优维显造影剂在心导管检查及介入治疗应用中的护理

优维显造影剂为非离子型单体 ,具有毒性小、显影清晰等特点。广泛地被应用于心导管检查及治疗中 ,由于其副反应可大可小 ,小者引起不舒服 ,大者可危及生命。因此 ,预防和处理副反应相当重要。现将护理体会报告如下。一、临床资料 :我院自 2 0 0 0年 7月 2 0 0 2年 12月共施行心导管检查及介入治疗 687例 ,其中冠脉造影术 479例 ,PTCA +支架植入术 14 7例 ,左室造影 3 7例 ,右室造影 3例 ,主动脉造影 2 1例。发生副反应 15例。轻微反应 11例(1 6% ) (荨麻疹 5例 ,面部潮红 2例 ,咳嗽 2例 ,恶心呕吐 2例 )。严重反应 4例 (0 58% ) ,表现为…     

催产素联合安列克预防剖宫产产后出血疗效分析

目的探讨催产素联合安列克在预防剖宫产产后出血方面应用的有效性与安全性,为临床预防产后出血提供相应依据。方法收集2010年12月至2012年12月在我院收治的180例有剖宫产指征且有宫缩乏力高危因素的孕妇作为研究对象。随机分为对照组90例和观察组90例,对照组给予常规催产素预防方案治疗,观察组则给予催产素联合安列克预防措施治疗。比较2组术中出血量、术后2h及24h出血量、产后出血发生率、血红蛋白下降值及副反应发生率。结果对照组术中出血量、术后2h出血量、术后24h出血量分别为(361±57)mL、(431±92)mL、(464±54)mL、产后出血发生率为33.3%;观察组术中出血量、术后2h出血量、术后24h出血量分别为(223±48)mL、(301±49)mL、(316±58)mL、产后出血发生率为11.1%。观察组术中出血量、术后2h出血量及24h出血量均少于对照组,P均<0.05,差异均具有统计学意义。观察组产后出血发生率显著低于对照组,P<0.05,差异具有统计学意义。对照组与观察组患者术后24h血红蛋白浓度下降值相比较,观察组下降值更大,P<0.05,差异具有统计学意义。两组副反应发生率相比较,除腹泻无显著差异外,恶心呕吐、心动过速、面部潮红等副反应发生显著多于单独使用催产素组,所有副反应均无需特殊治疗在短期内消失。结论催产素联合安列克预防剖宫产产后出血有效且安全,值得进一步深入探讨研究与推广应用。     

环孢素A联合十一酸睾酮治疗再生障碍性贫血临床研究

目的探讨环孢素A(CsA)联合十一酸睾酮方案治疗再生障碍性贫血(AA,下称再障)的疗效及毒副反应。方法将东莞市人民医院2002年1月至2005年12月收治的51例AA患者随机分为A、B两组,A组26例采用CsA联合十一酸睾酮治疗,B组25例采用CsA联合司坦唑醇治疗;比较两种治疗方案的疗效、肝功受损情况。结果可评价疗效A组21例重型再障(SAA)总有效率66.7%,慢性再障(CAA)总有效率73.3%,肝功异常率14.3%;B组17例SAA总有效率60.0%,CAA总有效率75.0%,肝功异常率70.6%。两组疗效差异无显著性意义(P>0.05),肝功异常率差异有显著性意义(P<0.01)。结论CsA联合十一酸睾酮治疗AA是一种疗效高、毒副反应小,特别是肝功损害小,从而药物依从性好的治疗方案。     

青蒿琥酯对防汛人群预防日本血吸虫感染的效果

[目的 ]评价大规模应用青蒿琥酯预防性治疗接触疫水的人群预防血吸虫感染的效果。 [方法 ]在防汛中对 170 31人在接触疫水后第 7天开始口服青蒿琥酯 ,每周 1次 ,每次 30 0 m g,连服 3wk,记录副反应。距末次服药平均 17d后开始查病 ,部分于两个月后随访。 [结果 ]全组无急性血吸虫病发生 ,EL ISA阳性 2 0 4例 (1.2 0 % ) ,COPT>3%者 195例 (1.14% ) ,仅数例有肝功能变化。服药副反应发生率低 ,绝大多数不需特殊处理。 [结论 ]青蒿琥酯预防血吸虫病具有高效、安全及方便等优点 ,是目前比较理想的预防药 ,可推广使用。     

