精神科门诊长期使用苯二氮类药物的病人的状况

目的了解长期应用苯二氮(廾卓)类药物的精神科门诊病人的状况,便于在精神科更好管理和使用苯二氮(廾卓)类药物.方法我们对安徽省精神卫生中心2004.10.1～2005.3.31门诊就诊的连续使用苯二氮(廾卓)类药物≥1.5年的门诊病人,随机整群抽取66名进行前瞻性调查,并分析所得.结果长期应用苯二氮(廾卓)类药物精神科门诊病人中神经症、癔症病人占45.5%,分裂症、躁郁症占42.4%;40～59岁占47.0%,老年人(≥60岁)占28.8%;女性病人占66.7%;病程中应用过1～2种苯二氮(廾卓)类药物占81.8%,剂量≤2片/d占95.5%;苯二氮(廾卓)类药物停药失败的首要原因66.7%是停用药后失眠.精神科门诊长期应用苯二氮(廾卓)类药物病人主要是神经症、癔症、分裂症、躁郁症病人,女性、40～59岁占多数,老年人亦占相当部分,精神科门诊病人要停用苯二氮(廾卓)类药物首先需解决的问题是停药之后如何应对失眠.     

精神科门诊长期使用苯二氮类药物的病人的状况

目的:了解长期应用苯二氮类药物的精神科门诊病人的状况,便于在精神科更好管理和使用苯二氮类药物。方法:我们对安徽省精神卫生中心2004.10.1～2005.3.31门诊就诊的连续使用苯二氮类药物≥1.5年的门诊病人,随机整群抽取66名进行前瞻性调查,并分析所得。结果:长期应用苯二氮类药物精神科门诊病人中神经症、癔症病人占45.5%,分裂症、躁郁症占42.4%;40～59岁占47.0%,老年人(≥60岁)占28.8%;女性病人占66.7%;病程中应用过1～2种苯二氮类药物占81.8%,剂量≤2片/d占95.5%;苯二氮类药物停药失败的首要原因66.7%是停用药后失眠。精神科门诊长期应用苯二氮类药物病人主要是神经症、癔症、分裂症、躁郁症病人,女性、40～59岁占多数,老年人亦占相当部分,精神科门诊病人要停用苯二氮类药物首先需解决的问题是停药之后如何应对失眠。     

苯二氮[艹草]类药物与氯氮平或氯丙嗪治疗失眠的对照研究

目的：了解氯氮平和氯丙嗪治疗失眠的疗效。方法将52例精神疾病伴失眠的患者随机分氯氮平和氯丙嗪组（观察组）26例,苯二氮[艹卓]类组（对照组）26例,依据匹兹堡睡眠质量表（PSQI）对失眠程度进行评估。结果氯氮平和氯丙嗪组有效率88．46％,苯二氮[艹卓]组有效率96．15％,2组疗效无统计学差异（P＞0．05）。结论苯二氮[艹卓]药物与氯丙嗪和氯氮平治疗精神疾病失眠疗效相当,为了防止苯二氮[艹卓]类药物滥用,选用替代药物也是一种很好的选择。     

纳洛酮治疗60例苯二氮(艹卓)类药物中毒临床分析

目的：观察纳洛酮治疗苯二氮[艹卓]类药物中毒的临床疗效。方法：选用60例苯二氮[艹卓]类药物中毒患者，入院后采取常规洗胃利尿排泄、输液等治疗外，主要用纳洛酮治疗。观察疗效并进行统计学分析。结果：疗效较好，全部60例患者除一例死亡外，其余59例均治愈出院，成功率为98．3％。结论：纳洛酮治疗苯二氮[艹卓]类药物中毒见效快，简便，价格便宜，疗效确切，副作用少。     

半个世纪的争议——苯二氮()类药物临床应用50年

上个世纪50年代,苯二氮(艹卓)类药物进入临床使用,由于此类药物高效、安全、耐受性良好,目前苯二氮(艹卓)类药物已成为抗焦虑和失眠领域应用最广泛的药物。根据统计,全球有超过5000万人服用苯二氮(艹卓)类药物。苯二氮(艹卓)类药物目前仍是失眠和抗焦虑的一线治疗药物。 然而,由于许多原因,苯二氮(艹卓)类药物只是用于短期的抗焦虑及失眠的治疗,这是因为人们担心长期使用     

