2014 Volume 16 Issue 6 Published: 28 December 2014
  

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    论著

  • 论著
    Zhou Shuang;Sheng Xiaoyan;Xiang Qian;Zhao Liping;Zhou Ying;Cui Yimin
    2014, 16(6): 327-9.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate systematically the efficacy and safety of lispro insulin (LP) in patients with type 2 diabetes mellitus (T2DM)Methods"Type 2 diabetes mellitus", "lispro insulin", and "randomized controlled trail" were selected as the key words and Medline, Embase, PubMed, Cochrane library, CNKI, and WanFang Data were searched. The evaluation of methodological quality for the literature in accordance with inclusion criteria and Meta-analysis were performed. According to the intervention measures, the subjects were divided into the experimental group (treated with LP) and the control group [treated with biosynthetic human insulin (HI)]. All subjects in the 2 groups could be treated with other oral hypoglycemic drugs or insulin at the same time. The efficacy was evaluated using fasting blood-glucose, 2 h postprandial blood glucose, glycemic excursion, glycosylated hemoglobin, C-peptide, and cholesterol levels; the safety was evaluated using the incidence of hypoglycemia.ResultsA total of 25 literature were entered in this study and their quality evaluation results were 2 high quality articles, 9 medium quality, and 14 low quality. A total of 2 975 patients were entered in the study. The Meta-analysis showed the following results. The efficacy of LP treatment in patients with T2DM to decrease the fasting blood-glucose, 2 h postprandial blood glucose, glycosylated hemoglobin, and cholesterol were better than those of HI treatment (MD=-0.16, 95%CI:-0.27--0.06, P=0.00; MD=-1.38, 95%CI:-1.46--1.30, P=0.00; MD=-0.28, 95%CI:-0.33--0.24, P<0.00; MD=-0.26, 95%CI:-0.35--0.18, P=0.00). The differences of glycemic excursion and C-peptide changes in the experimental and the control groups were not significant statistically (MD=-0.51, 95%CI: -1.04-0.01, P=0.05; MD=-0.02, 95%CI:-0.26--0.22, P=0.88); the incidence of hypoglycaemia was lower in the experimental group than that in the control group (OR=0.53, 95%CI: 0.38-0.74, P=0.00).ConclusionLispro insulin is effective and safe in treatment in patients with T2DM.
  • 论著
    Liu Chen;Wang Yuqin;Shen Qian;Li Xiaoling;Jiang Dechun;Li Xingwei
    2014, 16(6): 336-5.
    Abstract ( ) PDF ( )
    ObjectiveTo evaluate rationality of drug application in aged inpatients with brain infarction in Xuanwu Hospital of Capital Medical University. MethodsMedication records of ≥60 years old inpatients with brain infarction from January 1st, 2011 to December 31st in our hospital were collected. The patients′ general information was descriptively analyzed and drug utilization index (DUI), defined daily cost (DDC), and an average daily cost of each patient were calculated. Published guidelines in our country and abroad were searched and the therapeutic drugs used in aged inpatients with brain infarction in our hospital were compared with recommended drugs in Chinese guideline, and the rationality of drug use in our hospital was evaluated. ResultsData of a total of 430 patients were collected. Of them, 272 patients were male and 158 were female. The age of the patients was from 60 to 92 years and an average age was (71±7) years. The average number of diseases in each patient was 5.4. A total of 243 kinds of drugs were used during hospitalization and an average number of kinds of drugs in each patient was 17. A total of 8 guidelines related to brain infarction published in USA, Japan, China, South Africa, New Zealand, United Kindom, Europe, and Brazil were searched. There were 7 kinds of drugs in the above mentioned guidelines, including thrombolytic drugs, antiplatelet drugs, anticoagulation drugs, antifibrinolytic drugs, volume extending drugs, drugs for vasodilation, and neuroprotective drugs. The Chinese guideline recommended 3 kinds of drugs, including thrombolytic, antiplatelet, and antifibrinolytic drugs. Of them, 4 drugs in 2 kinds were used in our hospital, including alteplase (rt-PA), urinary kallidinogenase, aspirin, and clopidogrel and their DUI were 1.0, 1.2, 1.2, and 1.2, respectively. Thirteen kinds of neuroprotective drugs were used in aged inpatients with brain infarction in our hospital, whose cost accounted for 38.75% (1 782 343.6/4 599 576.7) of total medication cost, which was 17 times (1 782 343.6/103 779.7) the cost of recommended drugs in the Chinese guidelines. ConclusionsDrugs used in aged inpatients with brain infarction in our hospital are in accordance with recommended drugs in Chinese guidelines. However, neuroprotective drugs which are not recommended in Chinese guidelines are used excessively, which cost too much and should be standardized further.
