2012 Volume 14 Issue 3 Published: 28 June 2012
  

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    论著

  • 论著
    SHI Xue*;LIU Zheng-mao;ZHU Xiu-dan;GUO Xiu-hua
    2012, 14(3): 137-5.
    Abstract ( ) PDF ( )

    ObjectiveTo explore the effects of Fuzheng Jianpi decoction on adverse reactions to chemotherapy in children with solid tumor. Methods The children with solid tumor who were in/out-patients in oncological surgery of Beijing Children’s Hospital during the period from January 2005 to January 2008 were enrolled in the study. The children were divided into the chemotherapy drug group (the control group) and the chemotherapy drug plus Fuzheng Jianpi decoction group (the treatment group) by randomized digital table. The decoction contained 17 Chinese herbs. The time of taking the decoction was from the day before beginning of each chemotherapy cycle to one week after the end of chemotherapy. The peripheral blood cell count, scores for adverse reactions, compliance and the situation of chemotherapy completion in the two groups during the sixth and twelfth month of chemotherapy were observed and compared. ResultsA total of 167 patients were enrolled in the study. The control group (84 cases) comprised 48 boys and 36 girls with average age of (3.8±2.6) years. The treatment group (83 cases) comprised 45 boys and 38 girls with average age of (3.7±2.7) years. The differences in tumor types, tumor stages, white blood cell count, platelet count, and hemoglobin concentration before chemotherapy between the two groups were not statistically significant (P>0.05 for all comparison). The white blood cell count and hemoglobin concentration in the treatment group were higher than those in the control group [(4.2±2.0)×109/L vs (3.1±1.9)×109/L, P<0.01;(95±20) g/L vs (87±15) g/L,P<0.05)], the difference in platelet count between the two groups was not statistically significant (P>0.05) during the sixth month of chemotherapy. Three indexes of children in the treatment group were higher than those in the control group [white blood cell count:(3.8±1.8)×109/L vs (3.0±1.6)×109/L,P<0.01;hemoglobin concentration:(87±23) g/L vs (80±18) g/L, P<0.05;platelet count:(170±65)×109/L vs (146±51)×109/L, P<0.05] during the twelfth month of chemotherapy. Compared with the control group, the severity of vomiting was reduced markedly, activities of daily living, appetite and body weight were increased in the treatment group during the sixth month and the twelfth month of chemotherapy, respectively. The differences were statistically significant (P<0.01 for all comparison). The severity of constipation in the treatment group was lighter than that in the control group during the sixth month of chemotherapy (P<0.01). The severity of pain in the treatment group was lighter than that in the control group during the twelfth month of chemotherapy (P<0.05). The chemotherapy compliance in the treatment group was better than that in the control group [86.7%(72/83) vs 69.0% (58/84), P<0.01)]. The rates of chemotherapy completion in the treatment group was higher than that in the control group [81.9%(68/83) vs 667% (56/84), P<0.05]. ConclusionFuzheng Jianpi decoction can reduce the severity of adverse reactions to chemotherapy and might be used as an adjuvant treatment in children receiving chemotherapy for solid tumor.

