某院2021年儿科住院患儿抗菌药物使用情况分析

目的 了解和分析厦门市第五医院（简称“我院”）2021年儿科住院患儿抗菌药物使用情况,为促进儿童合理使用抗菌药物提供参考。方法 从我院病历系统中等距抽取2021年1月1日至12月31日300例儿科出院患儿的病历,统计并分析抗菌药物使用情况。结果 300例儿科住院患儿中有264例使用抗菌药物,抗菌药物使用率为88.00%,以静脉给药为主（94.32%）;使用的抗菌药物共17种,以青霉素类、头孢菌素类、大环内酯类为主;排名前三的疾病分别为急性支气管炎、急性上呼吸道感染和急性胃肠炎,抗菌药物使用率分别为100.00%、95.12%、78.89%;抗菌药物用药合理或基本合理者242例（91.67%）,用药不合理共22例（8.33%）;联合用药共17例（6.44%）,以头孢菌素类+大环内酯类、青霉素类+大环内酯类联用为主;儿科共上报17例抗菌药物引起的药品不良反应;病原微生物送检率为94.70%,检出阳性率为25.20%。结论 我院儿科住院患者使用抗菌药物存在不合理情况,主要体现在选药不合理、无指征用药、重复用药方面。     

我院儿科住院患者超药品说明书用药情况调查与分析

目的：调查我院儿科住院患者超药品说明书用药情况,并进行分析评价,为我院儿科患者的规范合理用药提供参考。方法：采用回顾性调查,随机抽取我院2016年2月1日到3月31日住院患儿病例600例,逐一阅读药品包装所附药品说明书, 判断超药品说明书用药处方并分析其原因。结果：共纳入住院病例600例,分析用药医嘱3769条,涉及药品157种。按病例数、用药医嘱、药物品种计,超药品说明书用药分别为93.2%、31.8%和 30.6%。各类型超药品说明书用药发生率分别为超适用人群（66.0%）、超适应证（25.6%）、超给药途径（22.6%）、超给药剂量（11.1%）;超药品说明书用药医嘱占据第一位的药物为心血管系统药（26.5%）,其次为呼吸系统类药物（21.6%）。结论：我院儿科住院患者超药品说明书用药现象普遍,相关管理部门应对超药品说明书用药行为进行规范,保障患儿用药安全,规避用药风险。     

我院儿科下呼吸道感染抗菌药物应用评价

目的：了解我院儿科下呼吸道感染抗菌药物的应用情况,为临床合理用药提供参考。方法：收集2013年6-11月我院儿科下呼吸道感染患儿出院病历共708份,统计分析抗菌药物使用情况。结果：我院儿科下呼吸道感染住院患儿抗菌药物使用率99.9%（707/708）,均为静脉滴注给药,联合用药率为52.5%（372/708）,换药率为16.2%（115/708）,2.1%（15/708）患儿无指征换药。红霉素、头孢硫脒、头孢呋辛钠用药频次居前三位,使用率分别为52.7%（373/708）、26.3%（186/708）、23.6%（167/708）。联合用药以红霉素＋β-内酰胺类抗菌药物为主。结论：我院儿科下呼吸道感染抗菌药物应用在用药指征、联合用药、给药途径、给药频次、药物更换等方面存在不合理情况,应加强抗菌药物合理应用的监管,促进临床合理用药。     

1 039例儿童上呼吸道感染处方用药构成分析与评价

目的:探讨我院儿童上呼吸道感染用药处方的合理性。方法:选取佛山市顺德区第一人民医院附属陈村医院2016年8-10月儿科门诊明确诊断为上呼吸道感染的1 039例患儿,对其用药类别、给药途径、药品费用、炎症指标及复诊情况等进行回顾性分析。结果:1 039例患儿处方中,中成药处方使用最多为780例次,抗病毒药物处方672例次,解热镇痛药物处方633例,抗菌药物处方129 例次;抗病毒药物使用金额比例最高,占35.70%,中成药占27.69%;口服给药处方929例,静脉给药处方110例,静脉给药与口服给药患儿抗菌药物使用比例相近,但静脉给药患儿复诊比例高。结论:我院儿科门诊上呼吸道感染处方用药基本合理,但存在部分中成药重复用药使用和抗菌药物用药起点高、糖皮质激素静脉用药指征不明确等情况。     

某三甲医院门诊与住院患儿用药结构特点与差异及合理性分析

目的：通过对某三甲医院儿科使用的抗菌药物、呼吸系统药物和消化系统药物现状的抽样调查,对比门诊与住院患儿用药特点与差异并进行相关因素分析,以期促进儿科用药的合理性与安全性。方法：随机抽取某院儿科2011年2月至2012年9月门诊处方2400张和2010年6月至2012年5月儿科住院电子病历1600份,采用DDDs排序法对数据进行统计分析。结果：门诊与住院患儿在给药途径、给药剂量、给药剂型以及药品种类选择上存在一定的差异。给药途径门诊患儿以口服为主,住院患儿以静脉滴注为主;部分呼吸系统药物用药剂量过大,住院患儿抗菌药物的使用起点选择较高,使用率、联合用药率也较高。结论：虽然该院儿科用药结构基本合理,但调查结果显示静脉给药方式在儿童用药中已逐步成为主流,为保证其用药的安全性,抗菌药物的合理选用（或联用）以及儿童用药剂量科学规范化值得重视与研讨。     

