鸦胆子油乳注射液及配置后静脉输液的室温稳定性研究

目的 考察说明书中贮存条件要求冷藏,且须临用前即配即用的鸦胆子油乳注射液的原液和稀释后的静脉输液在室温(25 ℃)下的稳定性,为该药品的临床管理与使用提供依据。方法 模拟临床给药剂量和给药时间,考察性状、pH、渗透压、颗粒细度和油酸含量在室温下放置不同时间点的变化。结果 在室温下,鸦胆子油乳注射液原液放置72 h质量稳定,配置后静脉输液(30 mL∶250 mL 0.9%生理盐水)在24 h内各项理化指标均无明显变化。结论 鸦胆子油乳注射液在医院内部的短时间药物配送无需严格实施冷链管理;配置后静脉输液室温放置24 h稳定,无需“即配即用”。     

Targeted-immunosuppression with vincristine infusion in the treatment of immune thrombocytopenia

Abstract Twenty-four patients with immune thrombocytopenia (ITP) were treated with vincristine (VCR) 1.0–2.0mg given as 4-hr I.V. infusions at weekly intervals for four-six weeks; four patients received further infusions, as maintenance therapy, at increasing intervals for up to 12 months. Eight often patients with recent-onset (< 6 months) ITP showed an excellent and sustained response, 7/8 without maintenance therapy. Among the 14 patients with ITP of >6 months' duration, seven showed a good or excellent but only transient response; sustained responses (two good, one partial) were seen only in the three patients who received maintenance therapy. The collective global experience with this novel therapeutic approach of targeted-immunosuppression for ITP is still small, but results to date suggest a promising role for this approach, especially in patients with recent-onset ITP. (Aust NZ J Med 1991; 21: 405–407.)     

Low subcutaneous degradation and slow absorption of insulin in insulin-dependent diabetic patients during continuous subcutaneous insulin infusion at basal rate

Summary As information on the absorption kinetics and local degradation of infused insulin is relevant to programming strategies for continuous subcutaneous insulin infusion, we examined the time relationship of systemic insulin appearance and quantitated subcutaneous degradation during a near-basal rate of continuous subcutaneous insulin infusion in five insulin-dependent diabetic patients. Plasma free insulin was monitored for 8 h during and 3 h after a subcutaneous (abdominal wall) infusion of neutral insulin at 2.4 U/h. An identical intravenous infusion (2–4 h) was given on a separate occasion. Plateau levels of free insulin were not significantly different during the subcutaneous (37±8 mU/l) and intravenous (40±7 mU/l) infusions. Fitting of the free insulin data to our two-pool model of the subcutaneous space gave a mean estimate of 9.2 units insulin (= 3.8 h infusion) for the subcutaneous depot after 8 h. Model estimates of systemic insulin appearance, as a percentage of subcutaneous infusion rate, were 59% and 93% after 4 and 8 h respectively, and 76% 2 h after cessation of infusion. In insulin-dependent diabetic patients subcutaneous degradation of infused insulin is negligible but local accumulation in the subcutaneous space is considerable. The delay in absorption has important clinical implications for interruption and resumption of continuous subcutaneous insulin infusion and also for programming of variable basal rates.     

Growth responses to patterned GH delivery

We have investigated the effects of different patterns of administration of recombinant human growth hormone (rhGH) on weight gain, organ growth, serum GH binding protein (GHBP) and insulin-like growth factor-l (IGF-1) levels in a series of studies using hypophysectomized (Hx) or GH-deficient dwarf (dw/dw) rats. Animals were given rhGH either by subcutaneous (s.c.) injections (1 or 2 per day) or s.c. infusions and rhlGF-1 (2 mg/kg/day) by s.c. infusion. In Hx rats, all rhGH regimes increased body weight, tibial epiphyseal plate width, and organ weights in a dose-related manner. Dwarf rats showed a smaller growth response to rhGH than Hx rats, whereas rhGH induced greater elevations in serum GHBP in drarf rats. Growth responses depended on the pattern of rhGH administration (twice daily injections > continuous infusions > daily injections). The shape of the body growth curves also differed; rhGH injections increased weight gain linearly, whereas infusions gave an initial rapid weight gain which slowed with time (a curvilinear response). For both regimens, tibial epiphyseal plate width increased linearly with rhGH dose but infusions were 5-fold more potent than daily injections. Spleen and thymus weights were markedly increased by rhGH and were also affected by the pattern of GH exposure. At 5 mg rhGH/kg/day, thymus weights were 390±35 mg for injectionsvs. 613 ± 34 mg for infusions (P<0.001) compared with 248 ± 16 mg in vehicle-treated Hx controls. Infusions of rhlGF-1 also stimulated specific organ growth but caused less weight gain. RhlGF-1 additively increased the weight gain caused by rhGH injections but not by rhGH infusions. Circulating IGF-1 and GHBP levels were increased in a dose-dependent manner by rhGH infusion, whereas daily injections were ineffective. Thus, differential organ growth could be related to the higher serum IGF-1 concentrations induced by continuous rhGH administration. These studies show that whole body growth is best maintained by intermittent rhGH exposure, whereas, paradoxically, differential organ growth is most pronounced with continuous rhGH administration.     

