乙酰半胱氨酸预防肺癌放射性肺损伤的效果观察

目的 观察乙酰半胱氨酸对肺癌放射性肺损伤的预防作用.方法 80例不能手术的非小细胞肺癌患者随机分成两组,采用体部伽玛刀立体定向三维适形放射技术,总剂量65～75 Gy.治疗组伽玛刀放疗同时联合应用乙酰半胱氨酸,对照组单纯予以伽玛刀放疗.结果 80例患者全部完成放疗计划,有效率( CR+ PR)治疗组为90％,对照组为85％,两组差异无统计学意义(x2=0.114,P＞0.05).急性放射性肺损伤和晚期肺纤维化发生率治疗组为15％和20％,对照组为33％和45％,两组差异均有统计学意义(均P＜0.05).结论 接受放射治疗的非小细胞肺癌患者应用乙酰半胱氨酸对放射性肺损伤的发生有一定的预防作用,而不影响放疗效果.     

中西医结合治疗男性不育合并支原体感染的疗效观察

目的观察不同治疗方案治疗男性不育合并支原体感染的疗效,为临床工作提供参考。方法选取我院就诊男性不育合并支原体感染患者392例,随机分为对照组和观察组,每组各196例。全部患者均给予阿奇霉素21d治疗,口服维生素E、叶酸。此外,对照组给予口服乙酰半胱氨酸;观察组给予口服复方玄驹胶囊、前列通瘀胶囊。30d为1个疗程,连续治疗3个疗程,比较两组患者临床疗效和不良反应。结果两组患者总有效率比较,差异无统计学意义(P>0.05)。两组治疗前后精子量、精子密度、精子成活率、精子畸形率比较,均有所改善,但对照组的改善效果较观察组明显(P<0.05),治疗期间两组患者不良反应发生率比较,观察组明显低于对照组,差异有统计学意义(P<0.05)。结论采用复方玄驹胶囊、前列通瘀胶囊治疗男性不育合并支原体感染,可以取得良好的临床疗效,同时不良反应较小,值得推广应用。     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

目的 探讨N-乙酰半胱氨酸对体外循环(CPB)下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法 择期CPB下行心脏瓣膜置换术的风湿性心脏病患者22例,性别不限,年龄21-60岁,ASA Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机分为2组(n=11):对照组(C组)和N-乙酰半胱氨酸组(N组).N组预充液中加入N-乙酰半胱氨酸100 mg/kg,停搏液中加入50 mg/kg,C组给予生理盐水替代.于麻醉诱导前10 min和术毕时,记录HR、MAP、中心静脉压(CVP)、肺动脉压(PAP)、肺毛细血管楔压(PCWP)、心输出量(CO)和心脏指数(CI).于切皮前即刻、主动脉开放后0.5、6、12和24 h时,采集桡动脉血样行血气分析,采集中心静脉血样测定血浆白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛(MDA)、心肌肌钙蛋白I(cTnI)的浓度和超氧化物歧化酶(SOD)活性.于CPB前即刻和停机即刻,取心肌组织,计数凋亡细胞,观察心肌细胞超微结构.结果 与c组比较,N组HR、MAP、CVP、PAP、PCWP、pH值、红细胞压积、动脉血氧分压、动脉血二氧化碳分压和剩余碱差异无统计学意义(P>0.05),主动脉开放后TNF-α、IL-6、cTnI和MDA的浓度降低,SOD活性升高,CPB停机即刻心肌凋亡细胞计数降低,术毕CO和CI升高(P<0.05或0.01),心肌病理损伤减轻.结论 N-乙酰半胱氨酸可减轻体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤.     

Impact of reducing the threshold for acetylcysteine treatment in acute paracetamol poisoning: The recent United Kingdom experience

Background. On 3 September 2012, the licensed indication for acetylcysteine was changed in the United Kingdom (UK) so that all patients with a plasma paracetamol concentration above a “100 mg/L” (4 h post ingestion) nomogram treatment line after an acute paracetamol (acetaminophen) overdose should be treated. This is a lower threshold than that used in the United States, Canada, Australia, and New Zealand. Here we report the impact of this change in the UK on the management of patients with acute overdose in different paracetamol concentration ranges. Methods. This is a cohort study, consisting of a retrospective analysis conducted on prospectively collected audit data in three UK hospitals. Following appropriate ethical and data protection authority approval, data for patients presenting within 24 h of an acute timed single paracetamol overdose were extracted. Numbers of admissions and use of antidote in relation to different paracetamol concentration bands (< 100 mg/L; 100–149 mg/L; 150–199 mg/L; and ≥ 200 mg/L at 4 h) were analyzed for one-year periods before and after the change. Results. Comparing the year before with the year after the change, there was no change in the numbers of patients presenting to hospital within 24 h of acute timed paracetamol overdose (1246 before and 1251 after), but more patients were admitted (759 before and 849 after) and treated with acetylcysteine (389 before and 539 after). Of the 150 additional patients treated with acetylcysteine in the year following the change, 114 (76%, 95% CI: 68.4–82.6) were in the 100–149 group and 9 (6.0%, 95% CI: 2.8–11.1) in the 150–199 group. Conclusions. Changes to national guidelines for managing paracetamol poisoning in the UK have increased the numbers of patients with acute overdose treated with acetylcysteine, with most additional treatments occurring in patients in the 100–149 mg/L dose range, a group at low risk of hepatotoxicity and higher risk of adverse reactions.     