  • 论著
    FAN Hua-ying;LIANG Jun-cheng;ZHOU Fen;SUN Li;LI Xiao-xiao;XU Guo-zhu;DENG Yan-ping
    2012, 14(3): 142-7.
    Abstract ( ) PDF ( )
    ObjectiveTo observe the tolerance of tetrodotoxin injection in opioid-dependent patients in the convalescent stage. Methods An open, non-controlled trial was conducted. The opioid-dependent patients aged 18 to 45 years, male or female, during the convalescent stage were enrolled as subjects. Two different dosage regimens were used in the trial: a single-dose regimen (5 μg or 10 μg or 15 μg once daily intramuscularly) and multi-dose regimen (10 μg or 15 μg thrice daily intramuscularly for 7 days). During the trial phase, the changes in vital signs and adverse reactions were observed and recorded. Laboratory test and electrocardiogram (ECG) were performed before and after administration and all the results were statistically analyzed. ResultsA total of 30 subjects were enrolled in the study. Eighteen subjects receiving the single-dose regimen were randomly divided into the 5 μg, 10 μg and 15 μg groups and 12 subjects receiving the multi-dose regimen were divided into the 10 μg and 15 μg groups. Each group comprised 6 subjects. During the trial phase, there were no marked changes in vital signs in all subjects. The levels of creatine kinase in the 5 μg and 10 μg groups receiving single-dose regimen and the 15 μg group receiving multi-dose regimen after injection of tetrodotoxin were significantly higher than those before drug administration ( all P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in one subject in the 5 μg group receiving single-dose regimen after injection of tetrodotoxin were higher than those before drug administration, and did not return to baseline 3 days after the trial completion. After tetrodotoxin injection administration, the levels of creatine kinase of 4 subjects in the 15 μg group receiving multi-dose regimen increased obviously and three of them decreased to normal level 3 days after the trial completion. An ECG revealed ST or T wave changes in 4 subjects receiving the single-dose regimen 24 hours after injection of tetrodotoxin and one subject receiving the multi-dose regimen 7 days after drug administration, and then ST or T wave changes normalised 3 days after the trial completion. Adverse reactions associated with tetrodotoxin injection occurred in 7 subjects, including xerostomia (6 subjects), fatigue (2 subjects), tongue numb (1 subject), limb pain (1 subject), the incidence of adverse reactions was 23.3%. The symptoms of adverse reactions spontaneously subsided or disappeared without withdrawal or dosage reduction. ConclusionTetrodotoxin injection could be well tolerated in a dose of 5-15 μg 3 times a day by intramuscular injection in opioid-dependent patients in the convalescent stage.
  • 论著
    FU Dong;LI Zhen-hua;LIU Min;CAI Hao-dong
    2012, 14(3): 149-5.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the influence of antiviral therapy on pregnancy outcome in active hepatitis B patients during pregnancy. Methods The patients, who were in 8-24 weeks of pregnancy and had abnormal liver function [alanine aminotransferase (ALT) ≥3×upper limit of normal] and HBV DNA level ≥5 lg copies/ml in the department of gynaecology and obstetrics, Beijing Ditan Hospital, Capital Medical University from August 2006 to April 2011, were selected. According to the patients’will, they were divided into the antiviral treatment group receiving lamivudine or telbivudine and the liver-protective treatment group receiving polyene phosphatidyl choline, adenosylmethionine, glutathione, Ganxile (肝喜乐) tablets and Ligankang (利肝康) tablets etc. The liver disease outcome during pregnancy, severe adverse events and neonates’outcome in the 2 groups were compared. ResultsA total of 102 patients were entered in this study. Of them, 56 patients were in the antiviral treatment group and 46 patients were in the liver-protective treatment group. There were no statistically significant differences in baseline characteristics of patients between the 2 groups (P>0.05). Fifty-three patients completed pregnancy and 3 patients lost from follow-up in the antiviral treatment group. Thirty-seven patients completed pregnancy in the liver-protective treatment group. Of the other 9 patients, 5 patients lost from follow-up, 2 selected artificial termination of pregnancy, and 2 patients’pregnancy failed. The rate of ALT levels returning to normal [90.6% (48 patients)] and the rate of HBV DNA levels changing to negative [58.5% (31 patients)] before delivery in the patients in the antiviral treatment group were higher than those [18.9% (7 patients), 8.1% (3 patients)] in the liver-protective treatment group (P=0.000 for all comparisons). The rates of natural or artificial termination of pregnancy (0) and non-birth-related hospitalization [7.5% (4 patients)] in the patients in the antiviral treatment group were markedly lowered than those [9.8% (4 patients), 26.3% (10 patients)] in the liver-protective treatment group (P=0.020, P=0.023). There were no significant differences in the rate of hospitalization due to abnormal liver function between the 2 groups (P=0.061). Of the 53 neonates in the antiviral treatment group, 46 completed the whole course of immunization and no neonate failed; of the 37 neonates in the liver-protective treatment group, 30 completed the whole course of immunization and 3 neonates (10.0%) were HBsAg-positive. The difference in the blocking rates of mother-to-child transmission in the neonates between the 2 groups was statistically significant (P=0.029). ConclusionLamivudine or telbivudine treatment used in active hepatitis B patients during pregnancy is safe and effective for mother and fetus. The treatment could inhibit effectively HBV replication, decrease ALT levels, and reduce the risk of HBV mother-to-child transmission.
  • 药源性疾病

