目的:了解安徽省内二级以上医院治疗药物监测工作开展现状,进一步丰富全国调研数据,为国内血药浓度监测和药物基因检测工作开展提供参考.方法:发放网络问卷,调研省内二级以上医院2019年和2021年治疗药物监测工作数据,比较分析开展品种和数量、检验方法、质量控制情况;采用Excel软件回收有效数据并进行双人核验.结果:两轮调研共纳入有效问卷118份.2021年,共有42所医院开展血药浓度监测,其中25所同时开展药物基因型检测(与2019年相比,分别新增11所和9所).2021年,开展血药浓度监测品种53个,累计检测151 185例次(同比增幅53.3％),主要包括精神类药物、免疫抑制剂和抗菌药物;开展化学药物用药指导基因检测21项,累计检测位点80 998个(同比增幅121.0％),主要以氯吡格雷、华法林、阿司匹林等心血管类药物为主.血药浓度监测方法以免疫法和色谱法为主,药物基因型检测方法主要包括荧光原位杂交、基因芯片法和荧光定量PCR技术.88.1％(37/42)的医院开展治疗药物监测质量控制,其中室内质量控制开展率为38.1％(16/42)、室内质量控制质控/室间质量评价联合开展率为28.6％(12/42);仅有18.9％(7/37)建立westgard多规则质控图.结论:安徽省二级以上医院治疗药物监测工作发展迅速.但规范性、质控管理同质化有待改进.

目的:调查老年脊柱手术患者术后谵妄发生情况,并分析其相关影响因素.方法:选取2018年7月～2021年5月我院收治的老年脊柱手术患者296例,统计其术后谵妄发生率,根据患者术后是否发生谵妄分为谵妄组和无谵妄组,采用单因素及多因素Logistic回归分析术后谵妄相关影响因素.结果:296例老年脊柱手术患者中有31例发生术后谵妄,术后谵妄发生率为10.47％.老年脊柱手术患者术后谵妄与手术时间、术前血红蛋白(Hb)水平、年龄、脑卒中病史、术中低氧血症、麻醉方式、手术部位、术前焦虑、苏醒时间、慢阻肺病史、术中低血压有关(P＜0.05).多因素Logistic回归分析结果显示:年龄≥70岁、手术时间≥120min、术前Hb＜100g/L、有慢阻肺病史、手术部位为颈椎、有术前焦虑、苏醒时间≥60 min、有术中低氧血症是老年脊柱手术患者术后发生谵妄的危险因素(P＜0.05).结论:老年脊柱手术患者术后谵妄发生率较高,且受手术时间、年龄、术前Hb水平等多种因素影响,临床应结合相关因素制定针对性干预措施,以减少此类患者术后谵妄的发生几率.

目的 采用全自动二维液相色谱(2D-LC-UV)法快速测定甲氨蝶呤的血药浓度.方法 采用10％三氟乙酸去蛋白剂对样本进行前处理后取上清液直接进样,待测物在一维柱Aston SC2(C18,4.6 mm×25 mm,5μm)上初步分离,通过中间柱Aston SN(苯基柱,4.6 mm×10 mm,5μm)截取保留,最后转移到二维色谱柱Aston SX1(氰基柱,4.6 mm×75 mm,5μm)上进一步分离、测定.一维流动相为甲醇-乙腈-10 mmol·L-1磷酸铵水溶液=1:1:10(V/V/V),流速0.6 mL·min-1;二维流动相为水(含1.0 mmol·L-1磷酸氢二铵水溶液,磷酸调pH至7.40)-水(含1.0 mmol·L-1磷酸氢二铵水溶液,磷酸调pH至3.00)-甲醇-乙腈(16:60:10:14)的混合体系,流速1.0 mL·min-1,柱温40℃;紫外检测波长304 nm.使用本方法监测2019年10月—2020年12月期间使用甲氨蝶呤治疗的48份样本的甲氨蝶呤血药浓度.结果 甲氨蝶呤可在10 min内完整出峰且无杂质干扰,在0.05～12.8μmol·L-1与峰面积线性关系良好(r=0.9997),方法学考察均符合要求.检测的48份甲氨蝶呤血药浓度样本中72.9％(35/48)的样本在标准曲线范围内,10.4％(5/48)的样本因使用剂量低未检出,另有16.7％(8/48)的样本使用大剂量甲氨蝶呤后血药浓度超出正常值上限.结论 本方法操作简单,灵敏度、专属性高,稳定性好,能够满足甲氨蝶呤用药后药物浓度监测及解救的需要.

