夫西地酸钠与奥硝唑注射液存在配伍禁忌

目前，临床上使用的新药很多，很多新药的不良反应、配伍禁忌等信息在药物说明书中未说明，临床使用过程中，常因对新药了解不全面或使用不当而出现一些配伍变化和临床反应。我科在临床应用中发现夫西地酸钠与奥硝唑存在配伍禁忌，现报道如下。     

ABO血型非同型血小板输注

血小板输注作为包括血液病在内的多种内、外科疾病的重要支持疗法,其安全性与有效性一直受到广泛关注.ABO血型非同型血小板输注在紧急情况下难以避免,关于其利弊的争论已持续半个多世纪,且至今尚无关于ABO血型非同型血小板输注的统一意见.笔者拟就ABO血型非同型血小板输注存在的风险与降低风险的可行性措施等进行综述.     

儿科静脉药物配伍禁忌及粉针剂稀释所需溶媒量

[摘要]目的：通过阅读药品说明书、文献资料以及结合工作实践，为医生、护士、临床药师提供正确的溶媒选择及药物配伍，以确保临床医疗质量。方法：本文总结了儿科各类常用药物的溶媒选择，对新发现的常用儿科药物配伍禁忌进行分析评价，根据工作实践列举了常用粉针剂需要稀释的溶媒量。结果：头孢曲松与氨溴索、含钙制剂、微量元素存在配伍禁忌；溴己新与阿奇霉素、阿莫西林克拉维酸钾存在配伍禁忌；葡萄糖酸钙注射液与维生素C粉针剂存在配伍禁忌。结论：药物与药物、药物与溶媒、药物与机体间相互作用错综复杂，要熟练掌握各种配伍禁忌情况，以保证病人的安全用药。     

Red blood cell transfusion in newborn infants

Red blood cell transfusion is an important and frequent component of neonatal intensive care. The present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. The most frequent indications for blood transfusion in the newborn are the acute treatment of perinatal hemorrhagic shock and the recurrent correction of anemia of prematurity. Perinatal hemorrhagic shock requires immediate treatment with large quantities of red blood cells; the effects of massive transfusion on other blood components must be considered. Some guidelines are now available from clinical trials investigating transfusion in anemia of prematurity; however, considerable uncertainty remains. There is weak evidence that cognitive impairment may be more severe at follow-up in extremely low birth weight infants transfused at lower hemoglobin thresholds; therefore, these thresholds should be maintained by transfusion therapy. Although the risks of transfusion have declined considerably in recent years, they can be minimized further by carefully restricting neonatal blood sampling.     

微柱凝胶法检测ABO母婴血型不合孕妇血清抗-A（B）IgG效价1154例的结果分析

目的探讨微柱凝胶法（MGT）检测1 154例ABO母婴血型不合孕妇血清抗-A（B）IgG效价的临床意义。方法采用MGT法对1 154例ABO母婴血型不合孕妇进行产前血清抗-A（B）IgG效价测定,分析血清抗-A（B）IgG效价与新生儿溶血病（HDN）发生的相关性。结果 1 154例孕妇在孕20周首次血清抗-A（B）IgG效价测定≥1∶64者占72.36%（835/1 154）,其中O-A型、O-B型和O-AB型夫妇抗-A（B）IgG效价的阳性率分别为72.48%（366/505）、66.45%（313/471）和80.90%（144/178）,各组阳性率差异有统计学意义（χ2=13.765,P〈0.01）。在产前第30周左右对1 154孕妇中的340例进行抗-A（B）IgG效价的二次随机测定,发现50.50%（51/101）孕妇抗体效价从阴性转为阳性,51.80%（129/249）孕妇（效价≥1∶64）抗体效价继续上升,其中O-A型、O-B型和O-AB型夫妇抗-A（B）IgG效价上升率分别为53.74%（79/147）、50.00%（77/154）和56.41%（23/39）,各组间差异无统计学意义（χ2=1.130,P〉0.05）;25例发生HDN的患儿母亲产前抗-A（B）IgG效价测定均≥1∶256,其中有12例血型抗体效价持续升高达4倍以上,1例效价〈1∶64。结论 ABO母婴血型不合孕妇血清抗-A（B）IgG效价水平与HDN的发生显著相关,利用MGT检测孕妇血清抗-A（B）IgG效价有助于HDN的早期诊断和干预。     

Liver transplantation： Yesterday, today and tomorrow

With the advances in technical skills, management of postoperative complications and improvements in immunosuppressive drugs, liver transplantation is the standard treatment for many patients with chronic liver disease. Today, shortage of donor organs seems to be the major limiting factor for the application of liver transplantation. This review focuses on five issues that are challenging to clinical practice of liver transplantation and relevant to gastroenterologists. These include living donor liver transplantation, recurrent viral hepatitis, non-heart-beating donors, hepatocellular carcinoma, and ABO incompatible liver transplantation. Living donor and non-heart beating donor transplantations were initiated as a solution to increase the donor organ pool and it is expected that there will be an increase in the number of these donors. Recurrent hepatitis C and hepatocellular carcinoma following liver transplantation are among major problems and ongoing research in these diseases may lead to better outcomes in these recipients.     

Comparison of severity and prognosis of jaundice due to Rh incompatibility and G6PD deficiency

IntroductionUndiagnosed and untreated hyperbilirubinemia in infants may result in Kernicterus Spectrum Disorder and poor prognoses. Rhesus incompatibility and glucose-6-phosphate dehydrogenase (G6PD) deficiency are among the known causes of infantile jaundice. This study was designed to define the severity and prognosis in jaundiced infants with Rh incompatibility or G6PD deficiency.MethodsA total of 144 term, 2– 14 days old jaundiced infants (bilirubin > 20 mg/dl) with Rh incompatibility(85 infant) or G6PD deficiency(59 infant) were included in this cohort study with 24-month follow-up through available sampling at Ghaem hospital between 2015 and 2022. Denver II test was used at 6, 12, 18, and 24-month ages after discharge. Infants with Rh incompatibility or G6PD deficiency were assigned into two groups of favorable and poor prognosis. Following that, the bilirubin levels of these infants were compared at the time of admission.ResultsThe bilirubin level in G6PD deficient infants with poor prognoses (37.96 ± 9.25 mg/dl) and neonates with Rh incompatibility (36.23 ± 5.08 mg/dl) almost was the same (P = 0.232). 40 babies (47%) caused by Rh incompatibility and 33 (56%) babies caused by G6PD deficiency had a poor prognosis (P = 0.465).Average bilirubin in babies with RH incompatibility with favorable prognosis is 21.8 and poor prognosis is 36.2 mg/dl. In infants with G6PD deficiency, it was 24 mg/dl with favorable prognosis and 38 mg/dl with poor prognosis (P < 0.0001). The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups (P < 0.0001).ConclusionThe two-year prognoses of hyperbilirubinemia caused by G6PD deficiency are as poor as that of Rh incompatibility. The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups.Exchange transfusion in cases with bilirubin < 25 mg/dl can improve the prognosis in both groups, especially in infants with Rh incompatibility.