  • 论著
    Liu Yongjiao;Yang Jing
    2014, 16(6): 341-4.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the status of medication error (ME) of outpatient pharmacy of Beijing Tongren Hospital Affiliated to Capital Medical University and to find effective prevention and control measures.MethodsAs a pilot run hospital of Beijing Municipal Health Bureau ME monitoring system, ME cases were reported since August 2011 by the hospital and ME reports were analyzed monthly to formulate prevention measures. ME cases of outpatient pharmacy, which were reported to Beijing Municipal Health Bureau, from August 2011 to March 2013 were collected. The ME cases were classified according to the ME classification standard of The National Coordinating Council for Medication Error Reporting and Prevention and the links in which ME cases occurred were analyzed. MEs that occurred from August 2011 to September 2012(the pilot operation stage of the Beijing ME monitoring system) were compared with those from October 2012 to March 2013( the operation stage of Beijing municipal bureau of clinical medication safety monitoring network). The effectiveness of prevention measures was evaluated.ResultsA total of 506 ME cases, accounting for 0.031%(506/1 636 429)of the number of outpatient prescriptions at the same time, were collected. There were 2 cases of category A (potential error problems), 462 cases of category B (errors happened but the drug was not given to patient, or the drug had been given to patient but was not taken), 42 cases of category C (patients had used the drug but not be harmed), and none of categories D-I. Among them, 459 ME cases occurred in the links of prescriptions by doctors including improper usage and dosage(75.16%, 345/459), improper administration route(12.64%, 58/459), improper drug selection(5.88%, 27/459), taking medication within comtraindication(3.05%, 14/459),imcompatibility(2.61%, 12/459), and improper choice of solvents(0.65%, 3/459). Forty-seven ME cases occurred in the links of dispensing prescriptions by pharmacists including sound alike, look alike, adjacent locations, and so on. Aiming to the links of doctors making prescriptions, a supervision model of "four-grade prescription comment and four-grade feedback" was carried out since October 2012 and the rate of qualified prescriptions was increased effectively. The proportion of ME cases in the links of prescriptions by doctors in all the prescription cases during the same period decreased from 0.035% (398/1 139 613) in the pilot operation stage to 0.012% (61/496 816) in the operation stage. Aiming to the links of dispensing prescriptions by pharmacists, many kinds of measures were carried out to improve the identification of easily confused drugs. The incidence of ME in the links of dispensing prescriptions by pharmacists decreased from 0.004% (40/1 139 613) in the pilot operation stage to 0.001% (7/496 816) in the operation stage.ConclusionThe ME cases in outpatient pharmacy of Beijing Tongren Hospital Affiliated to Capital Medical University were mainly category B and C and mostly occurred in the links of prescriptions by doctors. The main type of ME was usage and dosage. The supervision model of "four-grade prescription comment and four-grade feedback" could effectively prevent the ME in the links of prescriptions by doctors.
