不合理用药实例分析(17)

实例：患者，男，42岁。因心悸、气促3个月就诊。心电图：快速心房颤动。初步诊断：风湿性心脏病，二尖瓣狭窄并快速心房颤动。给予胺碘酮和维拉帕米口服。     

在Suzuki反应中，催化剂循环使用和产物回收的简便方法

在钯催化的Suzuki交叉偶联反应中，以聚环氧乙烷-甲醇为混合溶剂，反应结束后用正庚烷提取，产物进入非极性相，收率〉90％。催化剂留在极性相，可循环使用多次。     

聚凝胺法辅助鉴定ABO血型2例

某些疾病可能引起暂时性抗原减弱，血清抗体下降而导致血型鉴定困难。聚凝胺技术具有敏感性高、反应快速等优点，对ABO血型的鉴定有辅助作用。我们采用聚凝胺法辅助鉴定ABO血型2例，现报告如下。     

应用“阳离子交换法”对原汁果酒除铅的现场研究

对铅超标的酒类,既往常应用“凝固沉淀法”或“重蒸馏法”除铅。但用这些方法处理铅超标的原汁果酒,则易丧失该果酒固有的营养成分和风味特色。作者应用“阳离子交换法”除铅,不仅除铅效果良好,而且保留了该原汁果酒的营养成分和风味特色。     

异维A酸联合白花蛇舌草注射液治疗重度痤疮36例

痤疮是青年人群中最常见的一种皮肤病，重度痤疮常因面部出现较多炎性皮疹、囊肿、结节而使容貌受损，极大地影响患者身心健康。本病治疗方法较多，但疗效不满意。2000年以来，笔者应用口服异维A酸联合白花蛇舌草针肌肉注射治疗本病，取得较好效果，现报道如下。     

托尼萘酸治疗老年戊型肝炎

目的：观察托尼萘酸治疗老年戊型肝炎的安全性及临床疗效。方法：56例老年戊型肝炎病人分为治疗组和对照组，2组病人均给予常规护肝、支持、对症治疗。治疗组36例，男性28例，女性8例：年龄（67&;#177;s11）a。加用托尼萘酸，2片，po，tid。对照组20例，男性16例，女性4例：年龄（66＋12）a，仅给予基础治疗。治疗后4，8wk时比较2组病人的临床指标改变。     

S38-62脂肪胺的氮杂MichaeI反应Varala R等[Synlett,2006．（10）：1549]

脂肪胺和α，β-不饱和羰基化合物的水溶液，以3mol％硝酸铈铵为催化剂，室温搅拌制得相应的B．氨基羰基化合物。环状仲胺5～30min即可完成；芳香胺不反应。20例收率55％～99％。     

树脂吸附抢救急性摇头丸中毒的疗效观察

目的:探讨树脂吸附剂治疗急性摇头丸中毒的疗效。方法:将36例急性摇头丸中毒患者随机分为常规治疗组(常规组)和常规治疗基础上加树脂吸附治疗组(树脂组),观察比较治疗后3、6、12h两组的疗效、副作用和并发症。结果:治疗组的疗效明显优于对照组(H=3.9,P<0.05),尤其是6h时疗效更佳(H=10.4,P<0.01);2组均未发现明显的副作用和并发症。结论:树脂吸附能迅速清除血液中的有毒物质,可有效治疗急性摇头丸中毒。     

^1H-magnetic resonance spectroscopy screening for animals with acute cerebral infraction suitable forthrombolytic therapy

