伏立康唑单药及联合两性霉素B吸入治疗肺曲霉菌病15例的临床疗效观察

目的探讨伏立康唑单药及联合两性霉素B吸入治疗侵袭性肺曲霉菌病的临床疗效。方法回顾性分析我院2008年3月～2010年3月诊治的15例肺曲霉菌病患者的临床资料。结果11例使用伏立康唑患者中,死亡3例,好转3例,痊愈5例,均无严重毒副作用;3例输注两性霉素B患者,2例出现严重肝肾损害、胃肠反应,治疗1个月后病情好转出院,1例无明显反应,治疗3个月出院;1例口服伊曲康唑患者,出现严重肝损害及皮疹,放弃治疗出院。结论临床医师应掌握肺曲霉菌病的相关知识,提高业务能力,使肺曲霉菌病患者得到早期诊断和及时治疗,提高临床疗效。     

侵袭性真菌感染237例治疗分析

目的 观察侵袭性真菌感染应用氟康唑、伊曲康唑和两性霉素B治疗的临床疗效及安全性.方法 选择南方医科大学附属南方医院2002年2月至2007年2月收治的侵袭性真菌感染患者237例,单用常规剂量氟康唑107例、伊曲康唑84例、两性霉素B 46例;氟康唑治疗无效者改用伊曲康唑39例和两性霉素B26例,伊曲康唑治疗无效改用两性霉素B和脂质体两性霉素B 39例.结果 237例侵袭性真菌感染总的治愈率和有效率分别为54.85%和72.57%.单用氟康唑治疗组的有效率显著低于伊曲康唑和两性霉素B治疗组,分别为39.25%、53.57%和56.52%(P<0.05);用氟康唑治疗无效改用伊曲康唑或两性霉素B治疗的有效率分别为76.93%和84.61%.结论 伊曲康唑和两性霉素B抗真菌谱广且疗效相似,优于氟康唑;氟康唑和伊曲康唑安全性良好.而两性霉素B的不良反应发生率高.     

淋巴瘤化疗后侵袭性肺部真菌感染26例临床分析

目的:探讨淋巴瘤化疗后侵袭性肺部真菌感染(PFI)的临床特征。方法:收集淋巴瘤化疗后合并侵袭性肺部真菌感染的26例病例进行临床分析。结果:1非霍奇金淋巴瘤合并侵袭性肺真菌感染与霍奇金淋巴瘤合并侵袭性肺真菌感染的诊断率为分别1.6%和3.3%,且年龄与性别之间发生率差异没有显著性,而淋巴瘤化疗后合并造血干细胞移植患者的侵袭性肺真菌感染率大大增加。2真菌感染菌谱分布仍以白色念珠菌为主。326例患者中确诊5例,临床诊断IPFI 12例,拟诊9例。确诊率升高,拟诊率降低。4伊曲康唑、脂质体两性霉素B、伏立康唑及卡泊芬净真菌感染的有效率均超过50%,以伏立康唑疗效最好,有效率73%。结论:白色念珠菌是淋巴瘤化疗后侵袭性肺部真菌感染的主要病原菌,伏立康唑对其具有显著的治疗作用。     

两性霉素B脂质体治疗早产儿深部真菌感染不良反应的护理体会

目的 观察两性霉素B脂质体治疗早产儿侵袭性真菌感染的不良反应,探讨其护理措施.方法 对26例新生儿侵袭性真菌感染患者应用两性霉素B脂质体,观察其疗效及不良反应,并采取相应护理.结果 26例患儿中,痊愈21例,显效2例,放弃1例,死亡2例.不良反应为:16例出现呕吐,12例出现拒奶,10例出现发热、寒战,9例出现局部静脉炎,7例出现低钾血症,3例有肾功能损害.结论 预防和早期发现并发症并给予有效的治疗和护理是两性霉素B脂质体治疗安全和顺利进行的关键.     

