抗感染治疗重症急性胰腺炎合并腹腔间隙综合征患者1例的药学分析

本文对1例重症急性胰腺炎合并腹腔间隙综合征患者的抗感染方案进行用药分析。临床药师结合患者临床治疗过程及相关文献,参与制订抗感染治疗方案,实施替考拉宁联合美罗培南的抗感染方案,使得患者症状缓解出院。药师参与重症患者药物治疗方案制定具有积极意义。     

临床药师参与重症肌无力合并支气管哮喘病例的药学实践

1例重症肌无力合并支气管哮喘的中年男性患者,既往肾肿瘤切除病史,临床药师参与患者的药物治疗并对其进行药学监护。因患者哮喘控制欠佳,为重症肌无力一线治疗方案即溴吡斯的明的用药禁忌,且糖皮质激素用药初期可能引发重症肌无力危象,治疗方案需要多重考虑后制定。临床药师通过文献调研,利用药学相关专业知识,协助医师制定治疗方案,筛查用药合理性,对患者进行药学监护及用药依从性宣教。临床药师为医师及患者提供个体化药学服务,促进临床合理用药。     

临床药师对1例重症急性胰腺炎恢复期患者药学监护及分析

目的 通过临床药师对重症急性胰腺炎患者的药学监护,探讨临床药师对于重症胰腺炎患者制订个体化的治疗方案以及进行药学监护的重要性.方法 回顾临床药师在该院重症监护病房（ICU）1例重症急性胰腺炎恢复期患者的治疗过程,参与临床治疗方案的确定,监护患者用药的全过程,针对患者病情变化提出合理化建议.结果 通过临床药师进行临床服务,参与治疗过程,针对以患者的抗感染治疗为主的药物选用提供合理化建议,临床医生及时调整治疗方案,患者病情得以好转.结论 临床药师通过药学监护和用药分析,优化了重症急性胰腺炎患者的治疗方案,保障了患者的用药安全,并提高临床药师的实践水平.     

机械通气联合维库溴铵治疗重症哮喘的观察和护理

目的探讨机械通气联合维库溴铵治疗重症哮喘的观察和护理。方法对20例重症哮喘患者在机械通气联合维库溴铵治疗中的观察和护理进行回顾性分析和总结。结果全部病例在给予机械通气联合使用维库溴铵后,哮喘完全缓解．治疗前后血气主要指标明显改善。结论使用机械通气联用维库溴铵治疗重症哮喘疗效满意。在使用镇静剂、肌松剂期间严密监测血压,及时评估镇静肌松程度,及时、有效的翻身拍背、引流痰液尤为重要。     

临床药师参与3例重症感染病例治疗的经验体会

目的:结合襄阳市第一人民医院临床药师参与感染性病例会诊的情况,探讨临床药师在重症感染性病例药物治疗过程中的经验与教训,促进抗菌药物的合理使用。方法:回顾性分析我院临床药师参与的3例重症感染性病例的药物治疗方案调整过程。结果:临床药师通过干预用药,配合医生为患者提供最佳的用药方案,使患者获得优质的医疗服务。结论:临床药师参与患者药物治疗会诊,将成为医院整体医疗技术工作中不可或缺的一环,临床药学依托患者与临床才能有更广阔的发展空间。     

维库溴铵与顺式阿曲库铵苯磺酸盐在胆囊切除术中的肌松效果对比

目的：比较维库溴铵与顺式阿曲库铵苯磺酸盐（顺式阿曲库铵）在胆囊切除术中的肌松效果。方法选取2011年10月—2014年10月孝义市人民医院收治的胆囊结石患者160例,随机分为维库溴铵组与顺式阿曲库铵组,各80例。维库溴铵组患者静脉注射维库溴铵,顺式阿曲库铵组静脉注射顺式阿曲库铵。观察两组患者肌松药起效时间、临床作用时间、肌肉松弛恢复时间及气管插管等级评估情况。结果顺式阿曲库铵组患者肌松药起效时间及肌肉松弛恢复时间短于维库溴铵组,临床作用时间长于维库溴铵组,差异有统计学意义（ P ﹤0.05）;顺式阿曲库铵组患者气管插管良好率高于维库溴铵组,差异有统计学意义（ P ﹤0.05）。结论顺式阿曲库铵在胆囊切除术中的肌松效果优于维库溴铵,药物起效时间短,作用时间长,气管插管等级评估高,易操作。     

