胰激肽释放酶治疗2型糖尿病早期肾病的疗效

目的 总结胰激肽释放酶（TPK）治疗2型糖尿病早期肾病的临床疗效。方法 将州例伴有微量白蛋白尿的2型糖尿病患者随机分为胰激肽释放酶治疗（PKG）组和常规治疗（RTG）组，治疗前后测定尿微量白蛋白排泄率（UAER）、血浆内皮素-1（ET-1）及血清一氧化氮（NO）水平。结果 与治疗前比较，PKG组UAER及ET-1均显著降低（P＜0．01），NO明显升高（P〈0．01），并且脂质代谢紊乱亦有改善；RTG组则无明显变化（P＞0．05）。结论 胰激肽释放酶能减少2型糖尿病肾病（DN）患者尿微吊白蛋白的排泄，其机制可能与其能拈抗ET-1，升高NO水平，改善血管内皮细胞功能有关。     

比索洛尔对老年高血压患者舒张功能的影响

目的观察比索洛尔对老年高血压患者舒张功能的影响。方法入选老年高血压舒张功能不全患者89例,随机分成比索洛尔干预组45例及对照组44例,2组患者均给予抗高血压的常规治疗。比索洛尔干预组患者加用比索洛尔1．25～20mg／d,疗程6个月。比较2组患者治疗前后左心室超声舒张功能指标改善情况。结果治疗前后左心室等容松弛减慢指标等容舒张时间（IVRT）,左心室早期充盈减慢指标二尖瓣舒张早期血流最大速度E峰、舒张早期和晚期充盈速度比值（E／A）、E峰减速时间（DT）,以及左房前后径（LAD）、左心室舒张功能指标明显优于治疗前（P〈0．01）;比索洛尔干预组IVRT、E、E／A、LAD、HR等改善明显优于对照组（P〈0．05或〈0．01）。结论比索洛尔治疗老年高血压舒张功能不全患者可显著降低心率和血压,并改善左心室舒张功能。     

应用组织多普勒技术对早期糖尿病心脏病变的超声心动图检测

目的探讨组织多普勒成像（DTI）技术在评价早期糖尿病心脏病变左室功能方面的临床应用价值。方法检测39例糖尿病患者和24例健康人心室舒张早期快速充盈波E峰峰值流速（E）;心房收缩充盈波（A）;E/A值,用Simpson法测量左室射血分数（EF）。再记录后室间隔、侧壁、前壁、下壁、前室间隔、后壁六个壁的瓣环、基底段两个位置的收缩期、舒张早期和舒张晚期运动峰值（分别为Sa,Ea,Aa）。结果左室舒张早期充盈峰值速度与心房收缩期充盈峰速度（E）,左室舒张早期充盈峰值速度与心房收缩期充盈峰值速度的比值（E/A）,左室射血分数（EF）差异均无统计学意义;左室心房收缩期峰值充盈速度（A）（68.00±10.08）高于对照组（60.17±90.45）,差异有统计学意义（P〈0.05）。糖尿病组下壁和前间隔瓣环Sa均小于对照组（P〈0.01）。结论DTI技术为临床早期检测出糖尿病心脏病变左室功能变化提供一种无创性方法,在早期舒张功能异常的检测方面,频谱多普勒舒张参数A可能是比DTI舒张功能参数更敏感的指标;在收缩功能的检测方面,左室前间隔和下壁的瓣环是DTI检测较敏感的部位。     

冠状动脉内成形及支架术对左室舒张功能的影响

目的　用多普勒超声心动图探查冠状动脉内成形 +支架术 (PTCA+Stent)前后左室舒张功能的变化。方法　对 12例行 PTCA+Stent术的心绞痛患者 ,分别于术前 3～ 10 d(8± 3) d和术后 30～ 6 0 d(42±9) d,分别行多普勒超声心动图检查。并获得左室最大早期舒张血流速度 (E) ,晚期最大舒张血流速度 (A) ,得出舒张早期和晚期最大血流速度比 (E/A)和 E峰加速时间 (EAT) ,测出左房内径 (L A)。结果　 E峰、E/A术后较术前明显增大 (P均 <0 .0 0 1) ,A峰、EAT术后较术前明显减少 (P <0 .0 0 1,P<0 .0 5 ) ,L A术前后无差异 (P>0 .5 )。结论　 PTCA可使狭窄的冠状动脉通畅 ,心肌血流灌注正常或明显改善 ,显著改善冠心病患者的心肌缺血 ,使左室舒张功能改善     

