基于加权TOPSIS法的拉氧头孢钠在儿科中的药物利用评价

目的:建立拉氧头孢钠药物利用评价标准,为儿科临床合理应用拉氧头孢钠提供参考依据.方法:参考拉氧头孢钠的药品说明书及应用指南等,在查阅相关文献的基础上制定儿科药物利用评价细则,并通过加权TOPSIS法对南京医科大学附属儿童医院2019年上半年120例应用拉氧头孢钠的出院病历进行评价.结果:120份病历中,相对接近度大于9...     

我国儿科药品分剂量工作现状及思考

缺乏儿童适宜剂型和规格的药品是目前儿科治疗面临的主要问题之一,由此导致药品分剂量在儿科临床治疗中极为普遍。由于缺少相应的政策支持和指南规范,我国儿科药品分剂量工作缺乏有效的管理,致使分剂量药品的质量参差不齐,存在临床用药安全隐患。本文从儿科药品分剂量的需求、风险、政策法规和职业暴露等方面总结分析了国内儿科药品分剂量工作的现状及存在问题。同时结合经验提出了思考和建议,包括鼓励开发儿童适宜药品、评估风险、完善制度保障、探索新设备新技术、优化院内药品目录、加强宣传等,为我国儿科分剂量工作施行同质化管理和质量提升提供参考。     

Use of milrinone in critically ill children

Background

Optimal dose adjustment of milrinone in critically ill children is challenging because of conflicting information about the association between dose and outcomes in this age group.

Objectives

To describe the use of milrinone in critically ill children and to explore associations between milrinone dosing and clinical outcomes, specifically effectiveness and adverse events.

Methods

This retrospective cohort study was performed in a consecutive sample of children admitted to a university-affiliated critical care unit (January to June 2004). The relations between milrinone dosing and its effectiveness (based on prevention of low cardiac output syndrome, defined as a difference in oxygen saturation between arterial and mixed venous blood of at least 30% or an increase in serum lactate > 2 mmol/L) and its adverse effects (thrombocytopenia, arrhythmia) were evaluated by logistic regression.

Results

A total of 197 children from 213 admissions (ranging in age from newborn to 18 years) were included in the study. Milrinone was initiated with a median loading dose of 99.2 μg/kg (range 22.1–162.2 μg/kg). The initial loading dose was higher if given in the operating room rather than the Critical Care Unit (median 99.7 versus 51.0 μg/kg; p < 0.001). Subsequent loading doses, for patients who received them, were lower (median 49 μg/kg). Milrinone was infused at a median rate of 0.64 μg/kg per minute (range 0.13–2.08 μg/kg per minute) for a median of 43.1 h. There was no relation between serum creatinine level and the maintenance dose of milrinone (r ² ≤ 0.0335). Low cardiac output syndrome was relatively frequent (166 [77.9%] of the 213 admissions). There was a trend for occurrence of this syndrome in patients with greater average milrinone dose rate (odds ratio [OR] 8.21, 95% confidence interval [CI] 0.98–69.15, p = 0.053) and with longer duration of milrinone therapy (OR 1.01, 95% CI 1.01–1.02, p < 0.05). Adverse events were relatively frequent (thrombocytopenia for 27 admissions [12.7%], arrhythmia for 82 admissions [38.5%]) but were not significantly associated with milrinone dosing.

Conclusions

A retrospective evaluation of milrinone use in critically ill children revealed variable utilization and frequent occurrence of both low cardiac output syndrome and adverse events. Further prospective research is needed to understand the impact of individual pharmacokinetic differences on pharmacodynamic responses, to guide optimal dose adjustment, improve outcomes, and minimize toxic effects.     

2种氟喹诺酮类药物对临床分离金黄色葡萄球菌突变选择窗的影响

目的通过测定左氧氟沙星及莫西沙星对金黄色葡萄球菌临床分离菌株防突变浓度(MPC),比较氟喹诺酮类对金黄色葡萄球菌突变选择窗(MSW)的影响,为临床合理使用抗菌药物,防治细菌耐药产生提供依据。方法采用标准琼脂二倍稀释法测定2种氟喹诺酮药物对38株临床分离的金黄色葡萄球菌和金黄色葡萄球菌质控菌株ATCC25923的最低抑菌浓度(MIC),采用肉汤法富集3×1010CFU.mL-1的金黄色葡萄球菌测定2种氟喹诺酮药物MPC,计算MPC50、MPC90、MPC/MIC。结果左氧氟沙星对38株金黄色葡萄球菌的MPC90、MPC90/MIC90分别为16 mg.L-1、8,莫西沙星分别为2 mg.L-1、4;结合药物动力学参数莫西沙星400 mg.次-1,1次.d-1,其Cmax/MPC90、AUC/MPC90分别为2.3、18,左氧氟沙星500 mg.次-1的Cmax/MPC90、AUC/MPC90明显高于300 mg.d-1组,分别为0.5、2.4。结论对金黄色葡萄球菌的临床分离菌株莫西沙星比左氧氟沙星MPC90低,MSW窄,防突变能力更强。左氧氟沙星500 mg.次-1,1次.d-1,能够提高左氧氟沙星的防突变能力。