住院药房常见用药差错原因与防范措施分析

目的 减少住院药房用药差错,提高药品调配质量,保证患者用药安全。方法 回顾性分析本院住院药房2013-01~2013-12收集的91例用药差错,归纳分析差错类型和原因,找出容易出错的环节和药品,并制定防范措施。结果与结论 常见的用药差错分成五大类,如：药品发错（45.05%）、数量发错（24.18%）、混淆病区（16.48%）、遗漏差错（13.19%）、质量差错（1.10%）,其中药品发错主要表现为发错药品品种（通常为外观或发音相似的药品）;发错名称相同药品的不同规格、不同厂家、不同剂型等。造成用药差错的主要原因有药品因素、药师因素、流程因素、配送工人因素以及环境因素,可通过科学合理地摆放药品、设计醒目标识、标准化工作流程、改进工作模式、合理调整药房区间布局、加强业务学习、合理排班等措施进行防范,以减少用药差错。     

喜炎平注射液联合小儿豉翘清热颗粒治疗儿童急性上呼吸道感染的临床研究

目的观察喜炎平注射液联合小儿豉翘清热颗粒治疗儿童急性上呼吸道感染的临床疗效和安全性。方法选取2015年3月—2015年4月汉中市中心医院儿科进行治疗的急性上呼吸道感染患儿120例,随机分为对照组和治疗组,每组患儿各60例。对照组给予小儿豉翘清热颗粒,开水冲服,3次/d,饭后服用,不同年龄组用量不同,6个月~1岁患儿:1~2 g/次;1~3岁患儿:2~3 g/次;4~6岁患儿:3~4 g/次;7~9岁患儿:4~5 g/次。治疗组患者采用喜炎平注射液静脉滴注,1次/d,0.2~0.4 m L/kg,小儿豉翘清热颗粒的用法、用量同对照组。两组患儿均连续治疗5 d。观察两组的临床疗效,同时比较两组治疗前后主要症状、体征消失时间以及血清学指标。结果治疗后治疗组和对照组患儿总有效率分别为96.67%、75.00%,两组总有效率比较差异具有统计学意义(P0.05)。治疗组患儿退热时间、腹泻消失时间、呕吐消失时间、咳嗽消失时间、鼻塞消失时间和咽痛消失时间均显著低于对照组患儿,两组比较差异均具有统计学意义(P0.05)。治疗后两组患儿hs-CRP、TNF-α和IL-6较治疗前显著改善,治疗前后比较差异具有统计学意义(P0.05);治疗后治疗组患儿hs-CRP、TNF-α和IL-6较对照组患儿有显著改善,两组比较差异具有统计学意义(P0.05)。两组患儿在治疗期间均未观察到不良反应。结论喜炎平注射液联合小儿豉翘清热颗粒治疗儿童急性上呼吸道感染临床疗效好,起效快,未发现不良反应,具有一定的临床推广应用价值。     

气管-主支气管分支型部分覆膜内支架治疗主支气管内膜结核瘢痕性狭窄随访研究

目的观察气管-主支气管分支型部分覆膜内支架植入治疗主支气管内膜结核瘢痕性狭窄后长期疗效和并发症。方法选择2003年4月至2007年1月郑州大学第一附属医院放射科17例有较完整的随访资料的主支气管内膜结核瘢痕性狭窄放置气管-主支气管分支型部分覆膜内支架患者,17例患者分别在支架取出后第1、6个月行视觉类比测试法(VAS)。其中14例分别于支架取出后第1、6个月门诊行胸部CT和支气管镜复查,电话随访与信访3例。结果17例均一次性植入支架成功并在25～90d内成功取出支架,随访6～50个月,1例患者在支架取出后7d发生再狭窄,经治疗后未再发生呼吸困难,其余患者均未再次出现呼吸困难。支架取出后第1、6个月,17例患者VAS均较术前有明显改善(P<0.05)。结论气管-主支气管分支型部分覆膜内支架植入治疗主支气管内膜结核瘢痕性狭窄,操作成功率高,远期疗效可靠。     

云南省主要感染季节不同阶段人群血吸虫感染情况观察

目的了解云南省血吸虫病重疫区主要感染季节的不同阶段居民血吸虫感染、再感染情况,为制定更具针对性的防治措施提供依据。方法根据农事活动和季节变化将主要感染季节分为前期、中期和后期3个阶段。选择高原峡谷型血吸虫病流行区洱源县的4个自然村作为观察点,将6~60岁居民随机分为Ⅰ、Ⅱ两组,Ⅰ组人群观察主要感染季节前期和后期血吸虫感染、再感染情况;Ⅱ组人群观察主要感染季节中期血吸虫感染、再感染情况。在各阶段开始前10d用吡喹酮治疗,观察期结束后30d查病。同时选择30名学生作为记录员,记录各自家庭成员每天接触疫水的时间。结果在主要感染季节前期、中期和后期居民血吸虫感染率分别为32.17%、12.42%、7.10%,平均每人每天接触疫水时间分别为(82±26)min、(30±14)min和(14±6)min。结论云南省重疫区主要感染季节的前期(栽插期)血吸虫感染率最高,主要与感染性钉螺密度高和居民接触疫水时间长有关。     

Bronchial anomalies in VACTERL association

VACTERL association is an acronym made of associated defects including vertebral anomalies, anal atresia, cardiac, tracheal-esophageal fistula, and renal/radial limb anomalies. Tracheal bronchus is a condition characterized by ectopic location of the right upper lobe bronchus at the mid to distal trachea. This condition is associated with congenital anomalies and has been reported in one previous case of VACTERL. We report another infant with VACTERL presenting with respiratory complications due to presence of tracheal bronchus. She also had a narrowed segment of her right main stem bronchus.     