  • 论著
    Sun Xiangju;Wu Yubo;Jiang Aihua;Xu Na;Liang Jing;Wu Yumeng
    2014, 16(6): 345-5.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze and compare the prothetic effects of reduced glutathione and polyene phosphatidyl choline on liver injury evoked by cyclophosphamide in mice.MethodsForty Kunming mice were divided into the liver injury model group, the reduced glutathione group, the polyene phosphatidyl choline group, and the control group by simple random sampling. Each group comprised 10 mice. The mice in the fornamed 3 groups received intraperitoneal injection of cyclophosphamide (100 mg·kg11·d11) to evoke the liver injury on day 1 to 4 of the experiment and 0.9% sodium chloride solution 0.2 ml, reduced glutathione 180 mg· kg11· d11, and polyene phosphatidyl choline 90 mg·kg11·d11 were given respectively in the 3 groups on day 5 to 14 of the experiment. The mice in the control group received intraperitoneal injection of same volume of 0.9% sodium chloride solution on day 1 to 14 of experiment. The body weight of mice in the 4 groups were measured on the first day before intraperitoneal injection of cyclophosphamide and the fifteenth day of the experiment. The mice in the 4 groups were executed on the fifteenth day of the experiment. The blood samples were taken from eye pit before the mice were killed and the serum total bilirubin and glutathione levels were measured. Their liver tissue were taken and weighed, and the liver coefficient were calculated. The liver tissue were taken and the activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), superoxide dismutase (SOD), catalase (CAT) and the level of malonaldehyde (MDA) in the liver tissue were measured. The morphological changes in the liver tissue in the 4 groups were observed.ResultsOn day 15 of experi1ment, the body weights in mice in the liver injury model group, the reduced glutathione group, and the polyene phosphatidyl choline group were lower significantly than those in the control group (P<0.01 or P<0.05). The body weights in mice in the reduced glutathione group were higher than those in the liver injury model group (P<0.05). The liver coefficient in mice in the liver injury model group (5.74%±0.11%) was higher than that in the control group (4.68%±0.37%) and the reduced glutathione group (4.81%±0.19%) (all P<0.01). The liver coefficient in mice in the polyene phosphatidyl choline group (5.25%±0.35%) was higher than that in the control group(P<0.05). The levels of serum total bilirubin in the liver injury model group, the reduced glutathione group, and the polyene phosphatidyl choline group [(129.8±1.9), (110.9±1.3), and (125.7±2.6) μmol/L] were higher than those in the control group [(100.8±3.0) μmol/L] (all P<0.01). The level of serum total bilirubin in mice in the reduced glutathione group was lower than that in the liver injury model group (P<0.01). The levels of serum glutathione in mice in the liver injury model group and the polyene phosphatidyl choline group [(50.5±1.9) and (55.9±2.4) g/L] were lower than those in the control group and the reduced glutathione group [(73.8±4.3) and (71.3±3.7) g/L](all P<0.01). The activities of AST, ALT, SOD, and CAT in the liver tissue in mice in the liver injury model group, the reduced glutathione group, and the polyene phosphatidyl choline group were lower than those in the control group [(144.5±7.9),(223.1±15.1),(173.9±5.3)U/mg vs. (332.6±7.3)U/mg], [(50.5±4.0),(108.0±8.0), (62.3±2.0)U/mg vs. (139.6±7.0)U/mg], [(99.0±9.7), (165.0±114.6), (115.6±7.3)U/mg vs. (207.6±8.3)U/mg], [(35.4±1.0), (39.3±1.1), (36.3±1.2)U/mg vs. (42.5±2.3)U/mg] (all P<0.01). The MDA levels in the liver injury model group, the reduced glutathione group, and the polyene phosphatidyl choline group were higher than those in the control group[(23.4±2.6), (16.3±1.5), (20.2±1.9)nmol/mg vs. (10.2±2.2)nmol/mg] (all P<0.01). But the levels of above1mentioned four enzymes in the reduced glutathione group were higher than those in the polyene phosphatidyl choline group and the liver injury model group (P<0.01 or P<0.05), the levels of MDA were lower than those in the polyene phosphatidyl choline and the liver injury model groups (all P<0.05). There were many necrotic foci and inflammatory corpuscles in hepatic tissue in mice in the liver injury model group, the structure of hepatocyte was inordinate. The structure of most hepatocytes in the reduced glutathione group was normal, only few necrotic foci were seen. Part of the hepatocytes in the polyene phosphatidyl choline group showed gap increase, swelling, and a few necrotic foci. ConclusionsReduced glutathione has significant repairing effects on liver injury in mice evoked by cyclophosphamide. Polyene phosphatidyl choline can only increase the ALT activity in the model of liver injury evoked by cyclophosphamide in mice.
