哮喘药物治疗新进展

哮喘药物有吸入性糖皮质激素类、长效β2受体激动剂、复合型吸入剂、茶碱缓(控)释剂、新型抗胆碱药物、白三烯调节剂等,新型抗哮喘药物临床使用具有疗效好、不良反应少的特点.现就近年来临床使用的各类平喘新药的特点及应用进行综述.     

高效液相色谱法测定人血浆中甲磺酸帕珠沙星浓度

目的建立人血浆中甲磺酸帕珠沙星(PZX)浓度的测定方法。方法采用蛋白沉淀法处理血样,以高效液相色谱法测定。流动相乙腈-0.05mol·L-1KH2PO4(20∶80,v/v);检测波长245nm;流速1.0ml·min-1。结果线性范围0.1～15.0μg·ml-1(r=0.9999),平均提取回收率为98.6%,日内、日间RSD均<8.47%。结论本法测定人血浆中PZX浓度简便快捷,灵敏度高,重复性好,适用于人体药动学研究。     

前列地尔脂微球载体制剂治疗老年不稳定性心绞痛临床观察

目的 观察前列地尔脂微球载体制剂(凯时)治疗老年不稳定性心绞痛(UA)的效果。方法 103例住院患者均 为男性,分为治疗组(凯时)64例和对照组(常规药物)39例。进行临床和实验室对比研究。结果 治疗组临床显效55例 (85.9％),有效6例(9.3％),无效3例(4.7％),总有效率95.3％。对照组39例,临床显效11例(28.2％),有效15例 (38.5％),无效13例(33.3％),总有效率66.7％。两组比较,有显著差异(P<0.001)。同时,血液流变学综合指标检查,治 疗组改善率93.7％(60/64)。对照组改善率79.4％(31/39)。治疗组与对照组比较有显著差异(P<0.01)。结论 前列地 尔对老年UA具有明显的治疗效果。     

影响农村产妇住院分娩因素的调查与分析

目的 :摸清农村产妇住院分娩的影响因素。方法 :对 1380人农村产妇采用统一自制调查表入户调查。结果 :居住平原者与居住山区或丘陵者比较 ,前者住院分娩率明显高于后两者 (P<0 .0 1) ;家庭经济收入≥ 4 0 0元者与≤ 4 0 0元者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;文化程度初中及以上者与小学文化程度者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;孕期接受健康教育者与未接受教育者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;产前检查≥ 5次者与产前检查 <5次或未产前检查者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1)。结论 :影响农村产妇住院分娩首要原因是地处山区导致的交通不便 ,其次是经济收入和分娩费用制约 ;旧的生育观 ,孕产妇的健康教育和孕期系统管理也是不可忽视的影响因素     

Estimating numbers of injecting drug users in metropolitan areas for structural analyses of community vulnerability and for assessing relative degrees of service provision for injecting drug users

This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area. We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. Prevalence of drug injectors per 10,000 population varied from 19 to 173 (median 60; interquartile range 42–87). Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services.     

The effect of cystectomy, and perioperative methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy on the risk and pattern of relapse in patients with muscle invasive bladder cancer

PURPOSE: Trials have demonstrated decreased relapse with perioperative methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy in patients with muscle invasive bladder cancer. We evaluated whether the benefit of chemotherapy correlates with its effects on distant or pelvic relapse. MATERIALS AND METHODS: We retrospectively evaluated the records of all 107 patients who underwent cystectomy for muscle invasive bladder cancer at our institution between 1988 and 1994. Factors predicting relapse were identified and used to group patients at high or low risk. The outcome in each group with and without M-VAC chemotherapy was then analyzed in terms of overall, metastatic and pelvic relapse. Univariate analysis was performed using the Kaplan-Meier method and log rank statistic, and multivariate analysis was done using the Cox proportional hazards model. Median survival was 29 months for patients free of disease. RESULTS: Pathological stage T3 or greater according to the American Joint Committee on Cancer, tumor greater than 3 cm. and creatinine greater than 1.5-fold normal were independent poor prognostic factors in patients treated with cystectomy only. Patients with any of these factors or metastatic involvement of the pelvic lymph nodes were considered at high risk. All 35 low risk patients were treated with cystectomy only and had an excellent outcome with a 3-year relapse-free survival plus or minus standard error of 93% +/- 5%. The 3-year rates in 52 and 20 high risk patients treated without and with chemotherapy, respectively, were 42% +/- 8% versus 57% +/- 13% for relapse-free survival (p = 0.17), 38% +/- 9% versus 8% +/- 8% for pelvic failure (p = 0.02) and 39% +/- 9% versus 38% +/- 13% for distant metastases (not significant). Multivariate analysis of patients who underwent pelvic lymphadenectomy revealed that perioperative chemotherapy improved relapse-free survival and pelvic control but not metastatic control (p = 0.03, 0.02 and 0.31, respectively). CONCLUSIONS: Low risk patients have excellent disease control when treated with cystectomy only. Those with high risk features are at substantial risk for pelvic failure (38% at 3 years) after cystectomy only. Perioperative M-VAC chemotherapy has a profound impact on pelvic but not on metastatic failure.     

