静脉使用血管活性药物的护理安全问题及对策

目的 探讨提高静脉使用血管活性药物安全性的护理对策.方法 采用根本原因分析法回顾分析我科2011年1月至2011年6月期间160例静脉使用血管活性药物患者用药情况.结果 本组患者静脉使用血管活性药物共发生不良事件27例,护士因素17例(63%),患者因素10例(37%),其中以用药速度控制不良最常见.结论 通过提高血管活性药物用药知识,加强输液巡视,做好患者及家属的用药宣教,正确选择静脉穿刺,应用用药提示标识等措施可以减少使用血管活性药物不良事件的发生,提高用药安全,降低护理风险,保障患者生命安全.     

珠海地区246例药品不良事件报告分析

目的:了解珠海地区药品不良事件的发生情况、特征及影响因素。方法:收集2007年1～9月该地区上报的246例药品不良事件,并作统计分析。结果:246例药品不良事件中,涉及品种最多为抗感染药(43.24%),与其品种繁多、使用频率高、应用范围广有关;发生药品不良事件的主要给药途径为静脉给药(78.05%);药品不良事件最常累及皮肤及其附件(41.12%);119例(48.37%)存在不按说明书用药,其中113例涉及抗感染药。结论:医务工作者应加强药物知识的学习,注意药物使用各环节的安全。     

43例刺五加注射液不良事件影响因素分析

目的:分析我院刺五加注射液不良事件影响因素,促进临床安全用药。方法:对我院2012年1月-2015年1月上报的43例刺五加注射液不良事件报告进行回顾性研究,分析患者性别、年龄、不良事件史、不良事件发生时间、临床表现、超说明书使用率和超说明书用药类型。结果:43例不良事件报告中,男女比例为0.95∶1;40~60(不含60)岁年龄段患者最多,占46.51%;既往有不良事件史者1例(2.33%);30 min以内发生不良事件36例(83.72%);不良事件主要为皮肤及附件损害,共32例(28.83%),其次为全身性损害,共24例(21.62%);超说明书用药类型主要表现为超单次剂量和超适应证,各占81.40%和13.95%;严重的不良事件10例(23.26%),其中30%为超适应证用药,80%为超单次剂量用药。结论:超说明书用药是导致我院刺五加注射液不良事件的主要影响因素,临床药师应加强刺五加注射液的医嘱审核,督促临床医师严格按照说明书用药,保障患者用药安全。     

3869人次静脉输液不良事件的相关性分析

目的:了解输液相关不良事件与药物配伍因素之间的相关性,促进临床安全用药。方法:采用随机分层抽样方法,采集各级医疗机构中接受输液治疗的患者情况,集中监测不良事件发生情况,并采用Excel建立数据库,采用SPSS15.0对数据进行统计学分析。结果:共纳入来自天津市30家医院的患者3 869人次,收集输液相关不良事件301例次。药物配伍合理组(非暴露组)与药物配伍不合理组(暴露组)比较,不良反应及不良事件发生率有统计学差异(P<0.01)。常见的不良反应及不良事件为变态反应、心血管系统、输液反应及消化系统损害。结论:提高药物配伍合理性,有利于减少输液相关不良事件的发生。     

抗菌药物致甲状腺疾病手术患者不良事件的临床评价

目的:探讨甲状腺疾病手术患者围手术期抗菌药物的不良反应与合理应用。方法:采用随机数字表法,选取沈阳市某三级甲等医院的甲状腺疾病手术住院患者400例,提取病历中抗菌药物的应用信息,并设计《抗菌药物应用不良事件调查表》,对包括围手术期患者基本情况、抗菌药物使用情况、不良事件发生情况进行统计、分析。结果:抗菌药物不良事件发生率为26.16%,以头孢菌素类药物(29.94%)为主,临床表现以消化道系统不良事件比例最高(30.26%)。结论:甲状腺疾病围手术期抗菌药物使用的不良事件问题严重,主要由头孢菌素类抗菌药物引起。因此需加强对头孢菌素类抗菌药物的监管,关注患者用药后的变化,促进抗菌药物的合理使用。     

