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。     

腹腔镜胆囊切除术围术期继续口服阿司匹林对患者胆囊功能及血栓栓塞风险的影响

摘 要 目的：探讨腹腔镜胆囊切除术患者围术期继续使用阿司匹林对患者胆囊功能及血栓栓塞风险的影响。方法: 100例长期服用阿司匹林的择期腹腔镜胆囊切除术患者随机分为两组。观察组患者继续口服肠溶阿司匹林片,对照组患者于术前7 d停用阿司匹林,术后继续使用。比较两组患者围手术期血栓栓塞发生情况,胆囊功能、凝血功能变化,及术中、术后有关指标的差异。结果:术前1 d,观察组的胆囊体积减小,胆囊收缩率及排空指数均高于术前7 d时（P＜0.05）,且上述指标均显著优于对照组（P＜0.05）。两组治疗后各项凝血功无明显改变（P＞0.05）;两组手术时间、术中出血量、术后引流量、术后住院时间差异无统计学意义（P＞0.05）。观察组患者围手术期血栓栓塞总发生率为2.0%,显著低于对照组（P＜0.05）。结论:腹腔镜下胆囊切除手术,围手术期不停用阿司匹林使用,有利于胆囊体积缩小,促进胆囊排空,降低围手术期血栓栓塞风险,合理使用抗凝药对患者术后凝血功能无明显影响。     

血必净联合支气管肺泡灌洗辅助治疗重症肺部感染

摘 要 目的：观察血必净联合支气管肺泡灌洗辅助治疗重症肺部感染的临床疗效及安全性。方法: 重症肺部感染患者110例按入院单双号分为观察组和对照组各55例。对照组患者在常规治疗基础上给予支气管肺泡灌洗治疗,观察组患者应用血必净联合支气管肺泡灌洗治疗。观察两组疗效和药品不良反应,应用临床肺部感染评分(CPIS) 和急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分评估患者治疗前后肺部感染程度及预后。记录患者治疗或症状改善时间,检测治疗前后降钙素原(PCT)、超敏C反应蛋白（hs-CRP）和肿瘤坏死因子-α( TNF-α)等血清炎症因子水平。结果: 观察组显效率60.00%,高于对照组的43.64%（P＜0.05）。治疗后,两组患者CPIS 和APACHE Ⅱ评分较治疗前明显降低(P＜0.05),且观察组明显低于对照组(P＜0.05);两组血清PCT、hs CRP、TNF α水平均较治疗前显著下降(P＜0.05),且观察组均明显低于对照组(P＜0.05)。观察组机械通气时间、感染控制窗出现时间、呼吸衰竭纠正时间、肺部炎症基本消失时间、应用抗菌药时间均短于对照组(P＜0.05)。两组药品不良反应比较,差异无统计学意义（P＞0.05）。结论:应用血必净联合支气管肺泡灌洗辅助治疗重症肺部感染患者具有较好的临床疗效,预后改善显著,治疗时间缩短,炎症因子水平显著下降,且安全性较好。     

白内障手术患者围手术期抗菌药预防使用合理性评价

摘 要 目的:调查我院白内障手术患者围手术期抗菌药预防使用情况并进行干预,进行目标合理性评价与管理,为促进临床合理用药提供参考。方法：随机抽取我院2012年1～12月行白内障手术患者的200例病例为对照组,实施目标监测后,以2013年1～12月行白内障手术患者的200例为监测组,对两组患者的预防用抗菌药情况进行统计分析。结果：对照组的抗菌药品种选择合理率10.1%,给药时机合理率58.9%,预防用药时间合理率19.0%;监测组的抗菌药品种选择合理率100.0%,给药时机合理率 95.1%,预防用药时间合理率 88.7%,两组比较,监测组各项指标均明显优于对照组（P＜0.05或P<0.01）。监测组的平均住院天数（5.85±1.31）d,平均住院费用为（5 120±147）元,与对照组比较,差异有统计学意义（P＜0.05）,而对照组感染率2.5%,监测组感染率1.5%,两组比较差异无统计学意义（P>0.05）。结论：实施目标监测后明显提高我院白内障患者围手术期预防用抗菌药的合理性,促进我院围手术期用抗菌药更加规范合理,同时降低医疗费用,减轻患者的经济负担。     

血塞通注射液辅助应用对断指再植患者术后血凝指标及血栓并发症的影响

摘 要 目的： 探讨血塞通注射液辅助应用对断指再植患者术后血凝指标及血栓并发症的影响。方法: 2012年3月~2014年3月64例断指再植患者随机分为对照组和观察组各32例,对照组在常规基础治疗上加用低分子肝素,观察组在对照组基础上再加用血塞通注射液。两组疗程均为7 d。比较两组患者临床疗效、断指再植成活时间、手术前后血凝指标水平及血栓并发症发生率等。结果: 对照组和观察组患者临床总有效率分别为68.75%和93.75%,断指再植成活时间分别为（9.44±1.56）d和（6.72±2.28）d;差异均有统计学意义（P<0.05）。观察组患者术后1,4,7 d凝血指标水平均显著优于对照组（P<0.05）,术后血栓并发症发生率也明显低于对照组（P<0.05）。两组药品不良反应发生率比较差异无统计学意义（P>0.05）。结论:血塞通注射液辅助应用于断指再植患者可有效加快再植成活进程,改善术后血凝指标,并有助于降低血栓并发症发生风险。     