  • 药源性疾病
    SUN Zhen-xiao;YU Xiang-fen
    2012, 14(3): 154-6.
    Abstract ( ) PDF ( )
    Hyperprolactinemia is a common adverse effect of antipsychotic drugs. The clinical presentations of hyperprolactinemia are gynecomastia in men, and breast distending pain, galactorrhea, menstrual disturbance, sexual dysfunction, osteoporosis, and metabolic disturbance in women. The incidence of hyperprolactinemia is 25%-89%. The factors related to antipsychotic-induced hyperprolactinemia are gender, age, the type of antipsychotic drugs and dosage. The mechanism of antipsychotic-induced hyperprolactinemia may be related to blockade of dopamine D2 receptors on the anterior pituitary by antipsychotic drugs and reduction of dopamine inhibitory effect on prolactin secretion of prolactin cells, leading to prolactin elevation. Antipsychotic-induced hyperprolactinemia should be distinguished from hyperprolactinemia due to severe stress, depressive state, pregnancy, hypothyroidism, renal failure, pituitary tumor and ovarian disease. The treatment of antipsychotic-induced hyperprolactinemia includes discontinuing antipsychotic drugs, reducing antipsychotic drugs dosage, switching to a prolactin-sparing agent, prescribing a dopamine receptor agonist or Chinese herbal medicines, and using low-frequency repetitive transcranial magnetic stimulation.
  • 药源性疾病
    LIU Chen;WANG Yu-qin
    2012, 14(3): 160-5.
    Abstract ( ) PDF ( )
    Drug-induced hypertension is one of the common adverse drug reactions. The mechanism of drug-induced hypertension may involve stimulation of sympathetic nervous system activity, sodium and water retention, renin-angiotensin-aldosterone system activation, and changes in function and structure of arterial elasticity. Clinical presentations are increased blood pressure, rebound phenomenon, and even hypertensive crisis. The risk factors for drug-induced hypertension are advanced age, sex, genetic causes, previous history of hypertension, overweight, susceptibity to sodium, and underlying diseases. The drugs known to cause hypertension should be avoided in high-risk patients; if drug treatment is necessary, the treatment should start with a minimum dosage and blood pressure should be monitored during treatment. Once drug-induced hypertension occurs, the drug should be discontinued immediately or the dosage should be reduced, and symptomatic treatment should be given.
  • 中毒救治

  • 中毒救治
    DONG Gao-hong;ZHANG Yan-guo;HAN Yue-dong;HU Xin-hong;WEI Kai-jun
    2012, 14(3): 165-2.
    Abstract ( ) PDF ( )
    A 49-year-old male patient ingested a Chinese herb decoction daily for psoriasis, the decoction contained Sophora tonkinensis root 15 g ( recommended dose 3-6 g/d ) and 11 other herbs. On day 4, he presented with weakness of limbs, anorexia, dysphasia, and decreased memory. On day 11, the decoction was stopped. On day 15, the patient suddenly developed coma, incontinence of feces and urine, and rigidity in extremities. The toxic encephalopathy was considered to be induced by an overdose of Sophora tonkinensis root. An IV injection of high-dose glucocorticoid combined with human immunoglobulin and other symptomatic treatments were given, his neurological symptoms disappeared.
  • 误用滥用

