某院儿科门诊3467张抗菌药物处方用药及不合理用药的原因分析及其对策

目的:分析医院儿科门诊抗菌药物处方用药及不合理用药的原因及其对策,为儿科患者安全用药提供参考。方法:抽取2018年7月—2019年7月间儿科门诊抗菌药物用药处方3 467张,统计其抗菌药物联用情况、给药途径、用药频度(DDDs)和不合理用药处方;分析其用药的合理性及不合理用药处方的原因。结果:3 467张抗菌药物用药处方中,其中2 597张处方使用单一品种抗菌药物占74.91%,2种抗菌药物联用处方858张占24.75%,3种抗菌药物联用处方12张占0.35%;各抗菌药物给药途径均为口服给药、静脉给药;阿奇霉素、头孢克肟的DDDs较高;不合理用药处方497张占14.34%,主要为给药时间间隔不合理。结论:医院儿科门诊抗菌药物处方用药基本符合《抗菌药物临床应用指导原则》要求,但仍存在不合理用药现象,主要表现为给药时间间隔不合理等,应加强临床医师及药师专业知识培训,健全抗菌药物管理制度,以确保患者抗菌药物使用的合理性、有效性、安全性。     

某院小儿内科门诊处方点评结果及其用药合理性分析

目的:分析医院儿科门诊处方的点评结果及其用药的合理性与不合理用药的原因,为医院临床合理用药提供参考。方法:抽取2018年8月—2019年8月间门诊就诊的1 000张患儿用药处方,分析其门诊处方用药患者用药的合理性及不合理用药的原因。结果:1 000张患儿用药处方中,处方合格数为857张(合格率为85.70%),不合格处方143张(不合格率为14.30%);不合格处方中主要有不规范的处方89张占不合格处方的62.24%,不适宜的处方为54张占不合格处方的37.76%;使用抗菌药物的处方653张占所有处方的65.30%;静脉给药后发热的患儿为547例占所有患儿的54.70%;患儿平均药品的使用种数为2.16种,基本药物使用平均数为1.67种。结论:医院儿科的门诊处方用药基本合理,但是抗菌药物的使用占比较高,医院行政部门应重视临床医师及药师的专业用药知识的学习,提高其合理用药的水平。     

我院2010年上半年门诊抗菌药物使用现状分析

目的 了解该院儿科抗菌药物使用状况,及时改进存在问题,不断提高合理用药水平.方法 随机抽取该院2010年上半年门诊处方4800张,对抗菌药物的处方数、种类、使用率、联合用药等情况进行统计分析.结果 4800张处方中使用抗生素2968张占61.8%,其中头孢菌素类2281张占抗生素处方的76.9%、青霉素类266张占9.0%、大环内酯类325张占11.0%、林可霉素类96张占3.2%;口服给药861张占29.0%,静脉给药1426张占48.1%,口服+静脉给药681张占22.9%.单联用药(2088张)占70.4%,联合用药(880张)占29.6%.结论 该院抗菌药物使用率和使用起点偏高,建议临床医师规范使用抗菌药物,确保儿童用药安全有效.     

我院2010年上半年门诊抗菌药物使用现状分析

目的了解该院儿科抗菌药物使用状况,及时改进存在问题,不断提高合理用药水平。方法随机抽取该院2010年上半年门诊处方4800张,对抗菌药物的处方数、种类、使用率、联合用药等情况进行统计分析。结果 4800张处方中使用抗生素2968张占61.8%,其中头孢菌素类2281张占抗生素处方的76.9%、青霉素类266张占9.0%、大环内酯类325张占11.0%、林可霉素类96张占3.2%;口服给药861张占29.0%,静脉给药1426张占48.1%,口服+静脉给药681张占22.9%。单联用药(2088张)占70.4%,联合用药(880张)占29.6%。结论该院抗菌药物使用率和使用起点偏高,建议临床医师规范使用抗菌药物,确保儿童用药安全有效。     

我院门诊抗菌药物处方分析

目的 分析医院门诊处方中抗菌药物的使用情况,为临床合理用药提供参考.方法 随机抽取医院2010年1-12月处方9600张,运用Excel电子表格对应用抗菌药物的处方进行统计、分析.结果 9600张处方中,应用抗菌药物处方3763张占39.20%.其中,抗菌药物联用处方422张占应用抗菌药物处方的11.21%;注射用抗菌药物处方占抗菌药物处方的18.79%,口服抗菌药物处方占抗菌药物处方的70.98%.头孢菌素类和氟喹诺酮类药物应用频率较高,分别占33.29%、26.07%.儿科与内科应用抗菌药物频次较高,分别占35.98%、30.99%.抗菌药物不合使用情况有重复用药、无指征用药、药理作用拮抗及给药方案不当.结论 医院门诊处方抗菌药物的应用情况基本合理,但仍需进一步加强抗菌药物合理应用,提高我院临床用药的安全性、有效性、经济性.     