药物干预高血压继发左心室舒张功能不全的临床研究

目的 探讨血管紧张素Ⅱ受体拮抗剂（ARB）联合β1受体阻滞剂方案与ARB、β1受体阻滞剂联合醛固酮拮抗剂方案在控制高血压继发左心室舒张功能不全患者血压及心力衰竭风险方面的差异.方法 选取2010年10月至2012年4月航天中心医院门诊及住院的高血压继发左心室舒张功能不全患者249例,采用随机数字表法分为观察组（121例）和对照组（128例）.对照组给予ARB联合β1受体阻滞剂方案,观察组在对照组的基础上加用醛固酮拮抗剂.2组患者均治疗24个月.分析2组血压、左心室功能、脑钠肽等的变化.结果 入组前和治疗24个月后,观察组患者血清脑钠肽分别为（204±34）、（128±25） ng/L,对照组分别为（200 ±33）、（156±27） ng/L.2组患者治疗后血清脑钠肽均较本组治疗前明显降低,治疗前后差异均有统计学意义（P＜0.05）;观察组治疗后血清脑钠肽明显低于对照组治疗后,组问差异有统计学意义（P＜0.05）.观察组和对照组患者治疗后血压较本组治疗前明显下降,左心室射血分数、二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值较本组治疗前明显提高,治疗前后差异均有统计学意义[收缩压：（139±16） mmHg（l mmHg=0.133 kPa）比（163±25） mmHg,（137±17） mmHg比（162±25） mmHg;舒张压：（89±14） mmHg比（98±19） mmHg,（89 ± 13） mmHg比（98±20） mmHg;左心室射血分数：（58±5）％比（53±4）％,（52±5）％比（46±5）％;二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值：（1.34±0.68）比（0.68±0.23）,（1.06±0.55）比（0.71±0.21）,均P＜0.05].观察组治疗后血压下降、左心室射血分数及二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度比值的改善明显优于对照组,组间差异有统计学意义（P＜0.05）.观察组和对照组累计发生心力衰竭例数分别为21例和44例,对照组治疗期间发生     

氟伐他汀对原发性高血压患者心脏肥厚及舒张功能的影响

目的:探讨他汀类药物能否改善原发性高血压患者的左心室肥厚(left ventricular hypertrophy,LVH)及心脏舒张功能.方法:对110例血脂正常或轻度升高的原发性高血压患者采用随机、单盲、对照研究.用非洛地平降压同时分别加用氟伐他汀或安慰剂治疗24周.于治疗前、后检测室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心室舒张末期内径(LVDd),计算出左心室质量(LVM)及心肌重量指数(LVMI);测量及记录舒张早期及舒张晚期最大速度.检测血浆I型前胶原羧基端肽(PIP)及脑钠肽(BNP).结果:联合治疗组较安慰剂组血压达标率增加,脉压减小,24周后血浆PIP及BNP水平降低,LVMH、LVMI显著降低(P＜0.05);同安慰剂组相比,联合治疗组24周后二尖瓣后叶瓣环与左室侧壁交界处舒张早期及舒张晚期最大速度之比增加(P＜0.05).结论:高血压患者加用氟伐他汀可使心肌纤维化的相关指标改善、血压降低,逆转左心室肥厚及改善心脏舒张功能.     

