. Results In all the drug-administered groups, the speed of falling asleep, sleeping state, and feeling of freshness in the morning improved compared to the previous night and compared to the control group; the frequency of nocturnal awakening and dreaming decreased, and the total duration of sleep the night before surgery increased. Total duration of sleep was significantly longer in the groups with quazepam 30 mg and 45 mg than in the control and brotizolam 0.25 mg groups. No patients were drowsy with plasma concentrations of quazepam of 30 to 65 ng·ml⁻¹. Conclusion The preoperative night hypnotics, quazepam and brotizolam improved sleep before surgery. As a preoperative night hypnotic, quazepam 30 mg and 45 mg increased the total duration of sleep compared to brotizolam 0.25 mg.     

Focused hypnotic analgesia: local and remote effects

Suggestion for hypnotic analgesia aimed at a specific body area is termed "focused hypnotic analgesia". It is not clear, however, whether this analgesia is limited to a specific body location or spread all over the body. Focused hypnotic analgesia was studied, in response to ascending electrical stimuli, when analgesia and stimulation were applied to the same area (local), and when analgesia was applied to one location and stimulation was delivered to a different area (remote). The face or leg served alternately as the local or remote areas, and the effect was tested in 12 high-hypnotizable (HH) and 13 low-hypnotizable (LH) subjects. Hypnotic analgesia in the local site produced a significant pain reduction compared to the remote site in HH subjects (P<0.0001) but not in LH subjects (P=0.68). As stimuli increased in intensity the reduction in pain as a result of hypnosis was larger both in HH and LH subjects (P<0.0001). Nevertheless, significant analgesia occurred in the 3 highest intensities in the local and remote location of HH subjects, but only in 2 highest intensities in the local and 1 in the remote of LH subjects. We conclude that in HH subjects focused hypnotic analgesia is mostly confined to the area aimed at, but some spread of analgesia to remote areas cannot be dismissed all together. Alternatively, this "spread" of analgesia could be due to a placebo effect in the remote area. Focused hypnotic analgesia requires increased attention to the body area aimed at, unlike analgesia achieved by distraction of attention.     

20%脂肪乳对家兔持续异丙酚输注血药浓度、分布容积及药理效应的影响

目的 探讨20％脂肪乳对家兔持续恒速输注异丙酚血药浓度、分布容积及药理效应的影响.方法 52只家兔随机分为4组(n=13):异丙酚组(P组),低剂量脂肪乳组(L组),高剂量脂肪乳组(H组),生理盐水组(S组).每组家兔以70 mg/(kg·h)持续恒速输注异丙酚120 min.恒速输注异丙酚60 min后,P组维持原速率继续输注异丙酚,L组和H组输注异丙酚同时输注20％脂肪乳,速率分别为0.3 mL/(kg·h)和15 mL/(kg·h);S组输注异丙酚同时输注生理盐水,速率为15 mL/(kg·h),3组输注不同液体时间为60 min.各组取8只家兔于异丙酚输注后30、60、65、70、80、90、105、120 min以及停药后10、20、30、60、120、180 min采血测定异丙酚血药浓度,计算相关药代动力学参数;用平均动脉压(MAP)、心率(HR)、神经反射率评价药理效应;各组另取5只家兔于异丙酚输注120 min时获取家兔脑组织、测量异丙酚脑组织浓度.结果 H组经20％脂肪乳输注后,血药浓度上升,消除相分布容积(V)[各组分别为(34.56±16.11)mL、(33.37±29.87)mL、(7.29±3.20)mL和(35.46±13.58) mL]、稳态分布容积(Vss)[各组分别为(11.13±3.21) mL、(13.87±4.09)mL、(4.82±1.46) mL和(11.61±4.11) mL]降低(P＜0.05);MAP、HR上升(P＜0.05);90、120 min痛觉反射存在率与其余3组比较差异有统计学意义(P＜0.05);120 min时异丙酚脑组织浓度降低[各组分别为(1.92±0.41)μg/g、(1.90±0.53)μg/g、(1.27±0.40)μg/g和(2.02±0.49)μg/g,P＜0.05].结论 当20％脂肪乳以高剂量输注时,可降低异丙酚药物分布容积,升高血药浓度,降低异丙酚脑组织浓度,导致药理效应减弱.以临床营养支持相类似的低速率输注时,并不会对以上指标产生影响.     

深圳地区中毒洗胃现状调查

目的 了解深圳地区医院洗胃的基本情况,为合理应用洗胃术提供依据.方法 选取深圳代表性医院24家,采用调查表对2009年洗胃患者的中毒原因、洗胃机数量及分布影响、洗胃效果的因素、不良反应和并发症发生情况进行调查.结果 安眠镇静类药物中毒是导致洗胃的首要原因,在二级医院中以毒物中毒为首位.洗胃机以全自动洗胃机为主,三级医院基本均为全自动洗胃机.全自动洗胃机的不良反应和并发症少于半自动洗胃机.结论 不同医院洗胃主要原因存在差异,尽量选择全自动洗胃机进行洗胃.     

艾滋病患者对“四免一关怀”知晓与建议的分析

目的:了解艾滋病(HIV/AIDS)患者对“四免一关怀”政策的了解和建议情况,为艾滋病防治工作提供参考依据.方法:采用多阶段整群抽样的方法,在四个艾滋病高发县(上蔡、沈丘、确山、尉氏)抽取1129例艾滋病患者进行问卷调查,并对其结果分析.结果:85％以上的患者对“四免一关怀”政策有了解,90.9％患者对政策表示肯定,前六个建议占总建议的79.3％.讨论:相关部门需认真研究患者提出的建议,解决共性问题的同时补充个性问题,提高防治效率.     

对医疗保障城乡统筹的建议和思考

医疗保障城乡统筹是新医改工作的一项重点和明确任务,也是完善基本医疗保障制度建设的必然要求。文章借鉴发达国家医疗保障制度城乡统筹的经验,分析当前城乡统筹探索实践中存在的误区,对实现医疗保障城乡统筹提出建议和思考。     

湖南省邵阳县实施国家基本药物制度的现状与思考

文章在对邵阳县实施基本药物制度进行调研的基础上,发现了邵阳县在实施基本药物制度的过程中存在着县级财政经费困难、乡镇卫生院债务清偿难、基本药物难以满足居民用药需求、企业生产配送基本药物的热情不够等问题,并结合邵阳县的实际情况提出了相应的政策建议。     

公立医院与基层医疗卫生机构分工协作机制研究及政策建议

运用参与式快速评估方法,探索如何建立连续、协调的两级医疗卫生服务体系,以提升卫生资源的整体利用效率．并就推动公立医院与基层医疗卫生机构有效开展分工和协作提出政策建议。