Importance of vancomycin loading doses in intermittent infusion regimens

Purpose

Delayed achievement of target vancomycin serum concentrations may adversely affect clinical outcomes. The objective of this retrospective study was to explore the real frequency of loading dose use and to evaluate the impact of loading dose for the achievement of vancomycin PK/PD target in adult patients treated with intermittent vancomycin. As a secondary aim we determined optimal vancomycin loading dose based on individual pharmacokinetic calculations.

智能化电子输液卡在优化临床输液治疗中的应用研究

目的探讨护理信息化建设过程中,智能化电子输液卡在优化临床输液治疗中的应用效果。方法通过前期设计及沟通,于2016年6月逐步推进全院电子输液卡的使用。通过随机抽查各病区使用电子输液卡前后(分别抽取2016年5—8月的200份纸质输液卡作为对照组,抽取2016年10月—2017年1月的200份电子输液卡作为观察组)的输液记录质量,并调查患者满意度(电子输液卡使用前后分别调查250例患者)来评价电子输液卡的使用效果。结果使用电子输液卡后,静脉输液过程中的护理差错发生率明显降低,患者满意度有所提高。结论智能化电子输液卡可有效加强静脉输液过程中的质量控制,规范护理行为,提高护理记录质量,有利于节约人力、物力,维护患者权益,提高患者满意度。     

靶控输注不同镇静药物用于围术期自控镇静技术中的比较

目的探讨围术期自控镇静技术中靶控输注不同镇静药物的临床镇静效果。方法对在该院接受手术的80例患者入院资料进行分析,随机分为丙泊酚组和咪达唑仑组。本研究中二组患者在围术期靶控输注不同镇静药物,咪达唑仑组靶控输注咪达唑仑镇静剂,丙泊酚组靶控输注丙泊酚镇静,注射完后记录患者平卧10min、注射镇静药后2min、5min、10min以及手术结束前10min、手术结束时等6个时间点的OAA/S镇静评分值,并密切观察患者的镇静效果和呼吸情况。结果丙泊酚组T1时刻镇静评分为(5.0±0.0),镇静评分值在注射药物2min到5min后都明显下降,T2时刻镇静评分为(3.6±0.2)、T3时刻镇静评分为(2.5±0.4)与咪达唑仑组差异有统计学意义(P<0.05);T4、T5、T6时刻镇静评分二组患者差异无统计学意义(P>0.05);镇静后二组患者的MAP,HR均明显下降,丙泊酚组患者在镇静后2min,5min时的MAP、HR均低于咪达唑仑组(P<0.05),其他时间二组差异无统计学意义;丙泊酚组中有5例患者呼吸抑制,咪达唑仑组有3例(P>0.05)。结论围术期自控镇静技术中靶控输注丙泊酚镇静效果较好,患者麻醉后对其生命体征影响比较小,值得推广使用。     

Stability of Cefazolin in Polyisoprene Elastomeric Infusion Devices

Purpose

The aim was to investigate the stability of cefazolin in elastomeric infusion devices.

靶控输注依托咪酯意识消失的半数有效量的测定

目的 依托咪酯是一种非巴比妥类的静脉麻醉药,半衰期短.依托咪酯具有起效快、作用时间短、体内代谢迅速、恢复平稳、对心血管系统和呼吸系统抑制轻微、有脑保护的作用等特点,在临床上被麻醉医师广泛的应用.测定靶控输注依托咪酯镇静的半数有效量以及95％有效量.了解EC50(半数有效浓度)及EC95(95％有效浓度)剂量可以帮助确定依托咪酯的安全范围与有效范围;增加依托咪酯应用的安全性;提高麻醉质量与患者的舒适程度;提高合理用药.方法 选择煤炭总医院2013年1-5月择期椎管内麻醉下行下腹部或下肢手术患者41例.ASA Ⅰ ～Ⅱ级;采用靶控输注依托咪酯镇静.将其随机分为4组,靶控浓度分别为0.2 μg/ml、0.3 μg/ml、0.4 μg/ml、0.5 μg/ml观察30 min.每隔5 min记录患者警觉/镇静评分法(OAA/S)、血压、心率、呼吸次数、血气等监测指标.改良OAA/S评分为3分以上患者视为入睡.所有患者均不给术前药,同时记录药后患者镇静程度改变情况;计算靶控输注依托咪酯使患者意识消失的EC50及EC95.结果 TCI靶控输注依托咪酯的半数有效浓度为0.333 μg/ml,95％可信限为0.284～0.374 μg/ml;依托咪酯EC95为0.468μg/ml; 95％可信限为0.412～0.491 μg/ml.结论 依托咪酯靶控输注具有血流动力学稳定、对呼吸影响小,同时具有较低的肌阵挛发生率,可以广泛的应用于临床镇静和麻醉.临床推荐剂量为0.333～0.468 μg/ml.