门诊苯二氮（艹卓）类药物应用分析

目的 了解我院门诊苯二氮（艹卓）类药物（BZD）的使用情况,评价其合理性.方法 对我院2009年1月1日至12月31日使用苯二氮（艹卓）类药物的门诊处方共17 185张进行统计与分析.结果 苯二氮（艹卓）类药物广泛应用于精神科和心理科门诊,主要联合用药处方有苯二氮（艹卓）类与抗抑郁药7011张（40.80%）,苯二氮（艹卓）类与抗精神病药物6149张（35.78%）,不合理用药处方占所统计总处方数的1.32%.结论 苯二氮（艹卓）类药物在我院门诊的使用是基本合理的,但亦存在少数不合理用药现象,是造成苯二氮（艹卓）类药物滥用的主要原因.     

社区门诊失眠患者镇静催眠药使用情况调查分析

目的了解社区门诊失眠患者镇静催眠药的使用现状及合理性。方法对2009年1月1日—6月30日杭州市企业退休人员门诊医疗服务中心定海路门诊部接诊的237例失眠患者的门诊病历进行回顾性调查分析。结果社区门诊中60岁以上的失眠患者占失眠总人数的88.6%,以70～79岁者居多,占55.3%。<60岁的患者中以女性居多。社区门诊失眠患者苯二氮艹卓类药物的使用率为99.6%(236/237),唑吡坦类药物的使用率为0。其中18.1%(43/237)的失眠患者长期连续使用苯二氮艹卓类药物10年以上。结论社区门诊失眠患者镇静催眠药的使用率较高,以使用苯二氮卓艹类药物为主,社区门诊患者在镇静催眠药的使用上存在一些不合理之处,需要引起社区医师的重视。     

抢救苯二氮类药物中毒54例心理护理体会

口服过量苯二氮艹卓类药物或服药自杀已成为急诊科常见的急危症。针对病人心理特点,采取相应的心理护理,对病人抢救成功有极其重要的意义。1　临床资料2 0 0 3年1月1日至9月30日,我院急诊科共抢救苯二氮艹卓类药物中毒病例5 4例,其中男性13例,女性4 1例,年龄17～70岁。5 4例因长期用药突然停药的戒断症状5例,口服自杀4 9例。从中毒到就诊时间一般为0 .5～2h。临床表现:轻者精神软弱,主观不合作,头晕,嗜睡,运动失调;重者共济失调,手震颤甚至出现昏迷。戒断症状可有焦虑、厌食、失眠、震颤。2　急救抢救处理及心理护理2 .1　急救抢救处理[1]2 …     

右佐匹克隆治疗失眠障碍研究进展

右佐匹克隆是由美国Sepracor公司开发的一种快速短效非苯二氮艹卓类镇静催眠药,是佐匹克隆的S-异构体,2004年被FDA批准用于治疗失眠障碍。与GABAA受体亲和力要明显强于苯二氮艹卓类药物,具有类似于苯二氮艹卓类药物的催眠效应,但对正常睡眠结构破坏更少,且比苯二氮艹卓类药物更安全。与佐匹克隆相比,右佐匹克隆具有药效更强、不良反应和毒性更小等优点。临床研究显示其能有效地缩短睡眠潜伏期、改善睡眠维持和提高睡眠质量、延长总睡眠时间。目前临床上主要用于治疗入睡及睡眠维持困难的失眠障碍。现对其治疗失眠障碍方面临床研究进展及临床应用进行综述。     

催眠剂氟硝安定引起健忘1例

70年代引入的较巴比妥类催眠剂安全性高、不易产生依赖性、耐药性的苯二氮(艹卓)类催眠药在临床已广泛地应用。最近有一种较苯二氮(艹卓)受体亲和性高、作用更强的催眠剂上市。氟硝安定(FNZP)是苯二氮(艹卓)类药物之一,具有更强的催眠作用,临床应用为失眠治疗剂,麻醉前给药。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.