某院15000张门诊抗菌药物处方点评及其不合理用药原因分析

目的:分析医院门诊抗菌药物处方点评及其不合理用药原因。方法:选取2017年1—12月31日期间门诊医生开具的抗菌药物处方15 000张作为研究对象,点评其合理用及其不合理原因。结果:15 000张门诊抗菌药物点评处方中,不合理用药处方100张占0.67%,主要以用药不适宜为主;抗菌药物用药处方中不合理用药多出现在急诊科、内科;第2代头孢菌素类抗菌药物用药处方的不合理用药率为最高。结论:门诊抗菌药物的使用属基本合理,但仍需医院加强管理,进一步提高抗菌药物临床用药的合理性。     

某院抗菌药物专项处方点评模式的建立及其对不合理用药的原因分析和对策

目的:分析医院抗菌药物专项处方点评模式的建立过程及其对不合理用药的原因和对策。方法:抽取2018年8月—2019年7月间门诊处方和医嘱24 000张(每月2 000张),分析抗菌药物专项处方点评模式的建立过程及其对不合理用药原因。结果:24 000张门诊急诊处方和医嘱中,抗菌药物处方4 037张占16.82%;抗菌药物使用率逐年下降,处方合格率逐年升高,至2019年7月份处方合格率达98.88%;其中抗菌药物不合理处方237张占5.87%;处方不合理原因有适应证不适宜占45.57%,其次为选用药物不适宜占23.21%。结论:采用数字化信息系统实施抗菌药物专项处方点评,有效遏制了抗菌药物的不合理使用,处方合格率显著提高,体现了药师的作用和价值,促进了抗菌药物的合理使用,达到了预期目标。     

我院2011年上半年门诊抗菌药物应用分析

目的了解该院门诊抗菌药物使用的合理性。方法随机抽取门诊的1200张处方,统计处方中抗菌药物的品种、数量、联合用药等情况。结果在调查1200张处方中,使用抗菌药物处方642张占53.5%。不合理使用抗菌药物处方91张占14.2%。联合应用抗菌药物处方117张占18.2%,其中二联用药占16.2%,三联及以上用药占2.0%。结论该院门诊抗菌药物的应用基本合理,但必须严格按照抗菌药物使用原则用药,确保临床用药的安全、经济、合理和有效。     

我院2011年上半年门诊抗菌药物应用分析

目的 了解该院门诊抗菌药物使用的合理性.方法 随机抽取门诊的1200张处方,统计处方中抗菌药物的品种、数量、联合用药等情况.结果 在调查1200张处方中,使用抗菌药物处方642张占53.5%.不合理使用抗菌药物处方91张占14.2%.联合应用抗菌药物处方117张占18.2%,其中二联用药占16.2%,三联及以上用药占2.0%.结论 该院门诊抗菌药物的应用基本合理,但必须严格按照抗菌药物使用原则用药,确保临床用药的安全、经济、合理和有效.     

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。     

我院儿科门诊处方调查分析

目的调查该院儿科门诊处方用药情况。方法对1526张儿科门诊处方的性别年龄分布、处方金额、药物品种数、处方中的临床诊断和药品使用情况进行统计分析。结果 1526张处方合计金额为53 791.50元,平均每张处方金额为35.25元;合计品种数为4746种,平均每张处方品种数为3.11种。其中有呼吸系统疾病处方934张占61.21%,消化系统疾病253张占16.58%,五官科系统疾病81张占5.31%,血液系统疾病343张占2.23%,营养代谢疾病153张占10.03%,泌尿系统疾病40张占2.26%,其他疾病31张占2.03%。含抗生素药物处方最多,有931张占61.01%,其次为祛痰、镇咳、平喘药855张占56.03%。结论该院儿科门诊处方在用药上基本安全、经济、合理,但还存在许多不合理的地方,建议医院要进一步加强用药安全性、合理性教育,以确保患儿的安全、合理用药。     

我院儿科门诊处方点评与分析

目的了解我院儿科门诊处方药物的应用情况,促进处方用药的合理性与规范性。方法对我院2010年的3000张门诊普通处方和药师日常处方审核工作中所记录的疑义处方进行点评、统计和分析。结果我院处方基本控制较好,不合格处方129张,占4.3%,其中处方书写不规范的121张,用药不适宜的8张,分别占全部抽查处方比率为4%、0.27%。结论通过处方点评,提高了临床医师合理用药水平,特别是提高抗菌药物的合理应用水平,为提高医院医疗质量提供了基础。     

某医院10800张儿科门诊处方中抗菌药物使用的相关因素分析

目的:分析某医院儿科门诊抗菌药物的使用现状,为抗菌药物合理用药提供参考。方法:抽取2017年度儿科门诊处方10 800张,统计与分析其使用抗菌药物的处方数及其种类、给药途径、联合用药、不合理用药处方等相关因素。结果:10 800张处方中,6 825张处方使用了抗菌药物(占63.19%),药物类别主要以头孢菌素类为主;使用频次排名前3位的抗菌药物分别为头孢克肟颗粒(20.50%)、注射用五水头孢唑林钠(16.94%)和注射用头孢噻肟钠舒巴坦钠(6.45%);口服给药占54.46%,注射给药占39.43%,外用给药占6.11%;单一用药处方4 644张占68.04%,二联用药处方2 181张占31.96%,未见三联用药现象;抗菌药物使用不合理处方258张占3.78%。结论:在医院儿科门诊中,抗菌药物的使用存在一些不合理现象,应加强干预与监管以确保患者用药的安全、有效。     

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.