高龄ST段抬高急性心肌梗死患者急诊介入治疗分析

目的评价急诊经皮冠状动脉介入治疗(PCI)对高龄ST段抬高急性心肌梗死患者的治疗效果与安全性。方法选择急诊PCI的高龄急性心肌梗死患者64例为PCI组,并选择同期采取药物保守治疗的65例高龄急性心肌梗死患者作为对照组,评价两组患者手术成功率、病死率、相关并发症及随访期间心脏不良事件发生情况。结果 PCI组介入成功率为98.4%(63/64)、出血等并发症10.9%(7/64)、院内外死亡率1.6%(1/64)、经随访表明主要心脏不良事件12.5%(8/64)。药物治疗组介入成功率为95.4%(62/65),院内外死亡率为12.3%(8/65),经随访主要心脏不良事件16.9%(11/65)。两组院内外死亡率比较,差异有统计学意义(P<0.01),而心脏不良事件比较,差异无统计学意义(P>0.05)。结论高龄患者急性心肌梗死急诊介入治疗成功率高,比药物治疗的并发症少、存活率高,并发症处理及时,能够很好地控制病情。     

ICU护士药品管理与合理使用的集束化干预研究

目的:分析ICU护士药品管理与护理使用的集束化干预.方法:将2018年1月-2018年12月间在我院接受药物治疗的100例作为对照组,将2019年1月-2019年12月间在我院接受药物治疗的100例作为实验组,并接受集束化干预,分析这两组的ICU药物管理与使用不良事件发生率.结果:对比两组的ICU药物管理与使用不良事件发生率,实验组的ICU药物管理与使用不良事件发生例数有3例,发生率为3％;对照组的ICU药物管理与使用不良事件发生例数有10例,发生率为10％,结果对比差异显著(P<0.05),具有统计学意义.结论:在ICU护士药品管理与合理使用中应用集束化干预,能够有效降低ICU护士在药物管理与使用中的不良事件发生率,确保患者的用药安全.     

复方脑肽节苷脂注射液30000例上市后临床安全性医院集中监测分析

目的:监测分析复方脑肽节苷脂注射液上市后应用于30 000例患者的临床安全性。方法:采用前瞻性、非对照的临床研究设计方法，选取2020年4月至2021年4月全国不同区域的46家二级甲等以上医院中至少接受1次复方脑肽节苷脂注射液治疗的30 000例患者作为监测对象，通过监测其临床基本资料、用药信息以及药物不良反应等评价复方脑肽节苷脂注射液的安全性。结果:30 000例复方脑肽节苷脂注射液治疗期间不良事件发生率为8.85%(2 655/30 000),其中105例(0.35%)不良事件经研究判断为药物不良反应，其中轻度79例(0.263%)、中度26例(0.087%),未见重度不良反应。不同疾病患者药物不良反应发生率分别为：老年性痴呆患者1.250%、创伤性周围神经损伤患者0.906%、其他诊断患者0.360%、缺血性脑卒中患者0.333%、出血性脑卒中患者0.307%、颅脑损伤患者0.266%、脊髓损伤患者0.198%。药物不良反应类型主要集中在胃肠系统疾病、皮肤及皮下组织类疾病，分别为36、24例。不同医院等级、有无其他药物食物过敏史、是否首次使用、是否存在不合理用药的患者药物不良反应...     

临床药师对不合理用药事件的药学干预效果及其对治疗满意度的影响

目的:评价临床药师对不合理用药事件的药学干预效果及其对治疗满意度的影响。方法:选取2016年4月—2018年10月期间收治的临床药物治疗患者200例资料,按照临床药师干预情况的不同将其分为观察组和对照组(每组100例);观察组患者给予临床药师药学干预,对照组患者给予常规用药指导,比较两组患者不同方法干预用药后的不良事件发生率和患者对治疗的满意度的差异。结果:观察组患者干预后不良事件发生率为0.00%低于对照组为4.00%(P<0.05)以及患者对治疗的满意度为97.00%高于对照组为90.00%(P<0.05)。结论:临床药师干预有利于减少患者的用药不良事件,提高其满意度。     

我院2015年药品不良事件调查分析

目的:详细了解我院药品不良事件的相关因素,为临床合理用药提供依据.方法:网罗2015年60例药品不良事件报告,从给药途径、用药类型和不良症状等方面分析其发生情况.结论:药品不良事件的发生与患者年龄、药物种类(如抗生素、中药大针剂易发生)、给药途径、给药部位等多种因素相关,合理用药是消除不良事件的关键.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.