不同孕龄孕妇心脏结构和功能的变化特点

目的：应用超声心动图分析正常孕期妇女不同孕龄进程心脏结构及功能的变化特点。方法将180例正常初孕妇女根据孕期时间的进展分别在孕早期、孕中期及孕晚期期末进行心脏超声心动图检查,比较不同时间段孕期妇女的心脏超声结构及功能参数,分析孕龄妇女随孕期进程发展心脏结构及功能变化。结果孕晚期孕妇左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVEDs）、左心房内径（LAD）、二尖瓣舒张早期充盈速度／心肌舒张早期速度峰值（ E／Ea）均大于孕中期孕妇,左心室射血分数（ LVEF）、二尖瓣舒张早期充盈速度／二尖瓣舒张晚期充盈速度（E／A）均小于孕中期孕妇,差异均有统计学意义（P＜0．05）;孕中期与孕早期比较,LVEDd、LVEDs、LVEF、LAD、E／Ea差异无统计学意义（ P ＞0．05）,但孕中期 E／A 值小于孕早期孕妇,差异有统计学意义（ P ＜0．05）。结论随着孕期时间的发展,正常妊娠妇女心脏结构及功能负荷发生改变,左心室舒张功能随孕期进程发展呈生理性逐渐减低趋势。     

二、胰激肽释放酶对体外培养心肌细胞的影响

<正> 前已报导,小量胰激肽释放酶对麻醉犬心功能有正性肌力作用,剂量加大,对心脏有负性肌力作用,血压下降,心率减慢,TT1减小。又根据文献报导,胰激肽释放酶有促进男性生殖细胞增生和修复的功能,可能与DNA合成有关。为此,本实验室进一步探讨胰激肽释放酶对离体培养心肌细胞的搏动功能、DNA合成以及对缺氧缺糖是否有影响,现将实验结果报导于下: 方法与结果一、胰激肽释放酶对培养心肌细胞搏动功能的观察实验取用培养2～3天的大白鼠乳鼠(Wist-ar)心肌细胞,在倒置显微镜下选择一个搏动规律的细胞簇作为固定观察对象,记录正常搏动后,用Eagle培养基配制的胰激肽释放酶(20μl/ml)放入培养瓶内,记录给药1′、2′、5′、10′、15′、20′、30′心肌细胞的频率、节律、     

芪冬颐心口服液辅助治疗小儿重症肺炎合并心力衰竭疗效观察

目的 了解芪冬颐心口服液辅助治疗小儿重症肺炎合并心力衰竭的疗效.方法 选取2013～2015年收治的重症肺炎合并心力衰竭患儿76例,随机选取数字分为观察组、对照组各38例,对照组给予西药常规强心、利尿、抗感染、止咳祛痰等综合治疗,观察组在上述基础上加用中药芪冬颐心口服液辅助治疗.治疗前后采用彩色多普勒血流仪测定两组患儿左心室射血分数(LVEF)、左心室缩短分数(LVSF)、心脏舒张早期心室充盈速度／舒张晚期心室充盈速度(E/A).测血清氨基N末端B型利钠肽前体(NT-proBNP)、心肌酶谱(CK、CK-MB、LDH)变化.结果 观察组患儿肺啰音消失时间、心衰纠正时间、憋喘消失时间、平均住院时间均优于对照组,差异有统计学意义(P＜0.05).观察组治疗后左心室射血分数、左心室缩短分数、心脏舒张早期心室充盈速度／舒张晚期心室充盈速度改善效果优于对照组,差异有统计学意义(P＜0.05).观察组治疗后,血清氨基N末端B型利钠肽前体、心肌酶谱显著低于对照组,差异有统计学意义(P＜0.05).结论 芪冬颐心口服液辅助治疗肺炎合并心力衰竭患儿,能够提高心肌收缩力、保护心肌细胞,有效改善心功能,有利于患儿预后,临床疗效较好.     

贝那普利对高血压病和冠心病左室舒张功能不全的影响

目的 :了解贝那普利对高血压病和冠心病左室舒张功能的影响。方法 :81例左室舒张功能不全病人 (高血压 4 5例 ,冠心病 36例 ;男性 56例 ,女性 2 5例 )应用贝那普利 10～ 2 0mg(冠心病在口服硝酸酯类药基础上加服贝那普利 5mg) ,po ,qd× 5mo ;用药前后用彩色多普勒超声心动图测定舒张早期最大峰值速度 (E峰 )、舒张晚期最大峰值速度 (A峰 )、E/A峰值速度比值及最快充盈率 (PFR)。结果 :治疗后比治疗前E峰、E/A比值、PFR均升高 ,而A峰降低 ,差别均有非常显著意义 (P <0 .0 1)。结论 :高血压病和冠心病病人服用贝那普利 5mo左右 ,对左室舒张功能不全有明显改善作用。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。