国产、进口罗库溴铵用于全麻诱导气管插管肌松效果比较

目的观察国产和进口罗库溴铵在全麻诱导气管插管期间的起效时间、肌松效果以及对循环系统的影响。方法随机选择ASA I～II级行全身麻醉的择期手术患者80例,分为国产罗库溴铵组(G组)和进口罗库溴铵组(J组),每组各40例。全麻诱导用药为芬太尼4μg.kg-1、异丙酚2 mg.kg-1,待病人入睡后对尺神经作4个成串刺激(TOF)连续监测拇内收肌收缩情况,待TOF第1个肌颤搐反应高度(T1)稳定在100%时两组分别推注国产、进口罗库溴铵0.9 mg.kg-1,当T1=0时开始置入喉镜插管。观察两组肌松药起效时间、肌松效果及用药期间MAP、HR变化。结果平均起效时间G组、J组分别为(83±11)s和(81±10)s,组间比较无显著性差异(P>0.05)。声门暴露情况及气管插管条件两组差别不明显(P>0.05)。肌松药对MAP、HR影响小。结论国产罗库溴铵与进口罗库溴铵比较,肌松效果类似,但性价比较好。     

国产与进口罗库溴铵间断静脉注射的药效学临床比较

目的观察间断多次静脉注射国产罗库溴铵的药效学,并与进口罗库溴铵相比较。方法择期全麻患者50例,ASAⅠ～Ⅱ级随机分为A、B两组（n=25）。记录肌松程度、恢复时间和恢复指数,评价气管插管条件和术中肌松程度。结果两组均可顺利完成气管插管,A组肌松满意度率稍差,B组可获得满意肌松,但B组由于术中肌松程度较A组强（P〈0.05）,术后恢复时间较长。结论麻醉诱导气管插管时罗库溴铵0.6mg.kg-1均可产生满意的插管条件,进口罗库溴铵（爱可松）肌松程度优于国产罗库溴铵,但术后肌松恢复时间较长。     

1例多种可疑药物致重型药疹患者的药学监护

药学监护是临床药师的工作重点之一,本文通过临床药师参与1例重症药疹患者的治疗,体现了临床药师在药物不良反应的判断、治疗及临床合理用药中发挥着重要作用。临床药师通过分析患者的既往用药史,寻找出可疑致敏药物,协助医师优化治疗方案,并对患者实施全程药学监护,患者重症药疹得到良好救治。     

重症肌无力患者的药学监护

目的探讨重症肌无力患者的药学监护方法。方法临床药师参与整个治疗过程,从治疗方案的确定、不良反应处理、患者用药教育等方面展开工作。结果通过药物疗效和不良反应监护,调整治疗方案,患者症状好转,药物不良反应减轻,顺利出院。结论临床药师参与临床治疗团队,充分发挥药学专业技能,有利于提高医疗质量。     

原发胃癌恶性表型与患者自发淋巴细胞微核形成的关系

目的 探讨淋巴细胞微核形成与胃癌恶性度的关系.方法 术前取外周血采用体内微核实验方法检测130例胃癌患者(胃癌组)、13例良性胃肠病变(良性病变组)及59例正常人(对照组)淋巴细胞微核率(MNF).结果 胃癌组淋巴细胞MNF为(1.93±0.93)‰,明显高于良性病变组的(0.62士0.49)‰和对照组的(0.51±0.45)‰(P＜0.01);MNF随着胃癌组分化度降低及淋巴结转移率的增加而逐渐上升(P＜0.01).结论 淋巴细胞微核形成与胃癌恶性度密切相关,为胃癌患者的术前恶性度的判断和高危人群筛查提供了一个有用的生物学标志物.     

Absence of respiratory effects with ivabradine in patients with asthma

AIM

β-Blockers are commonly prescribed for stable angina and are recommended as initial therapy. However, β-blockers are contraindicated in patients with obstructive airway disease because of a risk of bronchoconstriction. Ivabradine is a specific heart rate-lowering agent that acts via I_f pacemaker channels in the sinoatrial node with no β-adrenoreceptor activity. Ivabradine has been recently approved for the treatment of stable angina. This study assessed the effects of repeated administration of ivabradine on lung function in patients with asthma.

METHODS

In this double-blind, placebo-controlled, crossover study, 20 subjects with asthma received either oral ivabradine 10 mg b.i.d. or placebo for 4.5 days. Forced expiratory volume in 1 s (FEV₁) and peak expiratory flow rate (PEFR) were designated as the main outcome variable. Diary cards were used to monitor asthma symptoms on a five-point scale, rescue medication usage, and adverse events.

