氧氟沙星加双黄连注射液静脉滴注致肝损害1例

氧氟沙星 (ｏｆｌｏｘａｃｉｎ)和双黄连 (Ｓｈｕａｎｇｈｕａｎｇｌｉ ａｎ)已成为临床常用的抗菌药 ,但其不良反应亦不可忽视。我们曾遇见 1例用该 2药治疗上呼吸道感染引起严重肝功能损害 ,报道如下。病人男性 ,2 1ａ。主要因咽痛、咯痰、发热 2ｄ入院。病人于入院前 2ｄ出现咽痛、咯黄痰、胸痛、发热 (Ｔ38.9℃ )。诊断为上呼吸道感染。在当地卫生所给予氧氟沙星注射液(四川科伦大药厂生产 ,规格 :1 0 0ｍＬ :0 .2ｇ批号 0 1 30 1 2 )0 .2ｇ(1 0 0ｍＬ) +双黄连注射液 (齐齐哈尔第二制药厂生产 ,规格 :每支 2 0ｍＬ批号 30 0 1 32 ) 2 0…     

1999至2001年广州地区临床常见肠杆菌科细菌耐药性监测结果分析

目的 了解临床分离常见肠杆菌科细菌的耐药性。方法 统一采用纸片扩散法进行实验，以美国NCCLS文件为判断标准，每次监测均有质控数据。结果 共有11家广州市三级甲等医院实验室参加耐药性监测，三年共统计临床常见肠杆菌科细菌3147株。结论 对肠杆菌科细菌，亚胺培南的耐药率最低，可考虑为临床首选药物，阿米卡星、头孢他啶耐药率相对较低，可选择用药。庆大霉素的耐药率有逐年下降的趋势，将来可能成为临床一线药。而磺胺甲噁唑／甲氧苄啶、四环素、萘啶酸等耐药率相对较高，应慎用。氨节西林的耐药率很高，应避免使用。     

京、沪、穗三城市2001年—2002年抗病毒药物利用分析

目的 :通过京、沪、穗抗病毒用药的药物利用分析 ,为药品研究、生产、流通和宏观控制提供参考。方法 :利用《全国医药信息网》提供的京、沪、穗三地的抗病毒药品 2 0 0 1年和 2 0 0 2年的统计数据 ,通过药品消耗排序、趋势分析、DDDs等指标 ,分析抗病毒药品的利用情况和市场走势。结果 :抗病毒药品的消耗总体呈增长趋势 ,其中专利品种如拉米夫定的优势远远大于仿制品种 ;国产药品目前在抗病毒药品消耗总金额中占绝对优势 ;京、沪、穗抗病毒用药金额差别较大 ,以广州最高。结论 :抗病毒药品具有广阔的市场前景 ,但要重视低水平的重复仿制与科技创新的矛盾。具有自主知识产权的专利品种是保持市场竞争力的关键。     

国产班布罗的平喘作用

目的　研究国产班布特罗的平喘作用。方法　采用豚鼠整体引喘法及兔肺溢流法。结果　班布特罗 (ig ,1 4、2 8、5 6mg·kg-1)同间羟叔丁肾上腺素作用相似 ,均具有平喘及松驰气管平滑肌的作用。结论　国产班布特罗具有明显的平喘作用     

去甲氧柔红霉素联合方案治疗难治性急性淋巴细胞白血病的远期疗效

目的探讨应用去甲氧柔红霉素（ＩＤ）为主的联合化疗方案治疗难治性儿童急性淋巴细胞白血病（ＡＬＬ）的远期疗效及其临床应用价值。方法初治诱导缓解方案用ＶＩＬＰ（长春新碱、去甲氧柔红霉素、左旋门冬酰胺酶、泼尼松）。完全缓解（ＣＲ）后作巩固治疗及庇护所治疗，然后再用ＶＩＬＰ作早期强化治疗。复发者诱导治疗用ＩＡ（去甲氧柔红霉素、阿糖胞苷）方案。ＣＲ后巩固和早期强化治疗用初治者同样方案。结果１０例初治患儿９例获ＣＲ，７例复治患儿５例获ＣＲ，总ＣＲ率为８２％（１４／１７）。ＣＲ的１４例中持续ＣＲ（ＣＣＲ）＞３年者４例，＞２年者４例，＞１年者１例。结论用去甲氧柔红霉素为主的联合方案是治疗难治性儿童ＡＬＬ有效的方法，对初治患儿作为一线药物其远期疗效会更好。     