目的 探讨对老年患者给予右美托咪定复合丙泊酚实施辅助全麻后对其术后恶心呕吐及麻醉复苏产生的影响.方法 选取2018年1月-2020年12月收治的80例老年气管插管全身麻醉患者进行麻醉研究.依据随机数字表法分为参照组(n=40,采用右美托咪定复合丙泊酚麻醉)以及研究组(n=40,采用丙泊酚麻醉);比较两组患者麻醉结果.结果 研究组手术时间(77.63±5.29)min、麻醉时间(98.22±5.28)min、睁眼时间(7.23±1.25)min以及拔管时间(7.53±2.02)min均短于参照组,差异有统计学意义(t=10.170、8.776、10.687、10.327,P＜0.05);T2-T7时,研究组MAP水平以及HR水平均低于参照组,差异有统计学意义(P＜0.05);研究组心动过缓、术后呕吐、恶心、低血压并发症发生率均低于参照组,差异有统计学意义(x2=4.507、7.314、4.507、7.314,P＜0.05);研究组躁动评分低于参照组,差异有统计学意义(P＜0.05).结论 右美托咪定复合丙泊酚辅助全麻方式有效运用,可有效缩短老年患者手术时间、麻醉时间、睁眼时间以及拔管时间,显著降低血流动力学指标,并且术后恶心呕吐等并发症出现减少,改善麻醉复苏情况,促进老年气管插管全身麻醉患者总体预后水平提高.

目的:探索自建色谱法血药浓度监测靶值的建立;对比色谱法和免疫法在血药浓度测定的水平差异.方法:选择安徽医科大学第一附属医院硫唑嘌呤代谢物和卡马西平血药浓度监测分别作为实验室自建色谱法和不同测定方法的项目代表.回顾性分析硫唑嘌呤代谢物部分质控数据,以即刻质控法初步建立室内靶值,Westgard多规则质控对该项目开展常规质控;43例卡马西平样本分别由实验室HPLC和全自动生化分析仪以及第三方医学实验室,通过相关和回归分析评价检验方法一致性.结果:硫唑嘌呤代谢物项目在第16次质控监测提示告警,第17次失控记录也证实其存在异常离群.常规检测过程中累积失控2次即22s及13s记录各1次.三水平质控品累积变异系数分别为8.85％、7.46％和4.73％.3组卡马西平血药浓度测定数据均为非正态分布,其中实验室免疫法测定质量浓度结果最高(中位数为6.00μg·mL-1),第三方实验室测定结果次之(中位数为5.50 μg·mL-1),而实验室色谱法测定结果最小(中位数为3.80 μg·mL-1).第三方实验室与实验室免疫法、第三方实验室与实验室色谱法以及实验室色谱法与免疫法其3组方法比较的秩相关系数分别为0.984、0.975和0.956,Pass-ing-Bablok回归方程分别为:y=0.298+0.817x,y=-0.246+1.539x,y=-1.009+1.947x.结果表明,以上测定方法的一致性较好.结论:即刻质控法可用于自建色谱法血药浓度监测的简易室内质控程序.色谱法和免疫法在卡马西平血药浓度测定中存在基线水平差异.

Background: We investigated the effect of propofol on activities and tumor-killing ability of natural killer (NK) cells in patients with colon cancer. Material/Methods: Twenty colon cancer patients and 20 healthy subjects were included. Peripheral blood (5 ml) was collected from all patients and healthy subjects. NK cells in peripheral blood were separated by negative screening using immunomagnetic beads. Flow cytometry was used to determine expression of activated receptors, inhibitory receptors, killing effector molecules, and proliferation-associated markers on NK cell surfaces. After in vitro treatment with propofol for 24 h, expression of activated receptors, inhibitory receptors, killing effector molecules, and proliferation-associated markers on NK cell surfaces was examined again. In addition, the tumor-killing effect of NK cells was studied by co-culture with K562 cells or colon cancer SW620 cells at a ratio of 1: 1. Results: The number of NK cells in peripheral blood from colon cancer patients was increased compared with healthy subjects, but activities and proliferation ability of the NK cells were decreased. The tumor-killing effect of NK cells isolated from colon cancer patients was decreased. Of note, propofol promoted activation of NK cells from colon cancer patients. In addition, propofol increased expression of tumor-killing effector molecules by NK cells and the proliferation ability of NK cells. Propofol also enhanced the killing effect of NK cells on colon cancer cells. Conclusions: The present study demonstrates that propofol promotes the activity and tumor-killing ability of NK cells in peripheral blood of patients with colon cancer.