BACKGROUND: As a non-invasive technique which can provide comprehensive biological information, 1H-magnetic resonance spectroscopy (1H-MRS) may provide valuable reference data for irreversible recovery or reversible changes in ischemic tissue after stroke. OBJECTIVE: To monitor and evaluate the effect of the urokinase thrombolytic therapy after experimental acute cerebral ischemia by 1H-MRS technology and investigate its adaptability. DESIGN: Randomly controlled animal study. SETTINGS: Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science. MATERIALS: Eleven healthy adult Sprague-Dawley (SD) rats, weighing 260–300 g and of both genders, were supplied by Experimental Animal Center of Tongji Medical Collage, Huazhong University of Science and Technology [SCXK (e) 2004-007]. 4.7T superconducting nuclear magnetic resonance meter was provided by Brucker Company. METHODS: The experiment was carried out in Shenzhen Hospital of Peking University and National Key Laboratory of Pattern and Atom & Molecular Physics, Wuhan Physics and Mathematics Institute, Chinese Academy of Science from August 2003 to December 2005. ① The rats were randomly divided into 30-minute self-thrombo-embolism group (n =6) and 60-minute self-thrombo-embolism group (n =5). Six rats in 30-minute self-thrombo-embolism group were occluded with clot embolus for 30 minutes and 5 rats in 60-minute self-thrombo-embolism group were occluded for 60 minutes. 10 000 U/kg urokinase was dissolved in 2 mL saline and the operation lasted for 5 minutes. ② 1H-MRS was performed before thrombolysis and at 3 hours and 24 hours after successful embolization. The metabolic changes of N-acetyl-L-aspartic acid (NAA)/phosphocreatine (PCr) + creatine (Cr), choline phosphate (Cho)/PCr+Cr and lactic acid (Lac)/PCr+Cr in the region of interests were analyzed. ③ The T2W image was conducted 24 hours after the thrombolytic therapy with TR=500 ms and TE=25 ms. ④ The subjects were sacrificed immediately after 1H-MRS and the brain tissues were cut into pieces and stained with HE method; in addition, pathological changes were observed under optic microscope. MAIN OUTCOME MEASURES: ① Metabolic changes of NAA/PCr+Cr, Cho/PCr+Cr and Lac/PCr+Cr in the region of interests; ② T2W image at 24 hours after the thrombolysis; ③ pathological observation of brain tissue. RESULTS: Eleven rats were all involved in the final analysis. ① Metabolic changes in the region of interests : In 30-minute self-thrombo-embolism group, the Lac peak emerged immediately after the embolism, but the ischemic zone decreased 3 hours after the thrombolytic therapy (0.252±0.01, 0.603±0.01, P < 0.01). Lac/(PCr+Cr) ratio was 0.290±0.01 at 24 hours after thrombolysis, which was higher than that at 3 hours after thrombolysis (P < 0.01). The NAA/ (PCr+Cr) ratio decreased significantly at 3 hours after the thrombolysis as compared with that before thrombolysis (0.922±0.16, 1.196±0.01, P < 0.05). In 60-minute self-thrombo-embolism group, the Lac/(PCr+Cr) ratio was higher at 3 hours after thrombolysis than that before thrombolysis (0.846±0.12, 0.601±0.11, P < 0.05) and the NAA/(PCr+Cr) decreased at 3 hours after the embolism. Fluctuation of NAA/ (PCr+Cr) ranged from 0.68 to 0.75 before thrombolysis and from 0.71 to 0.75 at 3 hours after thrombolysis. ② T2W image: T2W image showed that 2 subjects in 30-minute self-thrombo-embolism group whose Lac/NAA was higher than 0.7 suffered from intracranial hemorrhage. This meant that the subjects with Lac/NAA > 0.7 were more likely to suffer from intracranial hemorrhage. ③ Histological and morphological examinations: Optic microscope demonstrated that interspace surrounding nerve cells was widened at ischemic center; neurons were swelling; nucleus was stained lightly; pyknosis and mesenchymal edema were mainly observed in lateral cortex of brow and vertex and in lateral part of corpus striatum. CONCLUSION: ①Compound parameters in ischemic area before thrombolysis should be regarded as an important predicting marker for thrombolytic therapy, effect evaluation and termination. ② 1H-MRS combining with other imaging technique is a detecting way for screening cases who are suitable for thrombolytic therapy.