2H_3R_3E_3Z_3/4H_3R_3方案引起的药物性肝炎及其对抗结核效果的影响

目的观察和研究2H3R3E3Z3/4H3R3治疗初治涂阳病人药物性肝炎的发生率和药物性肝炎对抗结核效果的影响。方法对肝功正常、应用2H3R3E3Z3/4H3R3治疗的初治涂阳病人每月复查1次肝功,复查出现ALT升高的每周复查1次肝功,疗程完成后考核疗效。结果(1)药物性肝炎发生率为23.1%,其中有基础性肝病患者药物性肝炎发生率为66.3%;(2)抗结核过程中肝功检查第1次发现ALT在50 U/L~100 U/L,且无明显肝损症状和胆红素增高者,有51.2%的患者属于一过性转氨酶升高;(3)73.2%的药物性肝炎发生在抗结核治疗的前2个月,26.8%的药物性肝炎发生在抗结核治疗的后4个月;(4)无因药物性肝炎而死亡的病例,药物性肝炎患者停用抗结核药物并行护肝等治疗后肝功恢复时间平均为2.3周,其中,有基础性肝病者肝功恢复时间平均为3.9周,无基础性肝病者肝功恢复时间平均为1.8周;(5)总的肺结核治愈率为94.6%,未发生药物性肝炎患者肺结核治愈率为97.0%,发生药物性肝炎患者肺结核治愈率为86.6%,有基础性肝病患者肺结核治愈率为78.6%。结论(1)药物性肝炎是影响肺结核,尤其是影响有基础性肝病患者肺结...     

HIV/AIDS患者结核病的预防和治疗研究

目的　调查艾滋病病毒 (HIV) /艾滋病 (AIDS)患者结核菌素纯蛋白衍化物 (PPD)试验反应状况及与免疫系统受损程度的联系 ,并探讨其在HIV/AIDS患者中结核病 (TB)预防和治疗研究的意义。方法　采用前瞻性病例对照研究方法 ,对 2 0 2例健康者及 5 5例经蛋白印迹试验 (WB)确证的HIV感染者和AIDS病人做PPD试验 ,CD4、CD8淋巴细胞计数及分组服药 ,对照观察胸部病变情况。结果　HIV/AIDS患者PPD试验阳性率为 10 0 % ,健康者PPD试验阳性率 2 8 2 % ,差异有非常显著的统计学意义 (χ2 =7 17,P <0 0 1)。 13例CD4细胞计数 <2 0 0 /mm3 的HIV/AIDS病例 ,PPD试验均无反应 (0× 0mm)。当CD4细胞计数升高时 ,其PPD试验反应增强。病例服药组经化学药物预防治疗后 ,其肺部病变异常率为 30 8% ,低于病例对照组的异常率 4 1 7%。结论　HIV/AIDS患者PPD试验阳性率非常显著地低于健康人。对HIV/AIDS患者使用化学药物预防和治疗TB是有效的 ,这为制定相关政策提供了依据     

帕罗西汀与多虑平治疗急性期脑卒中后抑郁的对照研究

目的比较帕罗西汀与多虑平治疗急性期脑卒中后抑郁的疗效及副反应。方法71例急性期脑卒中后抑郁(PSD)病人被随机分为帕罗西汀组(34例)和多虑平组(37例),进行为期6周的治疗研究。以汉密尔顿抑郁量表(HAMD)、副反应量表(TESS)于治疗前及治疗后2周、4周、6周末分别对疗效及副反应进行测评。结果帕罗西汀组总有效率为87.9%优于多虑平组的60.0%(P<0.05);帕罗西汀组副反应的发生率及种类明显低于或少于多虑平组;两组治疗后TESS评分比较均有统计学意义(P<0.05)。结论帕罗西汀与多虑平对急性期脑卒中后抑郁均有一定的疗效。但帕罗西汀与多虑平比较具有药物副反应小、治疗依从性较好等特点。     