剖宫产仰卧位低血压综合征的防治

目的:探讨垫高产妇右髋对硬膜外麻醉剖宫产仰卧位低血压综合征的预防作用。方法:将144例ASAⅠ-Ⅱ级、无严重胎儿宫内窘迫、行硬膜外麻醉剖宫产术的产妇随机分为两组,A组垫高产妇右髋75例;B组床左侧倾斜30°69例。用监护仪连续监测并记录。收缩压较基础值下降30%或低于90 mmHg时,静脉注射麻黄素10~15 mg,比较两组麻黄素的使用率。结果:A组有7例使用麻黄素,占9.3%;B组有17例使用麻黄素,占24.6%,差异有显著性(P<0.05)。结论:硬膜外麻醉剖宫产垫高产妇右髋比床左侧倾斜30°防治仰卧位低血压综合征更有效。     

Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test

PURPOSE: It is often difficult to determine the functional status of the detrusor muscle in patients with detrusor areflexia. We performed a clinical study to establish a test defining residual detrusor capacity in such patients. MATERIALS AND METHODS: In phase 1, 5 controls with detrusor areflexia were tested with an intravesical instillation of 20 mg. bethanechol in 150 cc of sodium chloride 0.3% with and without 20 mA. of pulsed current applied via an electrode catheter through the saline. Cystometry simultaneously recorded intravesical pressure changes. In phase 2, 45 patients with detrusor areflexia were tested with electromotive administration of intravesical bethanechol. In phase 3, 25 mg. bethanechol given orally once daily were prescribed for 15 patients and voiding control was assessed after 6 weeks of therapy. RESULTS: Neither bethanechol without current nor current through saline only led to increased intravesical pressure. However, we noted a mean pressure increase of 34 cm. water during the electromotive administration of bethanechol in 24 of 26 patients with areflexia and neurological disease compared to only 3 cm. water in 3 of 11 with a history of chronic bladder dilatation. Oral bethanechol restored spontaneous voiding in 9 of 11 patients who had had a positive response to the electromotive administration of bethanechol, whereas all 4 without a pressure increase during the electromotive administration of bethanechol did not void spontaneously. CONCLUSIONS: Electromotive administration of intravesical bethanechol identifies patients with an atonic bladder and adequate residual detrusor muscle function who are candidates for restorative measures, such as oral bethanechol and intravesical electrostimulation. Those who do not respond to the electromotive administration of bethanechol do not benefit from oral bethanechol and are candidates for catheterization.     

思密达联合左氧氟沙星治疗成人急性感染性腹泻60例临床观察

目的：观察恩密达联合左氧氟沙星治疗成人急性感染性腹泻的疗效。方法：所选病例分成A组(60例)、B组(27例)和C组(30例)。给予A组患者恩密达每次1袋(3g)，每日3次，左氧氟沙星每次0.2g，每日2次；给予B组患者恩密达每次一袋(3g)，每日3次；给予C组患者左氧氟沙星，每次0.2g，每日2次。3组疗程均为3天。结果：A组显效51例，有效8例，总有效率达98．30％；B组显效19例，有效3例，总有效率达81．48％；C组显效20例，有效5例，总有效率达86．66％。结论：思密达联合左氧氟沙星治疗成人急性腹泻，疗效高，安全，且不影响抗生素吸收。     

肺炎链球菌对抗菌药物的耐药性分析

目的 :调查肺炎链球菌对青霉素等抗菌药物的耐药性 ,并进行初步分析。方法 :采用肉汤微量稀释法测定肺炎链球菌对常用抗菌药物的耐药性。结果 :统计分析 5年中痰标本分离的 16 0株肺炎链球菌对常用的 8种抗菌药物的耐药性 ,结果显示对头孢噻肟耐药率最低 ,对红霉素耐药率最高。结论 :肺炎链球菌的耐药性有逐年增加的趋势 ,其中耐青霉素肺炎链球菌 (PRP)的耐药性同时也有逐年增加的趋势。