十味龙胆花胶囊联合乙酰半胱氨酸胶囊治疗痰热壅肺型老年肺炎疗效观察及对外周血PLR与NLR水平的影响

目的探究十味龙胆花胶囊联合乙酰半胱氨酸在痰热壅肺型老年肺炎治疗中的疗效观察及对外周血PLR与NLR水平的影响。方法采用随机分组将我院2019年1月到2021年12月收治的107例老年肺炎病人分为观察组（n=54）与对照组（n=53）,对照组采用乙酰半胱氨酸胶囊治疗,观察组在此基础上联合使用十味龙胆花胶囊治疗。治疗前后观察两组病人血清相关指标（IL-8、CRP、IL-6）的水平和外周血PLR、NLR的水平。观察两组病人的临床效果疗效、不良反应出现概率、血氧饱和度恢复时间、症状消退和住院时间。结果 IL-8、IL-6、CRP方面,两组病人治疗前 水平并无差异（P＞0.05）。治疗5、10d后 观察组IL-8、IL-6、CRP水平较对照组较对照组显著降低（P＜0.05）。治疗前两组病人 PLR、NLR水平无显著差异（P＞0.05）。治疗5、10d后 观察组PLR、NLR水平较对照组较对照组显著降低（P＜0.05）。观察组总有效率为96.30%显著高于对照组86.48%（χ2=4.096,P=0.043）。治疗后观察组血氧饱和度恢复、症状消退、住院所用时间均显著低于对照组（P＜0.05）。治疗后观察组总不良反应发生率为7.40%略低于对照组11.28%,但两组病人但两组病人不良反应发生率无显著差异（χ2=0.483,P=0.486）。结论十味龙胆花胶囊联合乙酰半胱氨酸胶囊治疗能有效降低病人不良反应发生率,加快病人恢复时间,减少住院时间,提升临床疗效率,降低病人炎性反应。     

N-Acetylcysteine Improves Pancreatic Microcirculation and Alleviates the Severity of Acute Necrotizing Pancreatitis

Background/Aims

To investigate the beneficial effect of N-Acetylcysteine (NAC) on pancreatic microvascular perfusion in acute necrotizing pancreatitis (ANP).

Methods

Fifty-four rats were divided into a control group, an ANP group and an NAC-treated group. The ANP model was established by a retrograde injection of 3% sodium taurocholate into the pancreatic duct. The NAC-treated group received an intravenous infusion of NAC just 2 hours before and 30 minutes after the induction of ANP. The pancreatic microvascular perfusion was measured with laser Doppler flowmetry and pancreatic samples were collected for histological examination.

Results

The microvascular perfusion in the NAC-treated group decreased slightly and exhibited a significant increase compared to the ANP group (p<0.01). A pathological examination revealed that edema and inflammatory infiltration decreased, and the hemorrhaging and necrosis of the pancreas were significantly reduced.

Conclusions

NAC could improve pancreatic microvascular perfusion and alleviate the severity of sodium taurocholate-induced ANP, possibly representing a new therapeutic approach to prevent the progression of ANP.     

