某院持续干预围术期预防用抗菌药合理应用的效果评价

摘 要 目的:调查某院实施持续干预前后清洁手术和介入术预防用抗菌药（简称“预防用药”）的应用情况,为临床合理预防用药提供参考。方法: 随机抽取2011年1季度～2012年3季度行甲状腺手术、腹股沟疝修补术、乳腺手术、骨折内固定装置取出术、冠状动脉造影术患者,根据干预时间和干预措施分别纳入干预前组（n=208）、第1阶段干预组（n=176）、第2阶段干预组（n=449）和第3阶段干预组（n=341）,对各组患者的预防用药情况进行统计分析。结果:实施持续干预后,第1阶段干预组、第2阶段干预组和第3阶段干预组的预防用药率由干预前的100%降至49.4%,16.2%和9.1%,预防用药的选药合理率由干预前的46.2%升至62.1%,72.6%和96.8%,预防用药时间由干预前的（5.7±2.5）d缩短至（2.5±1.8）d,（2.0±1.4）d和（1.8±1.0）d,差异均具有统计学意义（P<0.01）。感染发生率从干预前的2.4%分别降至1.7%,1.3%和0.9%。结论:该院持续干预措施得力,干预效果显著,明显促进了围术期预防用药合理性。     

HPLC法测定姜黄素-槲皮素复方自微乳的载药量和包封率

摘 要 目的：建立HPLC法测定姜黄素 槲皮素复方自微乳（CUR-QUE-SMEDDS）的载药量和包封率。方法: 采用离心法分离游离药物,HPLC法测定药物含量。色谱柱：Purospher STAR LP C18 柱（250 mm×4.6 mm,5 μm）,流动相：乙腈 4%冰醋酸（50∶50）,流速：1.0 ml·min^-1,检测波长：370 nm,柱温：30℃,进样量：10 μl。结果: 姜黄素和槲皮素的线性范围分别为10.728~96.552 μg·mL^-1（r=0.999 8）和1.08~9.72 μg·mL^-1（r=0.999 9）,平均回收率分别为99.98%（RSD=1.46%,n=9）和100.34%（RSD=1.06%,n=9）。CUR QUE SMEDDS中姜黄素和槲皮素的包封率分别为（95.97±0.50）% 和（95.91±2.52）%,载药量分别为（25.82±0.15）mg·g^-1和（1.80±0.05）mg·g^-1。结论:该法准确可靠,快速简便,适用于测定CUR-QUE-SMEDDS的载药量和包封率。     

十一酸睾酮二元醇质体凝胶剂体内外透皮特性研究

摘 要 目的：对十一酸睾酮（TU）二元醇质体凝胶进行体内外透皮考察。方法: 采用注入法制备TU二元醇质体,以卡波姆941为凝胶基质,制备TU二元醇质体凝胶剂;以小鼠皮肤为屏障,采用Franz扩散池法对其体外透皮特性进行考察;以大鼠为实验动物,背部给予TU二元醇质体凝胶剂后,于设定的时间点测定血浆中TU浓度,计算药动学参数,并与TU二元醇质体进行比较。结果: TU二元醇质体及其凝胶的体外累积透皮百分率Q与时间t均符合一级动力学模型,线性方程分别为：Q=8.68t+6.78（r=0.998 2）和Q=6.09t+3.09（r=0.999 3）,稳态透皮速率分别为8.68 μg·cm^-2·h^-1和6.09 μg·cm^-2·h^-1,24 h后TU在皮肤中的滞留量分别为（208.80±55.26）μg·g^-1和（225.60±38.90）μg·g^-1;大鼠体内TU二元醇质体及其凝胶的主要药动学参数分别为：Cmax（18.50±2.75）mg·L^-1和（20.80±2.42）mg·L^-1;tmax（6.20±0.14）h和（9.54±0.52）h;AUC0-48h（336.74±2.05）h和（486.30±1.68）h。结论:TU二元醇质体及其凝胶均呈现较好的体内外透皮特性,且在缓释性上凝胶剂表现更优。     

