Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.@*METHODS@#In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.@*RESULTS@#In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).@*CONCLUSION@#In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02542748; https://clinicaltrials.gov/ct2/show/record/NCT02542748.

Effect of Addition and Subtraction Adjuvant Therapy of Bufeitang on Immune Inflammation After Tracheotomy in Stroke Patients with Syndrome of Deficiency of Spleen and Lung Qi / 中国实验方剂学杂志

Objective:To discuss the efficacy of addition and subtraction adjuvant therapy of Bufei decoction for pulmonary infection after tracheotomy in stroke patients (syndrome of deficiency of spleen and lung Qi) and investigate its effect on immune inflammation. Method:One hundred patients were randomly divided into control group (50 cases) and observation group (50 cases) by random number table. The patients in both groups got cefepime hydrochloride for injection, once every 12 hours, 2 g/time， at the same time, symptomatic and supportive comprehensive treatment was given. Patients in control group additionally got compound glycyrrhiza oral solution via gastric tube, 10 mL/time, 3 times/day. Patients in observation group got addition and subtraction adjuvant therapy of Bufeitang every morning and night via gastric tube, 1 dose/day. The treatment course was 14 days in both groups. At the 1st, 7th and 14th day after treatment, scores of clinical pulmonary infection scale (CPIS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) were graded. The time to control pulmonary infection and the antibiotics use time were recorded. Before and after treatment, levels of T lymphocyte subsets (CD3+, CD4+，CD8+ and CD4+/CD8+), regulatory T cells of (Treg cells), immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M(IgM), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-1β, IL-6 and IL-10 were detected, and safety was evaluated. Result:At the 7th and 14th day after treatment, scores of CPIS and APACHE Ⅱ in observation group were lower than those in control group (P<0.01). The time to control pulmonary infection and antibiotics use time were shorter than those in control group (P<0.01). Levels of Treg cells, CD4+ and CD4+/CD8+ were higher than those in control group (P<0.05). Levels of CD8+, PCT, TNF-α, IL-1β, IL-6 and IL-10 were lower than that in control group (P<0.01), while levels of IgA and IgM were higher than those in control group (P<0.01). There was no adverse reaction related to Bufeitang. Conclusion:Based on comprehensive treatment of western medicine for anti-infection and symptomatic support, addition and subtraction adjuvant therapy of Bufeitang can effectively control the severity of pulmonary infection caused by tracheotomy in stroke, reduce coughing and expectoration, shorten the course of pulmonary infection and the use time of antibiotics, regulate immune function and inhibit inflammatory reaction.

Current clinical application of ambroxol hydrochloride injection and consideration on the rational drug use / 中国药学杂志

OBJECTIVE: To evaluate the current clinical application of ambroxol hydrochloride injection and promote its rational use. METHODS: Based on the Hospital Prescription Analysis Cooperation Project, 160-day prescription data about ambroxol hydrochloride injection from 2010 to 2013 was sampled randomly from the database of 82 general hospitals in six cities including Beijing, Shanghai, Guangzhou, Hangzhou, Chengdu, and Tianjin. According to the drug instruction, relevant guidelines, expert consensus, and literature, the clinical use of ambroxol hydrochloride injection was analyzed. RESULTS: Within the scope of sampling time, there were 2.67 million prescriptions of ambroxol hydrochloride injection, and 14.01 million ampoules(15 mg per ampoule) were used clinically. According to the percentage of prescription complying with the drug instruction, the six cities were ranked in descending order as follows: Hangzhou(28.03%) > Chengdu(26.25%) > Shanghai(14.66%) > Guangzhou(9.38%) > Beijing(7.72%) > Tianjin(3.98%). However, various off-label uses were found in administration route, dosage, and indications. CONCLUSION: Off-label use of ambroxol hydrochloride injection is common in clinic, which needs to be paid great attention to and to be standardized.