肿瘤患者合并肺部念珠菌感染药敏测定研究

采用ＲＰＭＩ１６４０及ＦＤＡ抗生素３号两种培养基的微量稀释法对肿瘤患者合并肺感染分离出５１株念珠菌进行药敏对比测定。结果显示二性霉素Ｂ在两种培养基中均具有非常好的抗菌活性，敏感率均为９８．０％，其次酮康唑也显示出良好的抗菌活性，敏感率均为９４．１％。相比之下，在ＲＰＭＩ培养基中伊曲康唑和氟康唑的敏感性稍差，敏感率分别为９２．２％和９０．２％，但在ＦＤＡ抗生素３号培养基中，伊曲康唑和氟康唑敏感性明显下降，敏感率分别为７０．６％和６６．７％。为此我们建议抗真菌药敏试验，尤其是咪唑类药物应该选用ＮＣＣＬＳ推荐的ＲＰＭＩ１６４０培养基做药敏试验     

Effects of vecuronium and rocuronium in antagonistic laryngeal muscles and the anterior tibial muscle in the cat

BACKGROUND: Adequate vocal cord paralysis and full recovery of laryngeal muscle function are important when muscle relaxants are used perioperatively. This study was designed to compare the effects of vecuronium and rocuronium at the vocal cord abductor and adductor muscles and the anterior tibial muscle in cats. METHODS: Twelve adult cats were studied under pentobarbitone-N2O/O2-anesthesia. After supramaximal electrical stimulation of the peroneal nerve and the recurrent laryngeal nerve (0.1 Hz and intermittent train-of-four) evoked electromyographic responses were obtained from the anterior tibial muscle, the posterior cricoarytenoid muscle (vocal cord abductor) and two vocal cord adductor muscles, the lateral cricoarytenoid and the vocal muscle. Six cats received bolus doses of increasing size of vecuronium (ED90 22.5 microg x kg(-1)) and six cats rocuronium (ED90 90 microg x kg(-1)). RESULTS: Equipotent doses of vecuronium and rocuronium caused a similar degree of paralysis in all muscles (vecuronium ED90: 70% blockade at the posterior cricoarytenoid, 83% at the lateral cricoarytenoid, 84% at the vocal muscle and 90% at the anterior tibial muscle; rocuronium ED90: 71% at the posterior cricoarytenoid, 67% at the lateral cricoarytenoid, 78% at the vocal muscle and 90% at the anterior tibial muscle; vecuronium 2 x ED90: 93% blockade at the posterior cricoarytenoid, 95% at the lateral cricoarytenoid, 97% at the vocal muscle and 99% at the anterior tibial muscle; rocuronium 2 x ED90: 89% blockade at the posterior and lateral cricoarytenoid, 93% at the vocal muscle and 100% at the anterior tibial muscle). Onset time was significantly shorter at the posterior cricoarytenoid muscle (290 s) compared to the lateral cricoarytenoid muscle (400 s) after vecuronium ED90 and to the vocal muscle (150 s versus 210 s) after rocuronium ED90. Compared to the anterior tibial muscle (interval 25-75%: 6.5 min after vecuronium 2 x ED90 and 3.3 min after rocuronium 2 x ED90 and to the posterior cricoarytenoid muscle (interval 25-75%: 7 min after vecuronium 2 x ED90 and 4.3 min after rocuronium 2 x ED90), recovery of laryngeal adductor muscle function was markedly delayed with both neuromuscular blocking drugs (interval 25-75% at the lateral cricoarytenoid and vocal muscle: 14 min and 15.8 min after vecuronium 2 x ED90 and 10.3 min and 11.6 min after rocuronium 2 x ED90 respectively). CONCLUSION: In cats, the time course of neuromuscular blockade after vecuronium and rocuronium differs in antagonistic laryngeal muscles. The protective laryngeal function of glottis closure recovers later than vocal cord abduction after both vecuronium and rocuronium.     

