妊娠合并急性重症胰腺炎患者的药学服务分析

目的:分析妊娠合并急性胰腺炎患者的药学服务,探讨临床药师在药物治疗中的作用。方法:临床药师参与妊娠合并急性胰腺炎患者的药物治疗,与临床医师一起制订用药方案,监护用药过程。结果:临床药师参与急性胰腺炎的治疗方案,关注药物对妊娠的影响,提供药学监护。结论:临床药师参与临床急性胰腺炎的治疗,通过制订用药方案和药学监护,减少了药物对妊娠的影响,保证了胎儿的健康发育。     

1例异位妊娠孕妇伴药物性肝损害临床治疗的药学监护

目的:分析异位妊娠孕妇伴药物性肝损害临床治疗的药学监护。方法:临床药师参与1例异位妊娠孕妇伴有药物性肝损害临床治疗过程,提供个体化用药治疗建议,并进行全过程药学监护。结果:临床药师参与个体化给药方案的制订,监测了药品不良反应,避免药品不良反应对患者造成重大损伤,患者得到了有效治疗。结论:临床药师参与临床治疗过程中,密切关注药物的有效性及安全性,协助制订个体化给药方案,逐渐形成多学科综合治疗的模式,促进临床合理用药。     

1例肺部感染合并深静脉血栓患者的治疗分析与药学服务

目的:探讨临床药师参与深静脉血栓合并肺部感染患者的药学监护工作要点。方法:临床药师参与1例深静脉血栓合并肺部感染患者的治疗,对抗感染治疗方案的制订、抗凝药物剂量调整以及不良反应的处理等方面提出具体意见,为患者制订个体化的给药方案。结果:通过药学监护,临床药师为临床提供了合理用药方案,取得了良好的治疗效果。结论:临床药师与医师、护士共同组成治疗团队,有利于提高临床治疗水平,促进合理用药。     

临床药师在参与癫痫合并肺部感染药物治疗中的作用

目的:通过临床药师对癫痫合并肺部感染患者的药学监护,探讨临床药师如何在临床治疗中发挥作用。方法:介绍临床药师在1例癫痫合并肺部感染患者的治疗过程中,如何监护患者用药全过程,针对患者病情变化与医师共同制订个体化用药方案。结果:在临床药师参与下,临床医师通过调整治疗方案,做到药物治疗个体化,取得了良好效果。结论:临床药师通过药学监护,可避免不良反应的发生,并协同临床优化治疗方案。     

一例头孢哌酮钠舒巴坦钠致粒细胞缺乏症患者的药学监护

头孢哌酮钠舒巴坦钠致粒细胞缺乏症是临床较少见的不良反应。临床药师通过参与一例慢性阻塞性肺疾病急性加重期伴高血压患者应用头孢哌酮钠舒巴坦钠致粒细胞缺乏症的治疗全过程,协助医师为患者制订个体化药物治疗方案,监测患者在治疗过程中出现的药品不良反应,并对不良反应的处理方案提出药学建议,为患者提供了个体化的药学监护。临床药师通过药学监护参与临床治疗,可有效促进临床药物治疗的安全性和有效性。     

1例结核合并隐球菌性肺炎患者的药学监护

目的：探讨临床药师参与结核合并隐球菌肺炎患者治疗的药学监护切入点。方法：临床药师对1例结核合并隐球菌肺炎患者进行密切观察和随访,参与制定个体化的给药方案,监测疗效和药品不良反应,并给患者提供用药教育。结果：临床药师通过给患者提供药学监护,明显提高了药物治疗效果。结论：临床药师为患者进行个体化的药学监护,可协同医师优化药物治疗方案,保障患者用药安全、有效。     

肾内科临床药师参与1例腹膜透析相关性腹膜炎患者的药学监护

目的：探讨临床药师参与抗感染个体化治疗和开展药学监护的方法。方法：通过参与1例腹膜透析相关性腹膜炎患者的药物治疗实践,临床药师参与临床治疗团队,根据患者病情及药敏试验,提供合理性建议;对患者抽搐等不良反应进行药学监护;对患者血液滤过治疗实时调整药物剂量,提供个体化治疗方案。结果：患者腹膜透析相关性腹膜炎得到有效控制,不良反应症状消失,好转出院。结论：临床药师深入临床直接面向患者提供药学服务,在制订个体化治疗方案及药学监护中发挥了重要作用。     

坏疽穿孔性阑尾炎术后患者的药学监护

目的:探讨坏疽穿孔性阑尾炎术后的治疗方案及药学监护内容。方法:以1例妊娠合并坏疽穿孔性阑尾炎患者为例,分析患者治疗方案,为其制订个体化的药学监护方案。结果:通过药学监护,为临床提供了合理用药方案。结论:临床药师参与临床制订用药方案,可以帮助临床解决用药过程中的实际问题,加强患者用药针对性,提高救治成功率。     

1例糖尿病合并妊娠患者降糖药物的选择及药学监护

目的通过参与糖尿病合并妊娠患者降糖的药物治疗实践,探讨临床药师如何参与临床治疗及开展药学监护。方法临床药师参与临床治疗,根据患者的具体病情,提供合理的用药建议,与临床医师共同制定患者的个体化治疗方案,并积极开展全程化药学监护。结果患者糖尿病合并妊娠,口服降糖药由于可能通过胎盘导致胎儿低血糖及可能存在致畸作用,无法被患者选择,综合考虑患者病情、自身胰岛素的分泌特点以及药物作用特点等因素,临床药师建议给予超短效胰岛素类似物门冬胰岛素进行降糖治疗,并在治疗过程中根据患者血糖波动情况调整药物剂量,治疗方案维持6 d后,患者血糖控制平稳,准予出院。结论临床药师深入临床向临床医师和患者提供药学服务,参与制定个体化给药方案,开展药学监护,可避免或减少药源性疾病的发病率及病死率,提高治疗过程中用药的安全性和有效性,切实提高药物治疗水平和医疗质量。     

1 例慢性阻塞性肺疾病急性加重期合并多种老年病患者的药学监 护简

目的探讨,临床药师在治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并多种老年病患者的药学监护。方法参与1例AECOPD合并糖尿病、心功能不全、肾功能损害患者个体化治疗方案的制订,发挥自身药学特长,为患者进行药物选择、调整用法用量、监测药品不良反应及出院用药教育。结果通过对该患者的药学监护,避免了潜在的治疗风险,为临床合理用药提供了意见。结论药师直接深入临床为医生、患者提供药学服务,可有效提高药物治疗水平,避免药品不良反应,提高患者用药的依从性。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.