Résumé
Objective To analyze the distribution characteristics of vancomycin blood concentration in children with severe pneumonia complicated with congenital heart disease( CHD) and children with simple severe pneumonia after using the same dose vancomycin,and observe the clinical efficacy at the same time. Methods Plasma concentrations in pediatric patients with severe pneumonia complicated with CHD ( CHD group) who treated by vancomycin from November 2012 to September 2013 in Shengjing Hospital of China Medical University were collected. Plasma concentrations of children with simple severe pneumonia( control group) treated by vancomycin were also collected at the same period. The blood concentration values and therapeutic effects of the two groups were recorded into the database for statistical analysis. Peak,trough con-centrations and efficacy were analyzed by receiver operating characteristic(ROC) curve. Results Twenty-five children with CHD were collected,the average peak concentration was (28. 39 ± 6. 68) mg/L,the aver-age trough concentration was (13. 34 ± 6. 62)mg/L. Control group were also 25 cases,the average peak con-centration was (16. 23 ± 2. 50) mg/L and the average trough concentration was (2. 77 ± 1. 01) mg/L. Both peak and trough concentrations of CHD children were significantly higher than those of the control group (tpeak =8. 52,Ppeak <0. 05;ttrough =7. 89,Ptrough <0. 05). In the ROC of peak,trough concentrations and effica-cy,area under the curve were 0. 74(95％CI 0. 547-0. 935,P=0. 01) and 0. 77(95％CI 0. 605-0. 935,P=0. 004) respectively,and the difference was statistically significant. Conclusion Plasma concentrations of vancomycin in children with CHD are generally higher,it is necessery to monitor plasma concentration even under regular doses,to make the application of vancomycin more safe and effective in children with CHD. There is a correlation between plasma concentration of vancomycin and clinical efficacy in children,the high-er the blood concentration,the more likely the clinical efficacy is to be effective.
Résumé
OBJECTIVE:To study the compatible stability of Ceftriaxone Sodium with Compound Sodium Chloride Injection or Sodium Lactate Ringer's Injection and study the compatible stability of the simulated in vivo peak concentration of ceftriaxone sodium with instant high concentration of calcium gluconate ion injection. METHODS: The concentration of Ceftriaxone Sodium in the mixture was determined by HPLC,meanwhile,the changes of the mixture in appearance,pH value,and the insoluble particles at room temperature were observed. RESULTS: At 0～2 hours,the mixture of Ceftriaxone Sodium and Compound Sodium Chloride Injection was clear in appearance;however,at 2 hours,it was white cloudy macroscopically,and its pH valued increased,ceftriaxone sodium content decreased and insoluble particles increased. The ceftriaxone sodium content reduced when mixed with sodium lactate ringer's injection. After mixing of simulated in vivo peak concentration of ceftriaxone sodium with instant high concentration of calcium gluconate ion injection,the appearance of the mixture was stable but the concentration of Ceftriaxone Sodium reduced slightly. CONCLUSION: Ceftriaxone Sodium can't be used in combination with Compound Sodium Chloride Injection or Sodium Lactate Ringer's Injection. Whether it is suitable to infuse calcium gluconate when ceftriaxone sodium (iv gtt) reached peak concentration remains to be confirmed in future study.
Résumé
OBJECTIVES:The estimation of infarct size has been important in evaluation of prognosis of the patients who had acute myocardial infarction. The infarct size estimated by the thallium-201 SPECT has been known to correlate with the prognosis of patient. The enzymatic estimation by the total release of creatine kinase isoenzyme MB(CK-MB) has been widely used in estimating infarct size clinically, but inconvienent and not cardiospecific. Recently, serum troponin T, cardiospecific myofibrillar protein, has been used in the diagnosis of acute myocardial infarction, and used in the estimation of reperfusion following myocardial infarction. To assess the role of the late troponin T peak concentration on the estimation of infarct size, this prospective study was carried out. METHODS: The patients with acute myocardial infarction who were admitted, within 48hours after the onset of chest pain, to Ajou University Hospital between April 1995 and August 1995 were evaluated. All patients were divided into anterior and inferior infarct and checked serum troponin T and CK-MB serially, and underwent stress Thallium-201 SPECT 1 week after infarction, In each group, we assessed the correlation of the late toponin T peak concentration, the total release of CK-MB, and the infarct size estimated by thallium-201 single photon emission computed tomography(SPECT). RESULTS: 1) The eligible subjects consisted of 22 patients (17 men and 5 women), and age ranged from 29 to 77 years(mean 57.8 +/- 12.5 years). 2) The mean arrival time to the hospital after the onset of chest pain was 15.5 +/- 13.2 hours. The 19 patients had at least one risk factor for coronaryartery disease. 3) The late troponin T peak concentration and the total release of CK-MB in patients with anterior infarction were not different from those with inferior infarction. The infarct size estimated by the thallium-201 SPECT in patients with anterior infarction was larger than patients with inferior infarction The left ventricular ejection fraction in anterio infarction was lower than inferior infarction. 4) The late troponin T peak concentration ha: positive correlation with the infarct size estimated by the thallium-201 SPECT in the total patients, and both patients with anterior infarction and inferio infarction. 5) The total release of CK-MB correlated with the infarct size estimated by the thallium-20 SPECT in the total patients, and the patients of inferior infarction. CONCLUSION: The late troponin T peak concentration was more accurate than the total release o CK-MB in the estimation of infarct size. Therefore, when the patient arrived to the hospital less than 48hr after the onset of chest pain, the late troponin T peak concentration is useful in the decision and evaluation of therapeutic intervention and in the prediction of prognosis.