  • 论著
    Zhang Ailing;Liu Yao;Yang Liping;Hu Xin
    2014, 16(6): 350-6.
    Abstract ( ) PDF ( )
    ObjectiveTo analyze the influential factors for recurrent adverse cardiovascular events within one year and 15 years after percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease (CHD).MethodsThe patients with CHD, who underwent PCI or bypass operation of coronary artery meanwhile in Department of Cardiology, Beijing Hospital from January 1998 to March 2013,had complete medical records and received dual antiplatelet therapy with clopidogrel and aspirin for one year, were enrolled in the study. Patients′ specimens of blood were collected and cytochrome P450(CYP)2C19 genotype associated with metabolism of clopidogrel were detected. The patients were divided into the reference metabolizers group (*1/*1), intermediate metabolizers group (*1/*2 and *1/*3) and slow metabolizers group (*2/*2, *2/*3 and *3/*3) by the results of genotype detection. The situation of recurrent adverse cardiovascular events within one year and 15 years after the first PCI and the correlative factors were analyzed retrospectively.ResultsA total of 210 patients were enrolled in the study. They comprised of 148 males and 62 females with age 49184 (67±10) years. There were 163 and 47 patients undergoing PCI for the first and second times, respectively. There were 185 and 25 patients undergoing PCI only and bypass operation of coronary artery meanwhile, respectively. There were 158, 156, and 91 cases complicated with hypertension, hyperlipoidemia, and diabetes, respectively. The incidence of adverse cardiovascular events in the reference metabolizers group, the intermediate metabolizers group, and the slow metabolizers group within one year after PCI were 13.3%(13/98), 24.7% (23/93), and 31.6% (6/19), respectively. The incidence of adverse cardiovascular events in the slow metabolizers group and the intermediate metabolizers group were 2.37 and 1.86 times of those in the reference metabolizers group, respectively. Carrying CYP2C19*2 or *3 genotype was the independent risk factor (OR=1.781, 95%CI: 1.04213.046, P=0.035) and moderate drinking of white spirit was the independent protection factor (OR=0.054, 95%CI: 0.17511.016, P=0.045) in adverse cardiovascular events within one year after PCI. The incidence of adverse cardiovascular events in the reference metabolizers group, the intermediate metabolizers group, and the slow metabolizers group within 15 years after PCI were 32.7% (32/98), 33.3%(31/93), and 36.8% (7/19), respectively, the differences among the 3 groups were not statistically significant. Combination with diabetes (OR=3.243, 95%CI: 1.24515.165, P<0.05)and with familial history of CHD (OR=2.683, 95%CI: 1.23215.359, P=0.006)were the independent risk factors in adverse cardiovascular events within 15 years after PCI.ConclusionsCarrying CYP2C19*2 or *3 genotype is the risk factor in recurrent adverse cardiovascular events in patient with CHD within one year after PCI. Combination of diabetes and with familial history of CHD are the risk factors in recurrent adverse cardiovascular events within 15 years after PCI. It is suggested that the patients who prepare to perform PCI or have performed PCI recently should detect the CYP2C19 genotype and decide whether or not to receive the antiplatelet therapy with clopidogrel by the results of genotype detection.
  • 综述

  • 综述
    Wang Shujun;Qian Jiaming
    2014, 16(6): 359-3.