  • 误用滥用
    REN Ai-min;LI Hong;SHEN Shu-feng;LIANG Dong-zhu
    2012, 14(3): 167-2.
    Abstract ( ) PDF ( )
    A 29-year-old female self-administered metformin hydrochloride 500 mg thrice daily to lose weight. About one year later, she developed fever, upper abdominal pain, vomiting, yellowish urine, and clay-like stool. The liver function tests revealed the following levels: alanine aminotransferase(ALT)782 U/L, aspartate aminotransferase(AST)346 U/L, total bilirubin 26 μmol/L, C-reactive protein 23 mg/L. Metformin hydrochloride was withdrawn and liver-protective treatment was given. Fifteen days later, repeat liver function tests showed an ALT level of 65 U/L and an AST level of 50 U/L.
  • 误用滥用
    LI Ying;CHEN Yue-xiang
    2012, 14(3): 168-2.
    Abstract ( ) PDF ( )
    A 60-year-old male patient self-medicated with oral sorafenib 0.2 g twice daily after renal cancer surgery. After two months of treatment, he presented with generalized weakness, scleral jaundice and dark urine. Laboratory tests revealed the following levels: total bilirubin (TBil) 146 μmol/L, direct bilirubin (DBil) 94 μmol/L, alanine aminotransferase (ALT) 959 U/L, aspartate aminotransferase (AST) 1150 U/L and gamma-glutamyltransferase (γ-GT) 507 U/L. Sorafenib was stopped and he was given cytidine disodium triphosphate, reduced glutathione and ademetionine. Twenty-four days later, repeat liver function tests revealed the following levels: TBil 19 μmol/L, DBil 10 μmol/L, ALT 54 U/L, AST 40 U/L, γ-GT 22 U/L.
  • 误用滥用
    LIU Feng-rong;YI Yan-chun
    2012, 14(3): 170-2.
    Abstract ( ) PDF ( )
    A 6-year-old male child with epilepsy had received oral phenytoin sodium, lamotrigine, sodium valproate, and phenobarbital. Because of his irregular use of the drugs, he developed repeated epileptic seizures which progressively worsened. His parents gave him oral oxcarbazepine 300 mg thrice daily themselves and the above-mentioned symptoms did not reappear. However, 40 days later, he experienced unstable walking and torpid response, and his epilepsy symptoms became aggravated. The patient was diagnosed with epilepsy, generalized tonic-clonic seizure, oxcarbazepine-induced disorientation, and ataxia on admission. Oxcarbazepine was stopped, and sodium valproate, reduced glutathione, and vitamin C were given. The next day, his epilepsy symptoms were controlled and, on day 8, his disorientation and ataxia resolved. So he was discharged. He received regularly sodium valproate and clonazepam after discharge and epilepsy seizure, disorientation, and ataxia did not recur at one-month follow-up.
  • 病例报告

  • 病例报告
    LI Si-zhao;ZHAO Yi;YU Nai-chang;LI Xiao-xia
    2012, 14(3): 172-2.
    Abstract ( ) PDF ( )

    An 81-year-old man with aggravated rheumatoid arthritis received subcutaneous injection of recombinant human tumor necrosis factor-α receptorⅡ:IgG Fc fusion protein 25 mg twice weekly and oral methotrexate 10 mg once weekly. Thirteen months later, a painless mass was found in his left submandibular region. The man underwent surgical excision of his mass. Adenolymphoma was confirmed by pathological examination. The recombinant human tumor necrosis factor-α receptorⅡ:IgG Fc fusion protein and methotrexate were discontinued and he had no recurrence of lymphoma at an eight-month follow-up.

  • 病例报告
    QIAN Chong-fu;LIANG Xiao-li;HE Lu-lu
    2012, 14(3): 174-2.
    Abstract ( ) PDF ( )

    A 21-month-old boy with upper respiratory tract infection was given nimesulide granules 50 mg in 2 divided doses at 15-hour intervals. Three hours after taking the first dose, he developed convulsion, pallor and yellowish urine. Fifteen minutes after taking the second dose, he redeveloped convulsion, progressive worsening pallor, strong tea-colored urine. Laboratory tests showed the following levels and values: C-reactive protein 79.0 mg/L, white blood cell count 35.6×109/L, neutrophil count 27.1×109/L, hemoglobin 33.0g/L, platelet count 471×109/L, thrombin time 17.2 seconds,prothrombin time 20.4 seconds, international normalized ratio 1.63 and activated partial thromboplastin time 27.5 seconds, fibrinogen 2.95 g/L. He underwent electrocardiogram monitoring and received oxygen inhalation therapy, an IV infusion of dexamethasone, methylprednisolone and human immunoglobulin, an IV infusion of sodium bicarbonate, and a transfusion of washed red blood cells. The child worsened and presented with coma, twitching limbs, his blood pressure was 131/103 mm Hg and his heart rate was 153 beats/ min. He was treated with plasma exchange, anti-infective therapy, immunosuppressive drugs, hydration, and nutritional support, and then his condition improved. On hospital day 8, repeat routine blood tests showed a white blood cell count of 7.0×109/L, a neutrophil count of 5.3×109/L, a hemoglobin level of 117 g/L, a platelet count of 311×109/L, and a reticulocyte count of 0.02.