服用氯吡格雷或替格瑞洛患者的血小板最大聚集率差异研究

摘 要 目的：研究经皮冠脉介入术（PCI）后服用氯吡格雷的患者与服用替格瑞洛的患者血小板最大聚集率（MAR）的差异和出血情况,为临床使用抗血小板药物提供参考。方法: 选取因急性冠状动脉综合征(ACS)入院行PCI后服用氯吡格雷或者替格瑞洛的患者,在出院前对其MAR值进行检测,随访3个月内出血事件的发生情况,并比较两组患者MAR值以及随访结果的差异。结果: 服用氯吡格雷的患者出院时MAR为（51.1±13.7）%（n=76）,服用替格瑞洛的患者MAR为（32.6±15.7）%（n=76）,两组差异有统计学意义（P<0.001）。随访结果显示氯吡格雷组出血事件低于替格瑞洛组（P<0.05）。结论: 服用替格瑞洛的患者出院后出血的倾向可能比服用氯吡格雷的患者更大。     

FOCUS-PDCA循环法干预对Ⅰ类切口预防使用抗菌药物影响的回顾性分析

摘 要 目的：以医院等级评审为契机,探讨某院Ⅰ类切口围手术期预防用药的管理方法,提高抗菌药物的应用合理性。方法：利用FOCUS PDCA循环法对Ⅰ类切口抗菌药物的预防使用进行干预,选取该院2015年1～12月全部Ⅰ类切口患者出院病例进行回顾性分析,根据干预进程分为4个阶段,对每一阶段的抗菌药物应用指标进行比较,评价围术期抗菌药物的合理使用改进效果。结果：与干预前比较,干预第三阶段的Ⅰ类切口预防用药比例从62.90%降至28.32%,术前给药时机合理率从50.1%升至71.0%,品种选择合理率由53.5%提高至79.5%,预防用药疗程合理率从26.8%上升至56.3%,差异均有统计学意义（P<0.01）,而干预前后手术部位感染率无明显差异（P>0.05）。多项指标的好转促进了该院等级评审相关条款评分结果的提升。结论：医院等级评审中利用FOCUS PDCA循环法规范Ⅰ类切口围术期抗菌药物预防使用效果显著。     

有限采样法估算中国肾移植受者霉酚酸体内暴露

摘 要 目的：建立中国肾移植受者霉酚酸（MPA）有限采样法模型,预测采用不同免疫抑制方案的肾移植受者MPA的体内暴露。方法: 首次肾移植术后早期受者108例,根据术后免疫抑制维持方案分为：环孢素(CsA)+ 霉酚酸钠肠溶片(EC MPS)组（n=49）,他克莫司(TAC)+吗替麦考酚酯(MMF)组（n=32）以及TAC+EC MPS组（n=27）。术后14 d在服药前（0 h）及服药后0.5,1,1.5,2,4,6,8,10,12 h采血,应用液相串联质谱法（LC MS/MS）测定MPA血浆浓度。应用多元回归分析建立MPA 0～12 h浓度曲线下面积（AUC 0 12 h）的估算模型。选择相关系数高、临床应用方便的模型应用Bootstrap法及Bland Altman法对其准确性进行验证。结果: 3种免疫抑制方案MPA的AUC0 12存在差异。应用CsA+EC MPS的患者MPA AUC0 12为（54.66±26.86） ng·ml-1·h,显著低于TAC+EC MPS及TAC+MMF组（P<0.01）。经验证,CsA+ EC MPS组较为理想的回归模型为1.32×C1+ 0.54×C1.5+1.25×C2+3.21×C4+12.53,r2=0.75;TAC+ MMF组为1.54×C0.5+2.26×C2+6.60× C4-2.57,r2=0.96;TAC+ EC MPS组为1.21×C1+0.43×C1.5+1.16×C2+4.8×C4+19.32,r2=0.89。结论: MMF或EC MPS在与CsA或TAC联用会存在不同的药动学特征,应当应用不同的有限采样法MPA AUC0 12估算公式,更为合理的评估MPA药物暴露。     