Dedicated two-stent technique in complex bifurcation percutaneous coronary intervention with use of everolimus-eluting stents: The EES-bifurcation study

Objectives

To compare the outcomes of initial one-stent (1S) versus dedicated two-stent (2S) strategies in complex bifurcation percutaneous coronary intervention (PCI) using everolimus-eluting stents (EES).

Background

PCI of true bifurcation lesions is technically challenging and historically associated with reduced procedural success and increased restenosis. Prior studies comparing initial one-stent (1S) versus dedicated two-stent (2S) strategies using first-generation drug-eluting stents have shown no reduction in ischemic events and more complications with a 2S strategy.

Methods

We performed a retrospective study of 319 consecutive patients undergoing PCI at a single referral center with EES for true bifurcation lesions, defined by involvement of both the main vessel (MV) and side branch (SB). Baseline, procedural characteristics, quantitative coronary angiography and clinical outcomes in-hospital and at one year were compared for patients undergoing 1S (n = 175) and 2S (n = 144) strategies.

Results

Baseline characteristics were well-matched. 2S strategy was associated with greater SB acute gain (0.65 ± 0.41 mm vs. 1.11 ± 0.47 mm, p < 0.0001). In-hospital serious adverse events were similar (9% with 2S vs. 8% with 1S, p = 0.58). At one year, patients treated by 2S strategy had non-significantly lower rates of target vessel revascularization (5.8% vs. 7.4%, p = 0.31), myocardial infarction (7.8% vs. 12.2%, p = 0.31) and major adverse cardiovascular events (16.6% vs. 21.8%, p = 0.21).

Conclusion

In this study of patients undergoing PCI for true coronary bifurcation lesions using EES, 2S strategy was associated with superior SB angiographic outcomes without excess complications or ischemic events at one year.     

Three-year Follow-up of Patients With Bifurcation Lesions Treated With Sirolimus- or Everolimus-eluting Stents: SEAside and CORpal Cooperative Study

Introduction and objectives

To compare the 3-year incidence of major events in patients with bifurcation lesions treated with provisional sirolimus-eluting stents vs everolimus-eluting stents.

Methods

A pooled analysis of 2 prospective randomized trials with similar methodology (SEAside and CORpal) was performed. In these trials, 443 patients with bifurcation lesions were randomly assigned to treatment with either sirolimus-eluting stents or everolimus-eluting stents. The clinical follow-up was extended up to 3 years to assess major adverse cardiovascular events (death or acute myocardial infarction or target vessel revascularization).

Results

At 3 years, survival free of major adverse cardiovascular events was 93.2% vs 91.3% in the everolimus-eluting stent group vs the sirolimus-eluting stent group (P = .16). Exploratory land-mark analysis for late events (occurring after 12 months) showed significantly fewer major adverse cardiovascular events in the everolimus-eluting stent group: 1.4% vs 5.4% in the sirolimus-eluting stent group (P = .02).

Conclusions

Provisional stenting with either sirolimus-eluting stents or everolimus-eluting stents in bifurcation lesions is associated with low rates of major adverse events at 3-years’ follow-up. The results of a subanalysis of events beyond 1 year, showing a lower event rate with everolimus-eluting stents than with sirolimus-eluting stents, suggest that studies exploring the long-term clinical benefit of the latest generation of drug-eluting stents are warranted.     

胎盘生长因子在慢性哮喘大鼠肺组织中的表达

 目的 探讨胎盘生长因子(placenta growth factor,PlGF)在慢性哮喘大鼠肺组织中的表达。方法 45只雄性SD大鼠随机分为3组(每组15只):(1)正常大鼠组(A组):未行特殊干预处理;(2)卵清蛋白(ovalbumin,OVA)致敏及生理盐水吸入大鼠组(B组):应用OVA致敏生理盐水激发;(3)慢性哮喘大鼠组(C组):应用OVA致敏和反复激发制备大鼠慢性哮喘模型。各组大鼠于末次激发后24 h处死。ELISA法测定肺泡灌洗液(BALF)中PlGF水平;大鼠肺组织标本行HE染色、PAS染色及Masson三色染色,并行病理图像形态学测定和分析;免疫组化检测大鼠气道上皮细胞PlGF的表达。结果 慢性哮喘大鼠组(C组)气道上皮细胞PlGF的表达(PI为2.28±0.18)与正常大鼠组(A组)及OVA致敏生理盐水吸入大鼠组(B组),(PI分别为0.89±0.08、0.94±0.12)相比明显增多(A组与C组比较P<0.01,B组与C组比较P<0.01)。慢性哮喘大鼠组(C组)BALF中PlGF水平(18.87±4.53)ng/ml与正常大鼠组(A组)及OVA致敏生理盐水吸入大鼠组(B组),分别为(12.35±1.94)ng/ml、(13.14±2.52)ng/ml相比明显增高(P<0.05)。结论 胎盘生长因子(PlGF)在慢性哮喘大鼠肺组织中表达增多。