静滴红霉素致关节炎综合征2例

例1:女性,35岁。因上呼吸道感染,给予静滴红霉素(0.6g。每日2次)治疗。用药第6天时,出现双手、腕、肘、肩、踝、膝等关节剧痛,轻度红肿,有碍活动,生活不能自理。检查血常规、血沉、C-反应蛋白,免疫球蛋白、肝功、血尿酸,抗“O”、尿常规以及心     

脊柱结核患者术后静脉血栓栓塞的发生状况及处理

目的 通过分析脊柱结核术后静脉血栓栓塞(venous thromboembolism,VTE)的发生率,探讨围手术期采取相关措施预防VTE的必要性。方法 选取2012年5月至2017年8月在天津市海河医院骨科由同一组医师进行手术的146例未进行抗凝治疗的脊柱结核患者,术前进行血常规、凝血指标及双下肢静脉彩色多普勒超声检查,术后采用彩色多普勒超声对双下肢静脉进行复查,并随访3个月。结果 术前未发现深静脉血栓(deep venous thrombosis,DVT)形成的146例行脊柱结核手术患者中,术后11例发生DVT(发生率7.53%),无肺栓塞(pulmonary embolism,PE)发生。所有术后7~10d发现DVT的患者均为小腿肌间静脉血栓,位于膝关节以下,无明显临床症状,未进行相关治疗。术后3个月采用彩色多普勒超声复查时DVT消失。结论 脊柱结核围手术期不采用抗凝预防措施的情况下,DVT有较高的自然发生率;所有发生DVT的患者并未出现严重后果,脊柱结核围手术期无需常规药物预防DVT。     

口服异烟肼预防肺结核发病的效果

本文采用前瞻性设计,对咸阳西藏民族学院结素强阳性反应入校新生随机分配为两组,进行INH预防服药的对照观察。服药、未服药组各99例,两年间发病率分别为0.5％和4.0％。经统计学处理有显著性差异(P<0.05)。作者认为在学校推行对结素强阳性反应者的化学预防其效果是满意的。服药过程中未见明显肝功异常等副作用。     

肺结核合并丙肝患者治疗方案的选择研究

目的探究肺结核合并丙肝患者的有效治疗方案。方法选取2013年1月至2015年8月我院收治的50例肺结核合并丙肝患者,采用随机数字表法将这50例肺结核合并丙肝患者均分为甲乙两组。甲组患者抗结核治疗方案为异烟肼、利福喷丁、链霉素,乙组患者抗结核治疗方案为链霉素、异烟肼、利福喷丁、吡嗪酰胺。统计、分析两组患者的肺结核治疗效果、肝功能恢复效果以及治疗过程中的不良反应发生率。结果甲组患者总有效率为92%,乙组患者总有效率为72%,两组相比,甲组患者更优(P0.05);甲组患者肝功能经治疗后15例肝功能恢复正常、8例轻度肝损伤、2例中度肝损伤,乙组患者肝功能经治疗后10例肝功能恢复正常,7例患者肝功能轻度损伤,5例患者中毒肝损伤,3例患者重度肝损伤。两组相比甲组患者更优(P0.05);研究组患者不良反应发生无统计学差异,且两组在不良反应类型上也无差异(P0.05)。结论肺结核合并丙肝患者,采用异烟肼、利福喷丁、链霉素三联抗结核药物合并丙肝病毒清除药物及保肝药物效果较好,可为临床应用所借鉴。     

Clinico-laboratory diagnosis of adverse reactions in children to antitubercular drugs in different combinations

To clarify side effects in children, which resulted from the treatment of intrathoracic tuberculosis with rifampicin, 72 patients were examined. The findings were compared with those on 58 identical patients who received a routine combination of chemotherapeutic drugs. Hence, on the basis of this observation it was found that there were no differences in the incidence of adverse reactions in the compared groups, though their nature was varying. The children on rifampicin were observed to develop mild liver dysfunction 2.5 times more frequently. Besides, toxic-allergic reactions were recorded in the majority of the patients. The combination of isoniazid and rifampicin was proved to enhance their toxic and allergic effects. Liver dysfunction in the presence of different adverse reactions presented with a higher activity in the blood serum of indicator liver enzymes and its impaired protein-forming function.     

