Background: Midazolam and acetaminophen are often co-administered in anesthesia practice. Both are metabolized by CYP 3A4 enzyme in the liver, and hence compete for the enzyme sites. This might lead to reduced metabol...Background: Midazolam and acetaminophen are often co-administered in anesthesia practice. Both are metabolized by CYP 3A4 enzyme in the liver, and hence compete for the enzyme sites. This might lead to reduced metabolic breakdown and enhanced pharmacodynamic effects of midazolam in the presence of acetaminophen. Methods: The present study was undertaken to test this hypothesis. After IRB approval from Mount Sinai Medical Center, 15 healthy volunteers were used for 2 tests. For the first test, they were randomly assigned to receive oral doses of either midazolam 0.3 mg/kg in cherry syrup (Protocol A), or midazolam 0.3 mg/kg plus cherry flavored acetaminophen 15 mg/kg (Protocol B). At set intervals from 0 to 480 min, the blood levels of midazolam and the subjects pulse rate, mean arterial pressure, respiratory rate, BIS index, and OAA/S scores were determined. After 2 weeks, the same subjects underwent the second test;they received the other medication protocol. Results: Acetaminophen slightly, but not significantly, increased the half life of blood midazolam, and the depressive effects of midazolam on the clinical signs of the subjects. Conclusion: These results lead us to conclude that there is no need to reduce the doses of midazolam when used in combination with acetaminophen.展开更多
文摘Background: Midazolam and acetaminophen are often co-administered in anesthesia practice. Both are metabolized by CYP 3A4 enzyme in the liver, and hence compete for the enzyme sites. This might lead to reduced metabolic breakdown and enhanced pharmacodynamic effects of midazolam in the presence of acetaminophen. Methods: The present study was undertaken to test this hypothesis. After IRB approval from Mount Sinai Medical Center, 15 healthy volunteers were used for 2 tests. For the first test, they were randomly assigned to receive oral doses of either midazolam 0.3 mg/kg in cherry syrup (Protocol A), or midazolam 0.3 mg/kg plus cherry flavored acetaminophen 15 mg/kg (Protocol B). At set intervals from 0 to 480 min, the blood levels of midazolam and the subjects pulse rate, mean arterial pressure, respiratory rate, BIS index, and OAA/S scores were determined. After 2 weeks, the same subjects underwent the second test;they received the other medication protocol. Results: Acetaminophen slightly, but not significantly, increased the half life of blood midazolam, and the depressive effects of midazolam on the clinical signs of the subjects. Conclusion: These results lead us to conclude that there is no need to reduce the doses of midazolam when used in combination with acetaminophen.
文摘目的探讨三七通舒胶囊联合阿魏酸钠治疗急性缺血性脑血管病的疗效观察。方法选取2015年1月—2016年1月在四川省八一康复中心治疗的急性缺血性脑血管病患者96例,随机分为对照组和治疗组,每组各48例。对照组静脉输注注射用阿魏酸钠,0.3 g加入到5%葡萄糖溶液250 m L中,1次/d。治疗组在对照组基础上口服三七通舒胶囊,1粒/次,3次/d。两组患者均治疗28 d。观察两组的临床疗效,比较两组的血液流变学指标、血管内皮功能、炎症因子、美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数(BI)评分的情况。结果治疗后,对照组和治疗组的总有效率分别为79.17%、93.86%,两组比较差异有统计学意义(P<0.05)。治疗后,两组血浆黏度、全血黏度、血细胞比容(HCT)和红细胞聚集指数(RF)均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的下降程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组内皮素-1(ET-1)、白细胞介素-6(IL-6)、血栓素B2(TXB2)和肿瘤坏死因子-α(TNF-α)水平均显著下降,而一氧化氮(NO)水平显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组胰岛素样生长因子(IGF)均显著上升,而基质金属蛋白酶-9(MMP-9)均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组NIHSS评分均显著降低,而BI评分均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论三七通舒胶囊联合阿魏酸钠治疗急性缺血性脑血管病具有较好的临床疗效,能显著改善患者的血液流变学和血管内皮功能,降低NIHSS评分和炎症因子水平,提高BI评分,具有一定的临床推广应用价值。