  • 病例报告
    SHI Wei-feng;LI Xiao-yu;LIU Gao-lin
    2012, 14(3): 176-2.
    Abstract ( ) PDF ( )

    A 64-year-old male patient received thiamazole (10 mg two times every day orally ) and propranolol (10 mg three times every day orally ) for hyperthyroidism. Five days later, the patient developed skin rash with itching which improved after self-taking loratadine. On day 25, dosages of thiamazole and propranolol were adjusted to 10 mg three times daily and 20 mg three times daily, respectively, and he received hepatoprotective treatment as well. On day 9 after adjusting the dosages, the patient developed intermittent and migratory joint pain and limited joint mobility. On day 11, thiamazole was stopped and meloxicam was given. Two weeks after thiamazole discontinuation, his joint pain significantly improved without limited joint mobility.

  • 病例报告
    GU Sheng-wang;JIANG Zhao-rong
    2012, 14(3): 177-2.
    Abstract ( ) PDF ( )

    A 55-year-old female received an IV infusion of matrine and glucose injection 250 ml once daily for liver cancer and cirrhosis. The next day, she developed watery diarrhea, and matrine and glucose injection was stopped immediately. On day 3, diarrhea disappeared. Two days later, the patient was readministered an IV infusion of matrine and glucose injection 250 ml once daily. On day 3, she presented with severe painless watery diarrhea. Despite receiving garlicin, norfloxacin, compound diphenoxylate, and cefoxitin, her diarrhea did not improve. On day 4, matrine and glucose injection was discontinued. The following day, the patient’s diarrhea resolved.

  • 病例报告
    QU Cai-hong;QIN Feng;SONG Mei-hua
    2012, 14(3): 179-3.
    Abstract ( ) PDF ( )

    A 48-year-old male patient underwent resection of space-occupying lesion in his left tempus because of encephalopyosis with secondary epilepsy. The patient received an IV infusion of monosialotetrahexosylganglioside 40 mg and then an Ⅳ infusion of benzylpenicillin sodium 32 million U (negative skin test) on the first day after operation. About 5 minutes after infusion completion, the patient developed agitation, lip cyanosis, coarse breath sound with audible wheezes in the lungs. His respiratory rate (RR) increased to 30-40 breathes/min, his heart rate (HR) increased to 178 beats/min, his blood pressure decreased to 80-88/48-60 mm Hg, and his blood oxygen saturation was 0.60. The patient immediately received oropharyngeal ventilation tube, sputum aspiration, mask oxygen, tracheal intubation, and assisted breathing by a ventilator, followed by an IV infusion of dopamine 100 mg, metaraminol 40 mg, methylprednisolone 0.5 g, an IV bolus of deslanoside 0.2 mg and dexamethasone 4 mg. Two hours later, his HR and RR decreased to 110 beats/min and 19 breathes/min, respectively, and his blood pressure and blood oxygen saturation increased to 125-135/70-90 mm Hg and 1.00, respectively. His vital signs were stable. The anaphylactic shock was suspected to be associated with benzylpenicillin sodium. On the second day after operation, benzylpenicillin sodium was withdraw and an IV infusion of monosialotetrahexosylganglioside 40 mg in 0.9% sodium chloride solution 100 ml was continued. About 10 minutes later, the patient developed agitation and tachypnea again, his HR increased to 160 beats/min, his blood oxygen saturation decreased to 0.85, and his blood pressure decreased to 77/45 mm Hg. The IV infusion was stopped immediately. Symptomatic treatment such as mechanical ventilation, increasing blood pressure, decreasing HR, anti-anaphylaxis, and anti-inflammatory agents was given. Forty minutes later, his HR and RR decreased to 110 beats/min and 18 breathes/min, respectively, and his blood pressure and blood oxygen saturation increased to 110-145/60-90 mmHg and 0.98, respectively. The patient ’s vital signs were stable.

