利用PASS系统对2013年住院医嘱的调查分析

目的利用合理用药监测系统(PASS)对我院住院医嘱的用药情况进行汇总分析,以促进临床合理用药。方法采用PASS系统,回顾、监测我院2013年住院医嘱,并对不同类型的不合理用药结果进行统计、分析。结果在审核的不合理医嘱中,绝对禁忌医嘱占7.48%,较严重警示占55.50%,出现频率最高的不合理用药类型为药物相互作用,占不合理用药总数的43.08%。结论 PASS系统能在一定程度上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系统本身存在一定缺陷,应在使用过程中不断修正完善。     

我院住院药房不合理医嘱干预情况分析

目的:分析总结临床药师对住院患者医嘱的合理用药干预前后情况。方法:通过PASS软件对2012年1—2月(干预前)和2012年3月—2013年2月(干预后)不合理用药医嘱进行统计,分析医嘱中的警示级别、类型及医嘱修改率,并判定PASS审查警告与临床用药的相符性。结果:共监测医嘱1 901 751条,其中黑色警示条数4 512条,修改2 223条,修改率49.27%;红色警示条数188 191条,修改89 238条,修改率47.42%;橙色警示条数128 442条,修改64 190条,修改率49.98%。干预后,各类型不合理医嘱数量有逐渐下降趋势,在PASS系统监测过程中,出现可行性临床医嘱与PASS警告不相符的情况。结论:临床药师通过PASS软件监测并干预医嘱,促使本院临床用药从自律性转变成规范化行为,提高了临床合理用药水平,促进临床医师合理选药及用药。     

利用PASS系统对我院住院用药医嘱的监测与分析

目的:了解医院临床用药医嘱中潜在的不合理用药情况。方法:利用合理用药监测系统(PASS)对我院2009年5-11月共3980例住院患者的163 696条用药医嘱进行监测,并对监测结果进行分析。结果:不合理用药医嘱共有11 148条,不合理用药发生率为6.81%。绝对禁止黑灯医嘱179条,主要为药物配伍禁忌(占30.73%)、药物相互作用(占22.35%)、用药剂量不合理(占18.99%)等。结论:PASS系统能有效监测医嘱中的不合理用药情况,应用PASS系统有利于提高临床合理用药水平。     

合理用药监测系统在我院合理用药中的应用

目的分析合理用药监测系统（PASS系统）对住院用药医嘱同步监测的情况,促进合理用药。方法对2007年9月1日至15日PASS系统同步监测中发现的不合理用药情况进行统计分析。结果监测住院用药医嘱总数283306条,其中黑色和红色警示医嘱120条,经过核实确定的不合理用药情况108例。医生及时修改的不合理用药79例,占不合理用药情况总数的73.15%。结论同步监测可以及时有效地干预不合理用药,保证患者用药安全。     

利用PASS软件对我院临床用药合理性的分析

目的：通过合理用药监测系统（PASS）对临床用药情况进行统计分析,发现并纠正临床用药方案中存在的不合理因素。方法：采用PASS系统对我院2008年10月-2009年10月的临床医嘱进行审查,对不同类型的不合理用药情况进行归纳分析。结果：在审核的不合理医嘱中,严重警示占9.2%,较严重警示占31.9%,出现频率最高的不合理用药类型为药物相互作用,占不合理用药总数的45.3%。结论：PASS系统的使用需要与临床用药的实际情况相结合,临床药师开展药学监护工作,应争取同临床医师共同审核医嘱,才能有效减少不合理用药和药物不良反应的发生。     

医院静脉药物配制中心建立前后医嘱单静脉用药的合理性比较

目的:比较静脉药物配制中心(PIVAS)建立前后医嘱单静脉用药的合理性。方法:选取PIVAS建立前(2013年1—12月)静脉用药长期医嘱单为A组,PIVAS建立后(2015年1—12月)静脉用药长期医嘱单为B组,分析医嘱单用药不合理缺陷的原因,干预临床不合理用药医嘱,促使临床合理用药。结果:A组有117 381组(每瓶输液为1组)医嘱存在用药不合理现象占20.67%;B组有45 147组占8.06%,药师分析后事前做了干预,纠正率由25.05%提高到94.78%。结论:PIVAS药师在医嘱未执行前对其审核,并采取多种干预方式干预,有效制止了不合理用药现象,促进临床合理用药。     

合理用药监测系统对促进临床安全用药的意义讨论

目的研究分析采用合理用药监测系统对于临床安全用药的监测情况。方法选择合理用药监测系统对我院从2011年9月至2012年9月的临床用药医嘱进行监测,同时对监测信息进行分类统计分析。结果总共查询出问题医嘱1563943条,按照警示级别,黑色警示占3.2%,红色警示占11.9%,橙色警示占30.2%,黄色警示54.7%。结论合理用药监测系统是药师进行药学信息服务的重要助手和辅助工具,在应用合理用药监测系统之后能够有效减少临床不合理用药现象,值得广泛推广。     

利用PASS-PC评价我院临床药物治疗的合理性

目的:监测临床用药医嘱,评价用药合理性。方法:利用《合理用药监测系统》(PASS)单机版——《药学服务支持系统》(PASS-PC),对我院2009-2010年疑难病历及典型处方用药医嘱进行监测,对不合理用药医嘱及时分析并与临床医师沟通,结合患者病情共同商讨合理化给药方案。结果:共监测用药医嘱4777条,其中警示医嘱2541条,占53.19%,显示临床用药不合理情况较多,以药物不良相互作用、禁忌证、特殊人群用药等问题较突出。结论:药师利用PASS-PC能更好地开展临床药学工作,降低药源性疾病的发生,为临床合理用药提供有力支持。     

324例老年住院患者用药情况调查与分析

目的调查分析医院老年住院患者合理用药情况。方法应用合理用药监测(PASS)系统提取2013年11月医院65岁及以上老年住院患者的医嘱,对其用药情况进行回顾性监测、统计、分析。结果PASS系统共检出监测医嘱14660条,其中提示不合理用药的医嘱1866条,占所有医嘱的12.73%,包括绝对禁止医嘱0.64%、高度警惕医嘱7.93%、一般警示医嘱4.15%。结论该院临床用药基本合理,但医疗机构应加强对老年人用药的关注,提高合理用药水平,减少药品不良反应。     

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.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.