临床药师持续干预泌尿外科清洁手术预防用抗菌药合理使用的效果评价

摘 要 目的： 调查某院临床药师实施持续干预前后泌尿外科清洁手术预防用抗菌药（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: 提取我院泌尿外科2010年7月~2014年6月所有行清洁手术患者,根据干预时间和干预措施分别纳入干预前组（n=141）、第1阶段干预组（n=139）、第2阶段干预组（n=162）和第3阶段干预组（n=137）,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34.5%,18.5%和14.6%,预防用药的选药合理率由干预前的36.9%升至58.3%,63.3%和85.0%,预防用药时间由干预前的（138.2±31.6）h缩短至（89.9±48.0）h,（72.8±32.5）h和（45.1±29.5）h,差异均有统计学意义（P<0.01）。感染发生率呈下降趋势,从干预前的2.8%分别降至2.1%,1.8%和1.4%。结论: 临床药师的持续干预措施得力,干预效果显著,明显促进了泌尿外科清洁手术围手术期预防用药合理性。     

舒尔经颗粒联合戊酸雌二醇预防人工流产术后宫腔粘连的疗效观察

摘 要 目的：探讨舒尔经颗粒联合戊酸雌二醇预防人工流产术后宫腔粘连的临床疗效和安全性。方法: 人工流产术患者240例根据入院顺序分为观察组和对照组各120例。对照组患者术后均给予戊酸雌二醇治疗,观察组患者在对照组基础上加用舒尔经颗粒;治疗时间均为3周。观察两组患者治疗后阴道出血时间和出血量,月经复潮等指标及药品不良反应情况;比较两组患者手术前后血清纤连蛋白（FN）、人层黏蛋白（LN）、血管内皮生长因子（VEGF）水平变化;比较两组术后12个月宫腔粘连情况。结果: 观察组阴道出血时间、出血量均显著优于对照组（P<0.05）,术后月经量正常率高于对照组（P<0.05）。术后2周,观察组患者血清FN、LN、VEGF水平均显著低于对照组（P<0.05）;术后12个月,观察组宫腔粘连发生率明显低于对照组（P<0.05）。两组药品不良反应发生率差异无统计学意义（P>0.05）。结论: 舒尔经颗粒联合戊酸雌二醇预防人工流产术后宫腔粘连的疗效优于单用戊酸雌二醇。     

地佐辛联合舒芬太尼用于髋关节置换术后镇痛效果观察

摘 要 目的： 观察地佐辛联合舒芬太尼用于髋关节置换术后镇痛的效果。方法: 60例行髋关节置换术患者随机均分为观察组和对照组各30例。观察组术后采用地佐辛联合舒芬太尼镇痛,对照组术后单用舒芬太尼镇痛。比较两组患者的镇痛效果及药品不良反应。结果: 观察组术后3,6,12,24,48 h的视觉模拟评分（VAS）均低于对照组（P＜0.05）;术后1,3,5 h的MMSE评分均高于对照组（P＜0.05）。观察组总有效率为100.00%,明显高于对照组的70.0%（P＜0.05）。两组不良反应发生率比较,差异有统计学意义（P＜0.05）。结论:地佐辛联合舒芬太尼在髋关节置换术后的镇痛效果显著,不良反应发生率低于单用舒芬太尼镇痛,值得临床推广应用。     

慢性空洞型肺曲霉病围手术期抗真菌药物治疗病例分析

摘 要 目的：对真实的临床病例进行分析，探讨慢性空洞型肺曲霉病（CCPA）围手术期使用抗真菌药物的必要性，为临床治疗提供重要参考。方法：回顾性收集某三甲医院确诊为CCPA并在2011年5月1日～2018年6月30日接受手术患者的病历资料，其中8例围手术期使用抗真菌药物，定义为用药组（A组），26例未使用抗真菌药物，定义为未用药组（B组）。对两组患者术后的临床症状改善情况、血常规变化、并发症发病率、复发率和死亡率进行比较分析。 结果：两组患者术前基本情况差异无统计学意义（P >0.05），但B组患者肺功能好于A组（P<0.05）。术后咯血症状均较术前改善（A组：P<0.05，B组：P<0.01）；两组间临床症状改善情况及血常规变化比较无差异（P>0.05），两组最终结局（并发症发病率、复发率、死亡率）的差异无统计学意义（P>0.05）。 结论：慢性空洞型肺曲霉病患者围手术期间使用抗真菌药物获益不明显。     

“清醒”与静脉麻醉诱导状态光棒引导气管插管运用于困难气道的比较

摘 要 目的：比较“清醒”与静脉麻醉诱导状态光棒引导气管插管运用于困难气道的效果。方法: 将78 例困难气道患者随机分为清醒组和静脉麻醉诱导组,比较两组患者围术期生命体征的变化、气管导管插管时间及术毕气管导管拔管 1 h后咽喉部并发症情况。结果: 与气管插管前相比,静脉麻醉诱导患者插入气管导管后和拔除气管导管前血压、心率均显著上升（P＜0.05或P＜0.01）;与清醒组同阶段相比,差异也有统计学意义（P<0.05或P<0.01）。与静脉麻醉诱导组比较,清醒组患者插入气管导管所用时间明显缩短（P<0.01）,且术后24 h麻醉满意度明显提高（P<0.05）。结论: 与静脉麻醉诱导相比,“清醒”状态光棒引导气管插管运用于困难气道患者更具有优越性。     

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.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.