我院门诊抗菌药物处方分析

目的分析医院门诊处方中抗菌药物的使用情况,为临床合理用药提供参考。方法随机抽取医院2010年1-12月处方9600张,运用Excel电子表格对应用抗菌药物的处方进行统计、分析。结果 9600张处方中,应用抗菌药物处方3763张占39.20%。其中,抗菌药物联用处方422张占应用抗菌药物处方的11.21%;注射用抗菌药物处方占抗菌药物处方的18.79%,口服抗菌药物处方占抗菌药物处方的70.98%。头孢菌素类和氟喹诺酮类药物应用频率较高,分别占33.29%、26.07%。儿科与内科应用抗菌药物频次较高,分别占35.98%、30.99%。抗菌药物不合使用情况有重复用药、无指征用药、药理作用拮抗及给药方案不当。结论医院门诊处方抗菌药物的应用情况基本合理,但仍需进一步加强抗菌药物合理应用,提高我院临床用药的安全性、有效性、经济性。     

某院儿科门诊抗菌药物使用合理性分析

目的：了解某院儿科门诊抗菌药物使用情况,为临床合理用药提供参考。方法：对某院儿科门诊某月某一工作周5个工作日的处方进行统计,选择使用抗菌药物的处方进行分析。结果：共抽查处方2 336张,使用抗菌药物处方为1 018张,占43.58%,使用注射用抗菌药物处方数占总处方数的26.54%（620/2 336）,抗菌药物联合用药处方数占总处方数的3.42%（80/2 336）。儿科抗菌药物使用基本合理,但存在给药方案不当、联合用药不合理、给药时间不合理等一些问题。结论：应加强抗菌药物合理使用的培训及管理,提高儿科抗菌药物合理应用水平。     

儿科门诊处方抗菌药物不合理使用分析

目的对我院儿科门诊抗菌药物不合理使用情况进行分析。方法我院自2010年5月至2011年6月,按照随机抽样的原则,每月选择一天从我院门诊药房抽取儿科含抗菌药物的处方,抽取12d,共计1439张。对儿科抗菌药物不合理使用处方中出现的无指征滥用抗菌药物,选药不合理,给药剂量不准确,给药次数不当,联合用药不当,配伍禁忌等等进行评价分析。结果经过对1439张儿科抗菌药物的门诊处方统计,抗菌药物不合理使用处方124张,占抽查儿科抗菌药物不合理使用处方的比例为8.65%。结论我院儿科门诊处方中抗菌药物的不合理使用现象较明显,让患者能够使用安全、有效、经济的抗生素,不断提高合理用药的水平。     

我区基层医院抗菌素合理使用情况研究调查及干预效果的相关性研究

目的：探讨我区基层医院抗菌素合理使用情况研究调查及干预效果的相关性。方法：2015年6～12月,随机抽取我院及个别基层医疗机构门诊处方1200张,其中560张为抗菌药物处方,门诊抗菌药物使用率为46.7%;住院病历300份,其中抗菌药物220份,住院抗菌药物使用率为73.3%。调查具体情况及干预价值。结果：门诊不合理处方180张,占32.1%,住院不合理使用抗菌药物75份,占34.1％。门诊不合理处方中,外科100张,占55.6%,内科45张,占25%;妇产科20张,占11.1%;儿科15张,占8.3%。住院不合理处方中,外科40份,占53.3%;内科20份,占26.7%;妇产科10份,占13.3%;儿科5份,占6.7%。255张不合理处方中,因应用时间间隔不当87张,占34.1%,居首位;用法用量不当居其次,58张,占22.7%;其他依次为无用药指征,48张占18.8%;联合用药不当,33张占12.9%;用药与临床诊断不符,18张占7.1%;选择溶媒不当,8张占3.1%;其他3张占1.2%。结论：针对基层医院抗菌素使用存在的不合理情况,分析原因,并制定针对性干预措施,可对危险事件加以防范,起到保障合理用药的作用。     

门诊儿童用药调查分析

目的对儿科门诊用药的使用情况进行分析，找出存在问题，使药品在使用中能达到最佳治疗效果，最低药物不良反应，最经济的药物利用。确保儿科用药合理、安全、有效。方法随机抽取门诊处方6391张，统计使用情况，并评价用药合理性。结果不合理用药处方626张，占统计处方9．8％，其中选药不当174张占不合理处方的27．8％，用法用量不当320张占不合理处方51．2％，配伍不合理132张占不合理处方（21％）。同时统计出抗菌药物处方占统计处方的（74．5％）4761张，抗菌药静脉给药3873张占统计处方的60．6％，抗菌药口服处方888张占统计处方的13．9％。结论儿科抗菌药物使用率明显高于一般人群，应不断提高医师和药师专业技能；定期组织医务人员参加药学知识培训。确保合理安全用药。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

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.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.