目的:建立一种可简便、快速测定人血样中氯氮平浓度的反相高效液相色谱(HPLC)方法.方法:以2-氨基-5-氯-2'-氟二苯甲酮为内标,用正戊烷萃取经0.1 moL/L氢氧化钠碱化后的人血浆样品.以HPLC法进样分析,色谱柱为SB-C18(150 mm×4.6 mm,5μm),流动相为甲醇-水(67:33),每300 mL水中加入2 mL四甲基乙二胺与1.6 mL冰乙酸,流速为0.8 mL/min,柱温为40℃,检测波长为254 nm,进样量为20μL.结果:氯氮平血药浓度在50.0～1200.0 ng/mL之间时,其标准曲线线性方程为Y=0.00207485X-0.0141837,线性关系良好(相关系数r=0.99978),检测限为10.0 ng/mL;其低、中、高浓度(100.0 ng/mL、400.0 ng/mL、800.0 ng/mL)的回收率、稳定性及精密度均符合方法学要求.结论:本实验建立的HPLC法可有效测定患者血浆氯氮平的浓度,具有操作方便、成本低廉、专属性强、精密度高等特点,可满足临床进行治疗药物监测(TDM)和药动学研究的要求,具有显著的实用价值.

目的 探讨高压氧治疗(HBOT)烟雾病(MMD)患者的疗效及安全性因素.方法 回顾性分析南京紫金医院2020 年1 月—2021 年12 月收治的26 例MMD患者的临床资料,分析指标主要包括年龄、发病时长、血压、HBOT次数及压力、原发病情况、手术方式、入院及出院意识状态、肢体功能及有无不良脑血管病事件等.结果 入组患者平均年龄(45.2±15.2)岁,大多在发病 1 个月内来院治疗;大部分患者入院时血压波动于正常范围,少数患者血压有波动,经治疗后稳定;26 例患者中,13 例为缺血型 MMD,13 例为出血型MMD;26 例患者中,21 例行高压氧治疗 20～60 次,60 次以上者 5 例;高压氧治疗压力以 1.6 ATA或 1.6/2.0 ATA为主.治疗过程及治疗结束未见再出血及再次梗塞等脑血管事件发生.26 例患者中,21 例明显好转,4 例好转,1 例无变化.结论 儿童及成人缺血型、出血型MMD患者均可行高压氧治疗,尤其在行颅内外血运重建术及血肿清除术等手术后,高压氧治疗过程中未见再出血、再梗塞等不良脑血管病事件,提示安全性较高.在高压氧治疗前及过程中须控制患者的血压、颅内压等情况,可给予不同压力治疗方案.

Objective:To explore the predictive value of China Nanjing persistent vegetative state scale (CNPVSS) on the curative effect of the patients with chronic disorder of consciousness, by analyzing the curative effect of the rehabilitation treatment combined with hyperbaric oxygen (HBO) for patients with chronic disorder of consciousness.Methods:A total of 48 patients with chronic disorder of consciousness admitted to Nanjing Zijin Hospital to receive rehabilitation treatment combined with HBO from the September of 2016 to the May of 2019 were selected according with the analytical criteria. Before the treatment, the patients were evaluated by CNPVSS and received electroencephalogram (EEG) and evoked potentials (EPs) examinations. The patients′ consciousness was evaluated again before discharge, the results of CNPVSS and electrophysiological examinations were recorded, and the correlation between the results and the changes of the consciousness was analyzed statistically.Results:The results of CNPVSS was positive correlated with near-term curative effect ( r=0.401, P=0.005); the rate of awakening after treatment was 46.2% among those who were scored as minimally conscious state (MCS) by CNPVSS; the rate of awakening after treatment was 17.1% among those who were at vegetative state (VS) or in a coma; the rate of awakening after treatment of the MCS patients was higher than those of the patients at VS or in a coma ( χ2=4.255, P=0.039). The recordings of right somatosensory evoked potentials (SSEPs) N20 was positive correlated with curative effect ( r=0.312, P=0.031); and the left visual evoked potentials (VEPs) V100 was positive correlated with curative effect ( r=0.285, P=0.049). There were no statistical significance found between other electrophysiological recordings with curative effect. Conclusion:CNPVSS can be an important tool to predict the outcome of the rehabilitation treatment combined with HBO for the patients with chronic disorder of consciousness, and the recordings of SSEPs and VEPs also are of a certain reference value in predicting the prognosis.