Day-case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia

BACKGROUND: The study was aimed to evaluate the analgesic efficacy, postoperative comfort, recovery characteristics and side effects of three different analgesic agents administered prophylactically. METHODS: Eighty patients undergoing day-case minor operative laparoscopy were randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Group T), fentanyl 100 microg i.v. (Group F), 5 ml of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision respectively. Bupivacaine, 35 ml, 2.5 mg/ml was also administered into the pelvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pressures, SpO2 and respiration rates were recorded in the PACU. Postoperative pain was evaluated by verbal rating scale. Pain scores, analgesic requirements and side effects were evaluated by telephone calls until the 48th postoperative hour. RESULTS: Postoperative pain scores were lower and time to requirement of rescue analgesics was longer in groups F and B compared to Group P. In the PACU, analgesic requirements were lower in Group B, compared to Group P. Nausea and vomiting were increased in Group F. CONCLUSION: Tenoxicam 20 mg i.v. was found to be ineffective whereas bupivacaine was superior to other groups in reducing pain and analgesic requirements. Bupivacaine also increased time to first analgesics and obtained better recovery characteristics, underlining its value in prophylactic pain management compared to the other two agents.     

The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass

The institution of cardiopulmonary bypass during cardiac surgery has profound effects on the plasma concentration of drugs and thus their therapeutic effectiveness. These changes occur through acute hemodilution, altered plasma protein binding, hypotension, as well as the use of hypothermia and heparin administration. Isolation of the lungs from the circulation and the possible sequestration of drugs in the bypass circuit also affect drug plasma concentrations on bypass. The individual characteristics of the drug in question are also important in determining the final plasma concentration: Lipid soluble drugs with a high volume of distribution may be more readily taken up by bypass equipment, but the initial fall in concentration at the start of cardiopulmonary bypass may be more readily counteracted by back diffusion into plasma, if large tissue stores have accumulated. The extent of the drug's plasma protein binding is of importance as the effective free fraction in plasma for highly bound drugs will be sensitive to changes in plasma protein binding brought on by factors such as hemodilution, heparin administration as well as alpha, acid-glycoprotein binding. Clearly the fate of drugs administered before or on bypass is complex and can only be accurately determined by specific studies evaluating drug plasma concentrations. This review updates the available data on anesthetics and drugs used during cardiac surgery in order that anesthetists may predict better the likely effect of drugs administered before or during cardiopulmonary bypass.     

923份住院病历抗菌药使用情况调查分析

目的：调查住院患者抗菌药使用情况，提高临床合理使用抗菌药水平。方法：抽取深圳市属某综合医院2004年4月1、4、7、10、13、16、19、22、25、28日共10d34个临床科室的所有出院病历923份，对其抗菌药使用情况进行统计分析。结果：75．1％的患者(693／923)使用了一共86种抗菌药(其中头孢菌素类27种)，其中514例患者使用了2种以上的抗菌药，34例患者使用了6种以上的抗菌药，最多者使用了17种抗菌药。手术科室抗菌药使用率和联合用药率均明显高于非手术科室。仅87例进行了微生物学检查和药敏实验。没有一例进行血药浓度监测。结论：抗菌药使用广泛，比例偏高；多凭经验用药，缺少药敏实验依据。用药方案不尽合理，存在滥用现象。