Weekly rifapentine/isoniazid or daily rifampin/pyrazinamide for latent tuberculosis in household contacts

RATIONALE: Treatment of latent tuberculosis (TB) infection with weekly rifapentine and isoniazid is a potentially effective alternative to current therapies. OBJECTIVES: To compare the efficacy of weekly rifapentine/isoniazid to daily rifampin/pyrazinamide in preventing TB in household contacts of patients with pulmonary TB in Brazil. METHODS: Contacts of patients with TB were randomized to rifapentine 900 mg/isoniazid 900 mg once weekly for 12 wk or rifampin 450-600 mg/pyrazinamide 750-1,500 mg daily for 8 wk and followed for at least 2 yr. MEASUREMENTS: TB rates, adverse events, and adherence to therapy. MAIN RESULTS: A total of 399 household contacts were enrolled, 206 in the rifapentine/isoniazid arm and 193 in the rifampin/pyrazinamide arm. The median age was 34 yr, median weight was 63 kg, 60% of participants were female, and only one patient was HIV infected. Rifapentine/isoniazid was well tolerated, but the trial was halted by the investigators before completion because of unanticipated hepatotoxicity in the rifampin/pyrazinamide arm. Twenty of 193 participants (10%) receiving rifampin/pyrazinamide experienced grade 3 or 4 hepatotoxicity, compared with 2 of 206 participants (1%) on rifapentine/isoniazid (p<0.001). There were no hospitalizations or deaths due to hepatotoxicity, and all participants' liver enzyme levels returned to normal during follow-up. During follow-up, four cases of active TB developed, three in the rifapentine/isoniazid group and one in the rifampin/pyrazinamide group (1.46 vs. 0.52%; difference, 0.94%; 95% confidence interval, -1.6 to 3.7%). CONCLUSIONS: Rifapentine/isoniazid was better tolerated than rifampin/pyrazinamide and was associated with good protection against TB. Rifapentine/isoniazid weekly for 12 wk is likely a promising therapy for latent TB infection.     

3HP方案治疗风湿性疾病合并结核分枝杆菌潜伏感染的前瞻性研究

目的:评价3HP方案(异烟肼联合利福喷丁;各0.9 g/次,1次/周,共12次)预防性治疗风湿性疾病合并结核分枝杆菌潜伏感染患者的安全性与完成率。方法:采用前瞻性研究方法,纳入2019年6—12月深圳市第三人民医院就诊的38例风湿性疾病合并结核分枝杆菌潜伏感染患者,使用3HP方案预防性抗结核治疗,记录治疗过程中的不良反应和完成率,并随访2年观察活动性结核病发生情况。结果:使用3HP方案治疗患者不良反应发生率为15.8%(6/38),其中,消化道反应者2例(5.3%),失眠、头晕、皮疹、药物性肝损伤者各1例(2.6%);药物性肝损伤者中断治疗1例,治疗完成率为97.4%(37/38);随访2年均未观察到活动性结核病发生。结论:3HP方案预防性治疗风湿性疾病患者合并结核分枝杆菌潜伏感染的安全性好,完成率高,预防活动性结核病的效能仍有待进一步评价。     

Results of a directly observed intermittent isoniazid preventive therapy program in a shelter for homeless men.