N-乙酰半胱氨酸防治老年患者化疗药物性肝肾损害的临床研究

目的 探讨N-乙酰半胱氨酸(NAC)注射液对老年患者以顺铂为主的联合化疗所导致肝肾损害的改善作用.方法 40例接受肿瘤化疗的老年患者随机自身交叉分为AB和BA组,AB组第1周期为化疗加NAC治疗10 d,第2周期为化疗加肌苷、维生素C注射液10 d;BA组第1周期为化疗加肌苷、维牛素C注射液治疗10 d,第2周期为化疗加NAC治疗10 d,每21天为1个周期.观察比较两组患者肝肾损害程度的差异,并评价NAC治疗肝肾损害的疗效. 结果 A周期化疗后血清丙氨酸氨基转移酶(ALT)水平(29.18±5.43)U/L、门冬氨酸氨基转移酶(AST)水平(32.37±7.13)U/L、肌酐(95.22±20.60)μmol/L,与化疗前[分别为(25.32±5.23)U/L、(29.21±6.51)U/L和(89.87±19.56)±mol/L] 比较,差异均无统计学意义(均为P>0.05);B周期化疗后ALT(56.76±5.53)U/L、AST(48.83±6.64)U/L和肌酐(137.33±21.16)/±mol/L,较化疗前[分别为(26.19±5.51)U/L、(29.95±6.56)U/L和(88.66±18.27)μmol/L] 均增高(均为P<0.01).结论 NAC对老年患者化疗所致肝肾功能损害有明显保护作用,可防治化疗所致的肝肾功能损害.     

Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis

Objective Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients.Design and setting Retrospective cohort study in a 12-bed tertiary surgical ICU.Patients Were evaluated all contrast-enhanced abdominal computed tomography (CT) scans between 1995 and 2003 in patients not on renal replacement therapy (RRT) before the CT. Patients received prophylactic prehydration and, since 2000, acetylcysteine. Low-osmolarity, nonionic contrast was used. CIN was defined as an increase in serum creatinine of more than 44 μmol/l (0.5 mg/dl) within 48 h after contrast administration, with no increase in creatinine of 44 μmol/l during the preceding 2 days. RRT initiated after the CT was also recorded.Measurements and results The patient was not on RRT before CT in 486 of 589 cases (16% diabetics). In these 486 cases the median (IQR) creatinine decreased significantly from 88 μmol/l (66–124) on the day of the CT-scan to 84 μmol/l (63–118) 2 days later. Only 7 of the 486 cases (1.4%) fulfilled the criteria of CIN, and in another 17 (3.5%) RRT was started after the CT. Important coexisting causes of renal failure were present in these patients, and in all survivors renal function recovered.Conclusions CT with modern contrast is associated with a very low incidence of nephropathy in predominantly nondiabetic surgical ICU patients. Intravenous contrast should only rarely be withheld in these patients.     

N-乙酰半胱氨酸恢复糖尿病大鼠心脏Brg1蛋白表达的实验研究

目的探讨Braham相关基因1(Brg1)在糖尿病心肌中的表达及抗氧化剂N-乙酰半胱氨酸(NAC)对其表达的影响。方法将18只SD大鼠随机分为对照组、糖尿病组和NAC治疗组,每组6只。大鼠经尾静脉一次注射链脲佐菌素(65 mg/kg)造模,造模后4周终止实验,处死大鼠,取血和心脏标本,测定血糖;测定血浆和心脏组织氧化应激特异性指标15-F2t-isoprostane水平;并通过超声检测心脏功能,Western blot法检测心肌Brg1和血红素加氧酶1(HO-1)蛋白表达。结果 4周终止实验时,糖尿病组血浆及心肌组织15-F2t-isoprostane水平明显高于对照组,而心肌Brg1和HO-1蛋白表达低于对照组。且超声检测发现糖尿病大鼠左心室质量与体重比显著增高,而E/A比值显著降低(P<0.05或P<0.01)。NAC治疗显著抑制糖尿病大鼠血浆及心肌组织15-F2t-isoprostane水平,增加心肌Brg1和HO-1表达,并改善心功能(P<0.05)。结论心肌Brg1表达降低可能参与了糖尿病心肌氧化应激反应及心功能损伤。增加糖尿病心肌Brg1表达,进而增加HO-1表达,可能是抗氧化剂NAC改善糖尿病心功能损伤及抑制氧化应激反应的另一重要机制。     

乙酰半胱氨酸泡腾片治疗支气管扩张临床疗效观察

目的观察乙酰半胱氨酸泡腾片治疗支气管扩张的临床效果。方法选取2018年6月～2019年6月在我院呼吸内科收治的支气管扩张住院患者60例为研究对象,随机分为对照组和观察组,每组30例,对照组使用低渗盐雾化吸入治疗,观察组在对照组基础上使用乙酰半胱氨酸泡腾片治疗,比较两组治疗效果。结果治疗后观察组的血气指标上升更明显;肺功能指标FVC、FEV1明显高于对照组,CRP/ESR指标低于对照组,观察组CAT评分低于对照组,差异均有统计学意义(P0.05)。结论在支气管扩张中采用乙酰半胱氨酸泡腾片给予治疗可以帮助患者改善肺功能与血气指标,效果显著,可以在临床推广应用。