    Abstract ( ) PDF ( )
    The incidence of drug-induced pancreatitis (DIP) is not reported accurately. If DIP is not diagnosed, suspected drugs will be taken continuously by patients and relapsed pancreatitis will occur accompanied with painfulness and unnecessary medical expenses. There are no unified classification methods for drug-induced pancreatitis in the present. The most commonly used classification methods are 3-kind-method and 4-kind-method, which are divided by the number of patients and provocative tests or the number of patients, provocative tests, the incubation period, and the exclusion of other causes, respectively. The mechanisms of DIP are direct toxicity and idiosyncratic reactions. Diagnosis of DIP is difficult because it has no special clinical manifestations and specific diagnostic markers. For patients diagnosed as idiopathic pancreatitis, a careful examination for the patients′ medication histories is necessary. Treatments for DIP are similar to acute pancreatitis and discontinuation of the suspected drugs is the key point.
  • 综述
    Xie Qiufen;Xiang Qian;Zhou Ying;Cui Yimin
    2014, 16(6): 362-5.
    Abstract ( ) PDF ( )
    Amiodarone, one of Class Ⅲ antiarrhythmic drugs, may lead to hepatic injury, the incidence of which is about 14% to 82%. Clinical manifestations differ widely from asymptomatic elevated liver enzymes to fulminant hepatic failure and even death. Histopathological findings are similar to those of alcoholic liver disease and characterized by lysosomes phospholipidosis and granular cells. Pathogenesis includes toxicity of amiodarone and its major metabolite, immunological mechanisms, and genetic factors. Intravenous AIHI is mainly related to the effect of cosolvent, polysorbate 80. Men, heart failure and plasma concentration >2.5 mg/L may be risk factors. Indications to use amiodarone should be strictly controlled and patients′ physical conditions should be considered for choosing methods of administration. Monitoring closely is needed for liver function and/or blood concentration during treatment. When liver function is abnormal, weigh the benefits and risks of treatment carefully, and decide whether dosage reduction or withdrawal of the drug is necessary.
  • 综述
    You Lu
    2014, 16(6): 367-3.
    Abstract ( ) PDF ( )
    The hematological adverse reactions caused by lamotrigine includes decreasing count of white blood cell, neutrophil, and platelet, as well as disseminated intravascular coagulation. However, patient will not develop obvious clinical symptom. The mechanism of this adverse reactions is not clear and the risk factors include mainly concomitant use of other antiepileptic drugs, initial dose exceeding the recommended dose, too fast dose escalation, and so on. In the initial application and the process of gradually added count of lamotrigine, possible hematological adverse reactions must be alerted. The decision of drug discontinuation and changing should not be simply made only on the basis of leukocyte count. If the examination of bone marrow smear is normal or the ratio of bone marrow precursor cell to precursor cell of red blood cell increases, the drug can still be given. If the above ratio decreases or the level of neutrophil count is less than or equal to 0.5×109/L, the drug should be stopped or switched to other medication. These patients who ever had thrombocytopenia or leucopenia should be monitored regularly and should be treated with the laboratory test once every quarter at least. The surgery should be given very carefully to these patients and platelet function should be examined preoperatively.
  • 病例报告

  • 病例报告
    Mao Min;Shao Mingjing;Jia Haizhong;Huang Li;Lu Jin
    2014, 16(6): 370-2.
    Abstract ( ) PDF ( )
    An 82-year-old male patient with cerebral infarction received an IV infusion of cinepazide maleate 320 mg+0.9% sodium chloride injection once daily for 30 consecutive days. The patient′s neutrophil count (NEUT) was 5.7×109/L before treatments and 2.4×109/L on day 28 of treatments. An interval of 5 days later, cinepazide maleate was given again at the same dosage. On day 6 of second use of cinepazide maleate, the patient′s NEUT decreased to 0.2×109/L. Cinepazide maleate was stopped and mecobalamin (500 μg, twice daily), folic acid (5 mg, once daily), and leucogen (20 mg, twice daily) were given. Two days later, the patient′s NEUT decreased to 0. Recombinant human granulocyte colony stimulating factor 200 μg twice daily was injected subcutaneously. Two days later, the patient′s NEUT increased to 4.5×109/L. The patient received cinepazide maleate combined with 15 kinds of drugs at the same time because he suffered from several kinds of diseases. During 18 months of follow-up, the patient did not take cinepazide maleate again and most other combination drugs were used continuously and neutropenia did not recur. It was considered that cinepazide maleate induced the patient′s acute agranulocytosis.
