隨著世界現代醫藥學和我國傳統醫藥學的深入發展,中藥和西藥的在臨床上的聯合應用非常普遍。而目前在臨床中西藥合用過程中往往只注重中西藥合用的有效性,卻忽視了因配伍禁忌而可能出現療效降低、產生或增加毒副作用的不合理用藥。這不僅造成資源的浪費,同時也增加藥源性疾病的發生。這應引起廣大醫藥工作者及患者的高度重視。筆者參考近年來有關文獻資料,就臨床中西藥合用的配伍禁忌問題進行歸納論述。
Objective To establish a method for quality control of Astragalus Radix and Scutellariae Radix in Biqiaotong granules and provide basis for the establishment of quality standard. Methods The single-factor test method was used to investigate the factors of thin layer chromatography (TLC) conditions, including different extract method and solvents, developing system, comogemc agents, temperature, humidity, drawing amounts and thin layer boards, and to screen the best TLC conditions of Astragalus Radix and Scutellariae Radix . Results The TLC conditions of Astragalus Radix were used trichloromethane-methanel-water (13:7:2) as developing solvent, separated on silica gel G, heatd under 105℃ until the spots bacame clear. The TLC conditions of Scutellariae Radix were used methylbenzene-ethy acetate- formic acid-methanel (9:3:2:2) as developing solvent, separated on silica gel G, observed after 30 minutes under daylight until the spots were clear. Conclusions The spot features are clear, and with good separating degree, strong specificity, and good repeatability without the inference of negative control. The TLC method is simple, sensitive and accurate, which can be adopted for the quality control of Biqiaotong granules.
Objective To investigate the protective effect of recombinant erythropoietin (EPO) on the photoreceptor cells in rat with retinal detachment (RD).Methods One hundred and sixtytwo normal male rats were randomly divided into normal control (NC) group, RD model group, RD+phosphate buffer solution （RD+PBS） group, RD+EPO 100 ng group, RD+EPO 200 ng group and RD+EPO 400 ng group. Three days after RD, activated caspase3 and bclXL were detected by Western blot and/or immunofluorescence, and apoptosis were measured by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate digoxigenin nick-end labeling（TUNEL）. Fourteen and 28 days and two months after RD, the outer nuclear layer （ONL）thickness was measured by histopathologic method.Results Western bolt indicated that the protein level of activated caspase-3 and bcl-XL between six groups were statistically significant（F=35.96, 30.75；P＜0.01）. The number of TUNEL positive cells and activated caspase-3 positive cells are consistent with each other in different groups. Fourteen days and two months after RD，the differences of ONL thickness between six groups were statistically significant（F=21.52，96.25；P＜0.01）.Conclusion Supplement of EPO after RD can alleviate apoptosis by inhibiting of the caspase-3 activity and increasing the expression of bcl-XL,thus exerts protective effect on photoreceptor cells.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.
ObjectiveTo explore and analyze the risk factors for arrhythmia in patients after heart valve replacement.MethodsA retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis.ResultsThere were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930).ConclusionTaking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.