我院儿科门诊抗菌药物应用调查分析

目的：了解我院儿科门诊抗菌药物的使用情况,评价其用药合理性。方法：随机抽取我院2007年12月和2008年1月、2月儿科门诊处方6540张,对抗菌药物应用情况进行调查分析。结果：共抽查处方6540张,使用抗菌药物处方为3868张,抗菌药物使用率为59.1%,其中口服给药占使用抗菌药物的37.7%,静脉给药占62.3%。单用1种抗菌药物（包括与抗病毒药合用）的处方为3 589张,占使用抗菌药物处方的92.8%,二联用抗菌药物处方为280张,占使用抗菌药物处方的7.2%,无二联以上抗菌药物处方（但不包括与抗病毒药合用）。结论：我院儿科门诊抗菌药物应用基本合理。但应注意静脉给药比例偏大、细菌耐药性问题等,需加强抗菌药物的合理应用。     

163例呼吸道感染患儿抗菌药物使用分析

目的分析呼吸道感染住院患儿抗菌药物使用情况,提高儿科临床合理应用抗菌药物水平。方法统计163例呼吸道感染患儿病历资料,记录抗菌药物限定日剂量（DDD）、药物利用指数（DUI）、住院时间及联合用药情况,分析患儿抗菌药物合理应用情况。结果在抽取的处方中,有148例患儿使用了抗菌药物,占总数的90.80%。148例患儿共使用了14种抗菌药物,有10种抗菌药物DUI＞1.0,其中五水头孢唑林为2.71,头孢曲松为1.85,头孢唑肟为1.78,阿莫西林/克拉维酸为1.60。大环内酯类使用频率为87.1%,头孢菌素类73.65%,β 内酰胺酶抑制药及其复方制剂为49.4%。结论该院儿科抗菌治疗更多地关注革兰阴性菌和耐药菌感染,多数抗菌药DUI≥1.0。     

2011～2013年我院抗菌药物临床应用分析

目的：规范我院抗菌药物的使用。方法：随机抽取我院2011～2013年门诊处方2800张,对其中510份使用抗菌药物的处方进行整理和分析,住院病历500份（手术和非手术病历各250份）,调查我院抗菌药物的使用率、处方频数、联合用药、用药时间等。结果：我院门诊与住院病例抗菌药物使用率符合要求,但手术住院病例预防性用药比例比较高,门诊存在无适应症用药现象,抗菌药物联合用药现象比较多,部分手术住院病例抗菌药物选择及给药时间不规范。结论：我院抗菌药物的使用存在一定的问题,门诊和住院抗菌药物的管理都应加强。     

我院支气管肺炎住院患儿用药分析

目的 研究我院儿科支气管肺炎住院患儿的用药情况,为儿科合理用药提供参考.方法 对我院2015年1月~2015年12月支气管肺炎住院患儿的用药品种、数量、金额、用药频度及超说明书用药情况等进行回顾性统计和分析.结果 我院支气管肺炎住院患儿抗菌药物使用率为93.65%,其中58.18%患儿使用单一抗菌药,33.26%患儿使用二联抗菌药,17.35%患儿存在更换抗菌药物现象,68.19%患儿使用抗菌药联合雾化吸入,47.39%患儿使用抗菌药联合抗病毒药.使用的抗菌药物共有10种,用药金额、用量和DDDs排前几名的都是头孢噻肟、头孢替安、头孢哌酮舒巴坦钠、阿奇霉素等抗菌药.抽取的960份病历,共有10103条医嘱,其中超说明书用药医嘱2097条,占20.76%.超说明书用药类型以超适应人群用药和超给药途径用药比例最大.结论 我院支气管肺炎住院患儿治疗过程中存在抗菌药物用药起点过高、阿奇霉素用量偏大、用药频次偏高及超说明书用药现象较为常见等问题.     

北京市大兴区妇幼保健院儿科抗菌药物应用分析

目的：了解我院儿科抗菌药物的使用情况。为临床合理用药提供参考。方法：采用回顾性分析方法,以随机抽样法抽取2012年4—2012年10月我院儿科门诊处方1 261张,统计抗菌药物的使用情况,并分析用药合理性。结果：抗菌药物使用率为43.14%（544/1 261）,其中静脉给药占43.93%（239/544）,口服给药占51.29%（305/544）。共使用抗菌药物2类13个品规,其中β-内酰胺类药使用率最高。结论：我院儿科抗菌药物使用基本合理,但抗菌药物的使用率和静脉给药比例偏高,应加以控制。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.