  • 病例报告
    Ou Dengke;Zhou Xiaoming;Chen Yu;Zhao Limei;Zhao Li
    2014, 16(6): 372-2.
    Abstract ( ) PDF ( )
    Mezlocillin sodium and sulbactam sodium for injection(2.5 g, once every 12 hours) and azithromycin injection (0.5 g, once daily) were given to a 23-year-old female patient due to the community-aquired mycoplasma pneumonia and acute purulent tonsillitis. On the eleventh day, the treatments above mentioned were changed to oral moxifloxacin 0.4 g once daily because of the improvement of the patient′s condition. Thirty minutes after the moxifloxacin administration for the first time, the patient felt chest tightness, palpitation, fever, and generalized flush accompanied by wheal and papula on her limbs and trunk. The electrocardiogram examination showed double directional or inverted T waves in the precordial leads and prolonged QT period with corrected QT interval 462 ms. Laboratory examination showed creatine kinase (CK) 239 U/L, isoenzyme of creatine kinase (CK-MB) 35 U/L. TypeⅠhypersensitivity reaction was diagnosed. Moxifloxacin was stopped and ananaphylaxis and supportive treatments were given immediately. Three days later, her skin symptoms disappeared, ECG examination result returned to normal. The levels of CK and CK-MB were 40 U/L and 11 U/L, respectively.
  • 病例报告
    Zhou Hong;Yu Xiaojia;Liu Lihong
    2014, 16(6): 374-2.
    Abstract ( ) PDF ( )
    A 75-year-old female patient received treatments with cefoxitin, dyphylline, acetylcy-steine, and torasemide for interstitial pneumonia accompanied with infection. Before treatments, the laboratory test results were as follows: peripheral white blood cell count 9.8×109/L, neutrophile granulocyte 0.76, albumin 27.6 g/L, urea nitrogen 7.99 mmol/L, creatinine 130 μmol/L, uric acid 388 μmol/L. On hospital day 6, she received an IV infusion of cefepime 2 g twice daily instead of cefoxitin because of poor treatment effect. Other therapies were the same as before. On hospital day 9, the patient developed mania and no special treatment was given. On hospital day 10, she developed restlessness, paraphasia, and delirium. Cefepime, dyphylline, and acetylcysteine were discontinued at the same day and IM injection of diazepam 5 mg twice daily was given. On hospital day 12, the mental symptoms disappeared, dyphylline and acetylcysteine treatments were given again. The mental symptoms did not recur.
  • 病例报告
    Chen Jin;Gao Jie
    2014, 16(6): 375-3.
    Abstract ( ) PDF ( )
    A 53-year-old man took ciclosporin, mycophenolate mofetil, and prednisone regularly for seven years and two months after kidney transplantion. And because of radical operation for colon cancer, ciclosporin was stopped and switched to oral sirolimus 2.0 mg once daily. After about half a month of drug use, the plasma concentration of sirolimus was 12.65 ng/ml. And then, the dosage of sirolimus was reduced to 1.5 mg once daily by the patient. After 4 days, the dosage of sirolimus was changed to 1.0 mg once daily according to the doctor′s advice. One week later, clarithromycin 0.25 g twice daily orally was added because of pustules on his lips. On day 4 of concomitant use of the four drugs, the plasma concentration of sirolimus was higher than 30 ng/ml. Clarithromycin was discontinued on the day and the other drug did not change. After one week, the plasma concentration of sirolimus reduced to 9.82 ng/ml.
  • 病例报告
    Yang Siyun;Hu Xiaoyan;Ji Yifei;Su Qiang;Pan Zhaoping;Jiang Zhongcai
    2014, 16(6): 377-2.