顶空气相色谱法测定盐酸厄洛替尼中有机溶剂残留量

摘 要 目的：建立顶空毛细管气相色谱法测定盐酸厄洛替尼中有机溶剂残留量的方法。方法: 采用顶空毛细管气相色谱法,色谱柱为DB 624毛细管柱（30 m×0.53 mm,3.0 μm）,载气为氮气,流速为2.0 ml·min^-1,进样口温度为190 ℃,FID检测器温度为230 ℃,采用程序升温：初始温度为35 ℃,保持8 min,以28 ℃·min^-1升温至170 ℃,保持8 min,再以32 ℃·min^-1升温至200 ℃,保持7 min。顶空瓶平衡温度为100 ℃,时间30 min。结果: 乙醇、异丙醇、二氯甲烷、正丁醇分别在0.68~409.14 μg·mL^-1（r=0.999 8）、0.67~404.88 μg·mL^-1（r=0.999 8）、1.71~51.31 μg·mL^-1（r=0.999 7）、0.72~431.12 μg·mL^-1（r=0.999 8）浓度范围内线性关系良好,平均回收率分别为99.0%（RSD=0.41%,n=9）、100.2%（RSD=0.52%,n=9）、97.1%（RSD=1.75%,n=9）、102.5%（RSD=1.08%,n=9）。结论:该方法简便、准确性好,适用于盐酸厄洛替尼中4种有机溶剂残留量的测定。     

HPLC法测定α-倒捻子素在小鼠体内的组织分布

摘 要 目的： 建立高效液相色谱法测定小鼠组织样品中α-倒捻子素的含量,研究其在小鼠体内的分布特征。方法: 小鼠尾静脉注射α-倒捻子素注射液,不同时间点采集组织样品,采用高效液相色谱法测定其组织分布变化。结果: 不同组织中α-倒捻子素在0.10～10.00 μg·ml^-1 (r≥0.99)范围内线性良好,低、中、高浓度的提取回收率分别为(74.65±2.76)%,(75.97±2.16)%,(79.83±2.30)% (n=5);相对回收率分别为(101.38±2.02)%,(101.82±2.77)%,(100.55±2.29)% (n=5)。α-倒捻子素在肺中分布最多,其次为脾、心、肾、肝,在脑组织中分布相对较低,给药2 h后脂肪组织中药物浓度显著性增加。结论:α-倒捻子素在小鼠多个脏器中均有分布,能透过血脑屏障,并且在周边室具有较强的组织亲和力。     

小儿至宝丸中朱砂和雄黄的含量测定

摘 要 目的： 建立小儿至宝丸中朱砂和雄黄的含量测定方法。方法: 分别采用原子吸收分光光度法（AAS）和电感耦合等离子体发射光谱法（ICP-AES）测定小儿至宝丸朱砂中的汞和雄黄中的砷含量。结果: AAS法测定的汞的线性范围为5～100 μg·mL^-1（r=0.999 9）,砷的线性范围为2～50 μg·mL^-1（r=0.999 2）,汞的平均回收率为99.3%,RSD为3.0%（n=6）,砷的平均回收率为104.5%,RSD为2.1%（n=6）;ICP AES法测定的汞的线性范围为0.1～20.0 μg·mL^-1（r=0.999 97）,砷的线性范围为0.1～20.0 μg·mL^-1（r=0.999 99）,汞的平均回收率为96.6%,RSD为1.4%（n=6）,砷的平均回收率为104.1%,RSD为1.1%（n=6）。结论:本文建立的方法准确、专属性强,可用于控制小儿至宝丸中毒性成分的含量。     

PDCA循环干预Ⅰ类切口手术围手术期预防使用抗菌药效果分析

摘 要 目的：评价PDCA循环干预某院Ⅰ类切口手术围手术期预防使用抗菌药的效果。方法: 采用回顾性分析方法,随机抽取某院PDCA循环干预前（2015年1~6月）、第一轮PDCA循环干预后（2016年1~6月）,第二轮PDCA循环干预后（2017年1~6月）各600例行Ⅰ类切口手术患者的出院病历,比较分析围手术期抗菌药的预防使用情况。结果: 第二轮PDCA循环干预后,该院Ⅰ类切口手术围手术期抗菌药预防使用率由80.1%降至24.5%（P＜0.05）,药物选择、用药时长、用药时机、用法用量的不合理率均较PDCA循环干预前明显下降（P＜0.05）,人均抗菌药费用、抗菌药占药品费用、抗菌药占住院费用比例明显下降(P＜0.05)。结论: PDCA循环干预能有效地促进Ⅰ类切口手术围手术期预防用抗菌药合理使用。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。