伏立康唑在儿童急性白血病肺曲霉菌感染二级预防中的应用

目的：探讨伏立康唑在儿童急性白血病肺曲霉菌感染二级预防中的作用。方法：回顾性分析我院2009年2月-2012年7月住院的儿童急性白血病临床诊断侵袭性肺曲霉菌感染经伏立康唑治疗有效的患儿17例,在随后的化疗中应用伏立康唑片剂,每12 h口服1次,直至粒细胞恢复,共58例次（同一患儿在多次化疗骨髓抑制期使用）,观察真菌感染情况,综合评价该药物的疗效和安全性。结果：经过伏立康唑片剂二级预防,化疗后均无真菌感染发生,无明显不良反应。结论：应用伏立康唑二级预防对儿童急性白血病临床诊断侵袭性肺曲霉菌感染有效、安全。     

白血病真菌感染的新药与临床治疗分析

目的 探讨白血病真菌感染的新药与临床治疗.方法 选取白血病患者共276例,随机分为对照组与观察组,各138例.对照组患者接受两性霉素B药物治疗,观察组患者接受新唑类药物伊曲康唑治疗,对比2组患者治疗效果.结果 使用伊曲康唑治疗白血病真菌感染患者中有83例发生不良反应,发生率为60.14％,使用两性霉素B治疗白血病真菌感染患者中有60例发生不良反应,发生率为43.48％,2组数据比较,差异具有统计学意义(x2=10.702,P＜0.05).结论 新唑类药物可以有效抑制曲霉菌的生长,可以有效预防以及治疗白血病真菌感染,具有安全性及有效性,值得临床应用与推广.     

两性霉素B治疗白血病肺部真菌感染的护理

目的：观察两性霉素B（AmB）治疗白血病肺部侵袭性真菌感染的不良反应,探讨其护理措施。方法：对10例白血病肺部侵袭性真菌感染患者应用AmB,总疗程30-60天,观察其疗效和不良反应,并采取相应护理。结果：10例中,7例治愈,2例未能坚持,1例无效。结论：预防和早期发现并发症并给予有效的治疗和护理是AmB治疗安全和顺利进行的关键。     

伏立康唑治疗儿童白血病侵袭性肺部真菌感染疗效分析

目的:通过对19例儿童急性白血病合并侵袭性真菌感染病例分析,探讨伏立康唑治疗儿童白血病侵袭性肺部真菌感染的疗效及安全性.方法:回顾性分析19例肺部真菌感染患儿,全部病例均于诊断后给予伏立康唑治疗,轻症予伏立康唑口服(7 mg/kg·次,每12 h 1次),重症予伏立康唑静点(7 mg/kg·次,每12h/次),治疗2周...     

伏立康唑治疗48例儿童急性白血病侵袭性真菌感染的临床观察

目的：探讨伏立康唑治疗儿童急性白血病并发侵袭性真菌感染的有效性及安全性.方法：选择48例经临床资料和/或生物学证实儿童白血病并发侵袭性真菌感染的患者,均使用伏立康唑治疗,第1天予以负荷剂量为6 mg/kg,静脉滴注,每12 h 1次,随后予维持剂量为4 mg/kg,静脉滴注,每12 h 1次,用药时间5～28 d,中位数为11 d,并对用药前后患者肝、肾功能及电解质进行监测.结果：伏立康唑临床总有效率为72.92%,真菌清除率为78.26%,只有少数患者发生轻度肝功能损害、胃肠道反应、视觉异常等不良反应.结论：伏立康唑因其抗菌谱较广,耐药性少,在治疗儿童急性白血病侵袭性真菌感染中有非常好的疗效,毒副作用少,该药是一种安全高效的抗真菌药物.     

无免疫功能缺陷者侵袭性肺曲霉病3例并文献复习

目的 探讨无免疫功能缺陷者侵袭性肺曲霉病的诊断及治疗.方法 分析2008年1月至2008年12月在中国医科大学附属盛京医院呼吸内科住院的3例无免疫功能缺陷侵袭性肺曲霉病患者的病例资料,同时结合相关文献进行复习.结果 既往1例患糖尿病,1例怠慢性支气管炎,1例健康.临床共同特点是:病情进展快,发热,进行性呼吸困难,咯灰黄痰,双肺散在干湿罗音.CT表现呈多样性,双肺散在结节影、片影、实变影及多发空洞.洞内有絮状物是其特点,可见树芽征,纵隔多组淋巴结肿大.每例患者痰培养3次均提示烟曲霉茵生长.均用两性霉素B脂质体治疗显示有效,但1例发生急性肾功能不全,1例出现严重的恶心等副作用.结论 非免疫缺陷者或健康者也可发生侵袭性肺曲霉病.痰培养2次以上阳性者并结合临床可确定诊断.两性霉素B脂质体治疗侵袭性肺曲霉病有效,因其毒副作用,临床应用受到一定限制.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…