RESULTS

There were no significant differences in mean variation of FEV₁ (ivabradine P = 0.664; placebo P = 0.652) or PEFR (ivabradine P = 0.153; placebo P = 0.356) from baseline following administration of ivabradine. There was also no significant difference in maximum percent variation in FEV₁ or PEF between treatment groups (P = 0.994; FEV₁ and P = 0.704; PEF). On a similar note, there was no significant difference in asthma symptoms or rescue medication usage reported between the two groups. Adverse events were generally mild-to-moderate in intensity and no cardiovascular or serious adverse events were recorded.

CONCLUSIONS

This study confirms that ivabradine does not affect respiratory function or symptoms in patients with asthma and therefore represents a valuable therapeutic alternative to β-blockers for treating patients with stable angina and asthma.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Ivabradine is a new heart rate-lowering agent that acts specifically on the sinoatrial node via the I_f pacemaker channels.
• Ivabradine has demonstrated similar efficacy to β-blockers.
• As β-blockers are contraindicated in patients with obstructive airway disease, this study was conducted to assess the safety of ivabradine in patients with asthma.

WHAT THIS STUDY ADDS

• This study demonstrates that ivabradine has no effect on the pulmonary functions in patients with asthma and can be safely used a heart rate-lowering agent in patients with angina and coexistent airflow obstruction.

     

Improvement in quality of life with omalizumab in patients with severe allergic asthma

ABSTRACT

Background: Patients with severe persistent asthma experience daily symptoms and frequent serious exacerbations that contribute to a significant impairment of health-related quality of life (QoL).

Methods: A pooled analysis was completed of six controlled clinical trials that evaluated the effect of add-on omalizumab on asthma-related QoL in patients with severe persistent allergic (IgE-mediated) asthma. Asthma-related QoL was assessed at baseline and treatment endpoint using the well-validated Juniper Asthma Quality of Life Questionnaire (AQLQ). Change from baseline in AQLQ total score was compared between treatments using analysis of covariance methods. The percentage of patients who achieved a clinically meaningful (≥ 0.5-point) improvement in AQLQ total score was compared using the Mantel–Haenszel Chi-square test.

Results: The pooled patient population comprised 2548 patients (omalizumab, n = 1342; control, n = 1206), of whom 96% had severe persistent asthma according to the GINA 2002 classification. Omalizumab produced significantly greater improvements in AQLQ total score vs the control group (mean increases of 1.01 and 0.61 points, respectively; p < 0.001). In addition, significantly more omalizumab-treated patients achieved a clinically meaningful improvement in AQLQ total score than patients in the control group (66.3% vs 52.4%; p < 0.001).

Conclusions: Add-on therapy with omalizumab improves QoL to a significant and clinically meaningful level in patients with severe persistent allergic asthma.     

重症胰腺炎血小板计数的动态变化与预后的关系

目的探讨血小板计数变化对重症急性胰腺炎(SAP)并发腹膜后出血、多脏器功能衰竭及死亡率的的影响。方法将该院2009年10月～2011年8月收治的73例SAP患者,按血小板计数的动态变化,分成血小板降低组(100×109.L-1)和血小板正常组(≥100×109.L-1)。分析两组血小板计数动态变化对胰腺炎并发腹膜后出血、多脏器功能衰竭及死亡率的影响。结果血小板计数降低组47例,占64.4%;血小板计数正常组26例,占35.6%。两组在并发腹膜后出血、多脏器功能衰竭发生率及死亡率上均有统计学意义(P0.05)。结论血小板计数动态变化对提示重症胰腺炎的预后有一定的临床指导意义。     

拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染疗效观察

目的观察拉氧头孢联合罗红霉素治疗支气管扩张症继发肺部感染的疗效和不良反应。方法选取38例支气管扩张症继发肺部感染的患者,对比拉氧头孢联合罗红霉素治疗前后的临床情况、炎症指标、肺通气功能参数、细菌学评价,分析其疗效和观察不良反应。结果在全部38例病人中,痊愈18例,显效8例,进步6例,无效6例,总有效率84.2%（32/38）,细菌清除率为82.4%,没有发现严重不良反应。结论拉氧头孢联合罗红霉素可以作为支气管扩张症继发肺部感染的治疗方案之一。