We offered directly supervised isoniazid preventive therapy to middle-aged and elderly men who were exposed to tuberculosis during an outbreak of cases at a homeless shelter. Isoniazid, 900 mg, was administered twice weekly to men at the shelter and at the downtown Public Health Clinic. We report on compliance and adverse reactions associated with this preventive regimen. Isoniazid preventive therapy was offered to 64 men. Forty-seven men (73%) began therapy, and 23 of them (49%) completed the 6- to 12-month regimen. Men who failed to complete isoniazid therapy received a median of 11 biweekly doses (range, 1 to 41 doses) over a median of 9 wk (range, 3 to 37 wk). The most common reason for incomplete treatment was that the men no longer frequented the shelter. One hepatotoxic reaction occurred, for a 2.1% cumulative incidence among all men who started therapy and a 3.7% cumulative incidence among the 27 known alcoholic men who began therapy. In addition, we sought to identify personal characteristics of the men that might be associated with noncompliance. Out-of-state location of personal contacts in case of emergency was strongly associated with poor compliance. These data provide some assurance that directly supervised isoniazid preventive therapy may be offered safely to sheltered elderly men with a high prevalence of alcoholism. Further improvements in compliance with isoniazid preventive therapy in homeless populations may depend on the development of a therapeutic regimen of only 2 to 3 months duration.     

利福喷丁与利福平对肺结核患者肝功能影响的比较

目的比较利福喷丁与利福平对肺结核患者肝功能的影响作用。方法 74例初治肺结核患者随机分为利福喷丁组和利福平组,两组均服用异烟肼,吡嗪酰胺和乙胺丁醇治疗,利福喷丁组(37例)加用利福喷丁治疗,利福平组(37例)加用利福平治疗,观察和比较两组肝功能异常发生率。结果利福平组肝功能异常发生率(18.92%)明显高于利福喷丁组(8.11%)(P<0.05)。结论肺结核患者应优先采用含利福喷丁方案进行治疗。     

Liver damage in treatment of latent tuberculous infection by isoniazid

PURPOSE: To study the frequency and degree of liver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people. OBJECT AND METHOD: Chart review of Japanese persons who started isoniazid preventive chemotherapy in the two clinics in Tokyo, from 2003/1/1 to 2004/12/31. RESULT: There were 779 cases who did not transiently or completely stop INH preventive therapy because of adverse effect, and 26 cases who stopped INH transiently or completely because of liver damage as adverse effect (total 805 cases). In 371 cases, of those 779 cases, AST (asparate aminotransferase) and ALT (alanine aminotransferase) was measured after starting INH at least once. In 14.9% (59/397) of these 391 cases (= 371 + 26), liver damage as adverse effect was found. In 1.51% (6/397), liver damage with AST and/or ALT higher than 400 IU/L was found. Clinical hepatitis, associated with clinical symptom of hepatitis, was seen in 0.37% (3/805). Hepatitis with liver failure was seen in 0.12%. There was no death due to liver damage. CONCLUSION: Liver damage as adverse effect of isoniazid (INH) preventive therapy in Japanese people is not rare.     

Weekly moxifloxacin and rifapentine is more active than the denver regimen in murine tuberculosis

RATIONALE: Treatment of tuberculosis with an efficacious once-weekly regimen would be a significant achievement in improving patient adherence. Currently, the only recommended once-weekly continuation phase regimen of isoniazid plus rifapentine (10 mg/kg) is inferior to standard twice-weekly therapy with isoniazid plus rifampin and is, therefore, restricted to non-high-risk patients. The substitution of moxifloxacin, a new 8-methoxyfluoroquinolone, for isoniazid and an increase in the dose of rifapentine could augment the activity of once-weekly regimens. METHODS: To test this hypothesis we evaluated the sterilizing activity of improved once-weekly rifapentine-based continuation phase regimens in a murine model that mimics the treatment of high-risk patients with tuberculosis. The bactericidal activity of standard daily therapy and standard intermittent therapy ("Denver" regimen) was also assessed to evaluate the effect of intermittent drug administration during the initial phase of therapy. RESULTS: After 2 mo of treatment, lung colony-forming unit counts were 1 log(10) lower in mice treated with standard daily therapy than with the Denver regimen. During the continuation phase, the sterilizing activity of once-weekly moxifloxacin plus rifapentine (15 mg/kg) was significantly greater than that of the predominantly twice-weekly Denver regimen of isoniazid plus rifampin. No significant difference in sterilizing activity was detected between once-weekly isoniazid plus rifapentine (15 mg/kg) and the Denver regimen. CONCLUSIONS: These results suggest that the efficacy of the once-weekly isoniazid plus rifapentine continuation phase regimen can be increased by substituting moxifloxacin for isoniazid and by increasing the dose of rifapentine to a clinically acceptable level of 15 mg/kg.     

