Background: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use ...Background: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic andneurotoxic adverse events have been reported to occur. Observations: A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years’duration. Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30%lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity. The results of laboratory studies confirmed serum lidocaine levels within the toxic range. We postulate that the combination of the high concentration of topical lidocaine required to achieve sufficient anesthesia, together with the laser induced disruption in epidermal barrier function,may have been responsible for this phenomenon. Conclusions: Application of a 30%topical lidocaine gel to a limited area in conjunction with fractional photothermolysis may generate serum lidocaine levels high enough to elicit systemic toxicity. Laser surgeons should be alert to this phenomenon, particularly in patientswith underlying hepatic, endocrine, cardiac, or central nervous system/ psychiatric dysfunction; in patients with a low body mass index; and in patients who are taking medications that may interfere with hepatic lidocaine metabolism.展开更多
目的:探讨耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者环丝氨酸相关性药物不良反应(adverse drug reactions,ADRs)的发生情况及其临床特点,为临床MDR-TB患者环丝氨酸的用药安全提供参考。方法:选取2018年1月1日—2021...目的:探讨耐多药结核病(multidrug-resistant tuberculosis,MDR-TB)患者环丝氨酸相关性药物不良反应(adverse drug reactions,ADRs)的发生情况及其临床特点,为临床MDR-TB患者环丝氨酸的用药安全提供参考。方法:选取2018年1月1日—2021年12月31日苏州市第五人民医院收治的182例MDR-TB患者作为研究对象,采集患者的年龄、性别、职业、结核病类型、治疗结局、环丝氨酸的使用情况及其相关ADRs的发生情况等信息,着重分析MDR-TB患者环丝氨酸相关性ADRs的发生情况和临床特点。结果:182例MDR-TB患者排除失访、死亡和未使用环丝氨酸的患者后仅剩167例,其中治疗成功的有134例,治疗成功率为80.24%;167例患者中,发生ADRs的有10例,发生率为5.99%;诺氏评估量表显示,10例ADRs与环丝氨酸的关联性评分均为5~8分,即关联性为“很可能”;10例ADRs的发生时间为用药后的4~361 d(中位数值为67.5 d),而其临床表现均为中枢神经毒性症状(如自杀倾向、精神错乱、重度失眠、焦虑、抑郁、嗜睡等);通过停用环丝氨酸或加大维生素B6用药量,10例患者的中枢神经毒性症状均缓解或消失。结论:含环丝氨酸抗结核治疗方案对MDR-TB患者的疗效较好,同时环丝氨酸相关性中枢神经毒性症状的发生率相对较低,但其症状表现较为严重,因此临床在对患者开展用药宣教时应交代明确,以保障患者的用药安全。展开更多
近年来,由于不合理的使用各种广谱抗生素,产生了多种耐药性菌群,致使肺炎后脓胸发生率有上升趋势。因此,胸膜腔积脓或局限性脓胸再度成为临床较常见的疾病。我科自1987年7月至1992年3月,采用 B 超引导胸穿、低压灌洗、负压排脓技术,对2...近年来,由于不合理的使用各种广谱抗生素,产生了多种耐药性菌群,致使肺炎后脓胸发生率有上升趋势。因此,胸膜腔积脓或局限性脓胸再度成为临床较常见的疾病。我科自1987年7月至1992年3月,采用 B 超引导胸穿、低压灌洗、负压排脓技术,对26例肺炎后脓胸患者治疗取得较好疗效,现报告如下:临床资料(一)患者男25例,女1例,年龄13～75(平均45)岁,均有近期不同病程的肺炎病史。入院前在当地医院治疗,其毒性症状不缓解或减轻后又加重。展开更多
文摘Background: Topical anesthetics, unlike injectable anesthetics, can be applied painlessly and can provide sufficient pain control to maintain patient comfort throughout a variety of laser procedures. Although the use of topical lidocaine is considered relatively safe, instances of cardiotoxic andneurotoxic adverse events have been reported to occur. Observations: A 52-year-old woman underwent fractional photothermolysis for management of severe hypopigmentation and scarring of several years’duration. Shortly after termination of treatment to her face and neck, which required prolonged exposure to a 30%lidocaine gel compound both before and during surgery, she developed clinical signs and symptoms consistent with systemic lidocaine toxicity. The results of laboratory studies confirmed serum lidocaine levels within the toxic range. We postulate that the combination of the high concentration of topical lidocaine required to achieve sufficient anesthesia, together with the laser induced disruption in epidermal barrier function,may have been responsible for this phenomenon. Conclusions: Application of a 30%topical lidocaine gel to a limited area in conjunction with fractional photothermolysis may generate serum lidocaine levels high enough to elicit systemic toxicity. Laser surgeons should be alert to this phenomenon, particularly in patientswith underlying hepatic, endocrine, cardiac, or central nervous system/ psychiatric dysfunction; in patients with a low body mass index; and in patients who are taking medications that may interfere with hepatic lidocaine metabolism.
文摘近年来,由于不合理的使用各种广谱抗生素,产生了多种耐药性菌群,致使肺炎后脓胸发生率有上升趋势。因此,胸膜腔积脓或局限性脓胸再度成为临床较常见的疾病。我科自1987年7月至1992年3月,采用 B 超引导胸穿、低压灌洗、负压排脓技术,对26例肺炎后脓胸患者治疗取得较好疗效,现报告如下:临床资料(一)患者男25例,女1例,年龄13～75(平均45)岁,均有近期不同病程的肺炎病史。入院前在当地医院治疗,其毒性症状不缓解或减轻后又加重。