Objective To investigate the effect of dexmedetomidine on agitation after etomidate-remifentanil anesthesiabefore end of surgery.MethodsChose 100 patients who under general anesthesia laparoscopic operation, ASA I~II, randomly divided them into dexmedetomidine group(group D, 50 cases) and control group(group C, 50 cases), routine anesthesia induction, after tracheal intubation, breath control, maintenance of anesthesia: etomidate target controlled effect compartment (Arden Model) concentration of 0.3μg/ml, remifentanil 0.20~0.4μg/(kg·min) continuous infusion, vecuronium to maintain muscle relaxation. Operation before the end of 30 min after intravenous analgesia pump. Two groups of patients in operation before the end of the 10min stop drug input, using intravenous injection pump intravenous injection of physiological saline (group C) and dexmedetomidine 0.5μ g/kg, injection time of 10min. Compared with two groups of awakening, extubation time, extubation agitation of patients with HR, to observe the change of situation; SBP, DBP, RR. Analysis of data using SPSS 13 statistical softwar.ResultsSedation and agitation conditions compared with T0 group, Ramsay score decreased at T2, T4, T5 in group C(P<0.05); group D, T2, T4~T6 Ramsay score increased significantly (P<0.01), and higher than that of group C (P<0.01). Group D agitation score was significantly lower than group C (P<0.01).ConclusionIntravenous dexmedetomidine 0.5μg/kg before end of surgery can significantly reduce agitation etomidate intravenous anesthesia recovery period, stable hemodynamics without extending extubation time.

Objective To investigate the feasibility and safety of etomidate emulsion by TCI(target controlled infusion) during TIVA(total intravenous anesthesia) in gynecological laparoscopic surgery.Methods General anesthesia patients with 100 cases,ASAⅠ~Ⅱ,undergoing selective gynecological laparoscopic surgery were randomly divided into Etomidate group(E,n=50) and Propofol group(P,n=50).Anesthesia induction: The patients in group E were given TCI etomidate emulsion at an EC of 0.6 μg/mL,as those in group P etomidate emulsion 0.3mg/kg,and the rest of the drugs were in the same.Anesthesia maintenance : Remifentanil and Vecuronium were combined in both groups with the same dose,while the EC of etomidate in group E was reduced to 0.3μg/mL,and group P were set with Propofol 4～8mg/(kg h) as the controls.During perioperative period,the circulation maintained steady,with BIS index at 40～60,and intravenous analgesia was used 30 minutes before the operation was over.Observe and record cardiovascular response,BIS index changes and anesthesia recovery condition before anesthesia,after induction,5min and 30min after incising,and at operation end.Results The stable hemodynamics in both groups can be maintained during operation,but the fluctuation was significantly lower in group E than that in group P(P<0.05);Recovery time after operation of group P was shorter than that of group E(P<0.05).Conclusion Etomidate emulsions is more suitable for patients with less cardiovascular effects during the maintenance of general anesthesia than Propofol;However,the postoperative agitation incidence is higher comparatively,which shold be given nough attention.

目的观察异丙酚和七氟醚分别与瑞芬太尼复合麻醉应用于腹腔镜胆囊切除术的麻醉效果。方法ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术的病人50例,随机分为异丙酚复合瑞芬太尼组(P组)和七氟醚复合瑞芬太尼组(S组),每组25例。分别记录两组麻醉过程各时点的平均动脉压(MAP)和心率(HR)及苏醒各时段时间、术后24 h恶心呕吐(PONV)发生率。结果在T3、T4、T5时点P组的MAP较低,HR较慢,差异有显著性(P<0.05);两组病人术后苏醒时间差异无显著性(P>0.05);术后PONV发生率P组低于S组,差异有显著性(P<0.05)。结论异丙酚复合瑞芬太尼和七氟醚复合瑞芬太尼麻醉均可维持术中血流动力学稳定,术后苏醒迅速完全,而前者与后者相比,PONV发生率低。