A prospective,randomized, double-blind study of the tolerability of rifapentine 600, 900, and 1,200 mg plus isoniazid in the continuation phase of tuberculosis treatment

Once-weekly rifapentine 600 mg plus isoniazid (INH) during the continuation phase treatment of tuberculosis is associated with a relapse rate higher than that of twice-weekly rifampin plus INH. The safety and tolerability of higher rifapentine doses need to be determined. We conducted a prospective, randomized, double-blind trial of rifapentine at three doses (600, 900, and 1,200 mg) plus INH 15 mg/kg once weekly in the continuation phase treatment of culture-positive tuberculosis in 150 human immunodeficiency virus-seronegative adults. Outcome measures were discontinuation of therapy for any reason and adverse events on therapy. Treatment was discontinued in 3 of 52 (6%), 2 of 51 (4%), and 3 of 47 (6%) in the rifapentine 600-, 900-, and 1,200-mg treatment arms, respectively. Only one discontinuation, in the rifapentine 1,200-mg arm, was due to an adverse event possibly associated with study therapy. There was a trend toward more adverse events, possibly associated with study therapy, in the highest-dose arms (p = 0.051). Rifapentine 900-mg, once-weekly dosing appears to be safe and well tolerated and is being evaluated in Phase III efficacy trials of treatment of latent tuberculosis. Further evaluation of the safety and tolerability of rifapentine 1,200 mg is warranted.     

Rifapentine and isoniazid in the continuation phase of a 6-month regimen. Final report at 5 years: prognostic value of various measures.

SETTING: Clinical trial in 672 patients with newly diagnosed pulmonary tuberculosis in Hong Kong. After an initial 2 months of a four-drug intensive phase consisting of thrice-weekly streptomycin, isoniazid, rifampicin and pyrazinamide (SHRZ), a random allocation was made to a continuation phase of once-weekly 600 mg rifapentine + 15 mg/kg isoniazid (HRp1), HRp1 given in 2 of every 3 weeks (HRp1.2/3), or to thrice-weekly isoniazid + rifampicin (HR3), the standard treatment in Hong Kong. OBJECTIVE: Final report evaluating adverse events (46 relapses and one failure) after 5 years and the prognostic influence of various factors. METHODS: Kaplan-Meier analysis of adverse events and Cox proportional hazards analysis of prognostic factors. RESULTS: The two rifapentine regimens, HRp1 and HRp1.2/3 had similar final rates of adverse events of 10.8% and 11.7%, respectively, compared to 4.2% for the HR3 regimen (P = 0.02 and 0.009, respectively). In the initial univariate proportional hazards analysis, adverse events were significantly related to the regimen, age, sex, pretreatment radiographic extent of disease and cavitation, and also to sputum culture at 2 months. In the final multivariate analysis, after step-wise removal of non-significant factors, adverse events were related only to the regimen, patients' sex and pretreatment radiographic extent of disease. Elderly male patients were more at risk of an adverse event, as were those with more severe disease. Adverse events occurred at life table rates of 9.0% in patients with drug-sensitive strains and in 8.9% of those with initially isoniazid-resistant organisms at 5 years. CONCLUSIONS: The two rifapentine regimens were unsatisfactory because of their high incidence of adverse events. Isoniazid appeared not to contribute to preventing relapse. Further studies with increased rifapentine dosage are necessary.