  • 病例报告
    WU San-lan;CHEN Dong-sheng
    2012, 14(3): 181-2.
    Abstract ( ) PDF ( )

    A 50-year-old man received an intravenous infusion of amiodarone 150 mg via a pump for arrhythmia. About 5 minutes after infusion initiation, the patient developed an electric shock-like lower back pain and pallor. The infusion was stopped immediately and, about 15 minutes after drug discontinuation, his symptoms completely relieved. Ten minutes after remission, an IV infusion of amiodarone via a pump was readministered and, about 3 minutes later, an electric shock-like lower back pain recurred. The infusion was stopped immediately. About 5 minutes later, his back pain vanished entirely.

  • 病例报告
    CHEN Qiu-hong;SHI He-kun
    2012, 14(3): 183-2.
    Abstract ( ) PDF ( )

    A 60-year-old male with fracture received an IV infusion of propylgallate 180 mg in 0.9% sodium chloride 250 ml for prevention of deep vein thrombosis after undergoing surgery. About ten minutes later,the patient abruptly developed chest tightness, dyspnea, pallor, lip cyanosis, and cold peripheral extremities. ECG monitoring revealed a heart rate of 104 beats/min, his blood oxygen saturation was 0.85, and his blood pressure was 80/50 mm Hg. Propylgallate was discontinued immediately. Anti-allergic treatment, blood volume expansion, and mask oxygen were given. Twenty minutes later, his anaphylactic symptoms gradually improved, his blood oxygen saturation increased to 0.96, and his blood pressure increased to 100/58 mm Hg.

  • 病例报告
    SHI Cheng-mei;JIA Dong-lin;LI Zi-jian
    2012, 14(3): 184-3.
    Abstract ( ) PDF ( )

    A 74-year-old female patient received a preventive use of SC nadroparin calcium 6150 U once a day after undergoing right knee joint replacement surgery. Three days after operation, ecchymoses occurred at the location on her right waist and hip joint. The routine blood test showed a platelet count of 49×109/L and a hemoglobin level of 81 g/L. He then received a transfusion of concentrated red blood cells 400 ml. However, the ecchymoses diffused to the opposite waist and back. On day 5 after operation, nadroparin calcium was considered to be related to thrombocytopenia. Subsequently, nadroparin calcium was discontinued. On day 8 after operation, the color of ecchymoses faded and the platelet count was 88×109/L. On day 10, the patient was discharged with a platelet count of 123×109/L.

  • 病例报告
    WANG Li-jun;ZHAN Han-qiu
    2012, 14(3): 186-2.
    Abstract ( ) PDF ( )

    A 39-year-old man with chronic active hepatitis B and type 2 diabetes mellitus received compound glycyrrhizin, glutathione, polyene phosphatidylcholine, coenzyme complex, alprostadil, thymopentin and diammonium glycyrrhizinate, followed by entecavir, acarbose, and bicyclol. He then developed scattered maculopapular involving his entire body, with partial confluence on his chest and abdomen. Drug-induced rash was considered. All drugs were discontinued except entecavir. He was treated with methylprednisolone, calcium gluconate, vitamin C and loratadine, but these were ineffective. He subsequently had a large area of skin rash and worsening edema with blister, erosion, and desquamation. He was diagnosed with toxic epidermal necrolysis associated with entecavir. Entecavir was discontinued immediately and anti-anaphylactic treatment was continued. Ten days after the withdrawal of the entecavir, his skin lesions improved and, twenty days later, his skin eruptions disappeared completely.

  • 中药不良反应

  • 中药不良反应
    LONG Mei-fei;LONG Xiong-chu;ZHAO She-hai
    2012, 14(3): 188-2.
    Abstract ( ) PDF ( )

    A 44-year-old male patient deliberately ingested about 50 tablets of reserpine, and he was brought to the hospital emergency department with vomiting, nausea, dizziness, and asthenia. The patient was treated with an IV infusion of 50 ml of Xuebijing injection in 0.9% sodium chloride 250 ml. About 5 minutes later, the patient suddenly presented with tachypnea, hidrosis, facial flushing, palpitation, chest tightness, and dyspnea. Moreover, his blood pressure was 73/50 mm Hg, his heart rate was 93 beats/min and, his respiratory rate was 22 breaths/min. The infusion was stopped immediately. Hydrocortisone, dexamethasone, and dopamine were given and, in the meantime, he underwent oxygen inhalation and electrocardiogram monitoring. Thirty minutes later, his conditions improved and blood pressure increased to 106/76 mm Hg.