    Abstract ( ) PDF ( )
    Patient 1, a 25-year-old female with ectopic pregnancy received an IV infusion of desmopressin acetate 15 μg every 12 hours due to tubal embryo surgery incision and pelvic adhesion separation surgery. On day 2, about 30 minutes after the start of infusion, the patient developed delirium, confusion, convulsion, and trismus. Laboratory tests showed that serum sodium was 125 mmol/L (preoperative serum sodium was 142 mmol/L). Hyponatremic encephalopathy induced by desmopressin acetate was considered. Desmopressin acetate was withdrawn immediately and she was given sodium supplement. About 10 minutes later, the patient′s symptoms relieved. She had consciousness and serum sodium level rose to 141 mmol/L on the next day. Patient 2, a 42-year-old female patient received an IV infusion of desmopressin acetate 18 μg every 12 hours after radical treatment of perianal abscess. On day 4, the patient developed dizziness, sweating, tremor of hands, chills, and oliguria. On day 5, the patient developed nausea, upward deviation of the eyes, and muscular rigidity and clonus in both upper limbs. Laboratory tests showed that serum sodium was 124 mmol/L (preoperative serum sodium was 141 mmol/L). Her CT examination showed extensive edema in white matter of the cerebral hemisphere. Hyponatremic encephalopathy induced by desmopressin acetate was considered. Desmopressin acetate was stopped and she was given symptomatic treatments such as sodium supplement. One day later, the patient′s symptoms disappeared and her serum sodium increased to 138 mmol/L.
  • 病例报告
    Wang Jiesong*;Zhang Chaoli;Fei Jun;Xie Yajun;Guan Xiaochan;Wu Jiuhong
    2014, 16(6): 379-2.
    Abstract ( ) PDF ( )
    A 63-year-old female patient underwent coronary CT angiography and received an intravenous iohexol injection (350 mg/ml ) 80 ml as the contrast agent. At the sixth minutes of observation after CT test completion, the patient developed palm itching, bilateral conjunctival congestion and edema, sweating, vertigo, nausea, and vomiting a small amount of gastric contents and then followed by lip cyanosis, facial edema, cold limbs, skin ecchymosis, and bleeding the injection site. Blood gas analysis showed an oxygen saturation of 0.83 and an oxygen partial pressure of 47 mmHg. About an hour after CT scan, the laboratory test revealed the following levels: blood platelet count 19×109/L, prothrombin time (PT) 18 s, and thrombin time (TT) 6 s. Treatments with anti-anaphylaxis, coagulation factor supplementation, and correction of acidosis and electrolyte disorder were given. After 7.5 hours after CT scan, her blood platelet count was 8×109/L. The next day, large pieces of skin ecchymosis appeared in many parts of her body, a body temperature reached 38.1 ℃ and a blood platelet count was 6×109/L. Symptomatic and supportive therapy was continued and her condition gradually improved. On day 4, she presented with normal temperature, disappeared facial edema, and relief of skin ecchymosis. On day 6, her level of blood platelet and all the values of coagulation functions returned to normal.
  • 用药错误

  • 用药错误
    Chen Weibi;Gao Lehong
    2014, 16(6): 381-2.
    Abstract ( ) PDF ( )
    A 67-year-old woman was given furazolidone 0.6 g daily for gastritis. About one month after drug use, the patient developed rashes and itching on many parts of her body. About 40 days after drug use, symmetric numbness appeared in the area of her limbs and progressed to appear around the mouth as well as in tongue. About 50 days after drug use, she experienced dizziness and unstable walking accompanied gradually by hyperaction, a few of visual and auditory hallucination, and occasional involuntary shaking of her both upper extremities. About 60 days after drug use, the patient had taken furazolidone 36 g in total and stopped the drug. Electromyography test showed peripheral neurogenic damage. She was given an intravenous infusion of dexamethasone, thioctic acid, ganglioside, and compound coenzyme combined with intramuscular vitamin B1 and mecobalamine. On day 14 of therapy, her mental state and walking normalized, dizziness and numbness around the mouth and of tongue improved remarkably. At follow up after half a year, the patient had only light numbness in the acra of her limbs and skin pigmentation and others returned to normal.