Pharmaceutical thrombosis prevention in cardiovascular disease

Cardiovascular diseases are a leading cause of morbidity and mortality in modern society. As a result of this, great efforts have been made to establish regimens for prophylaxis and treatment of such disorders. Pharmacological intervention is also a prerequisite for the success of other therapeutic approaches, e.g. coronary angioplasty. Prevention of platelet aggregation is a goal that can be achieved by counteracting various receptors on the platelet surface. The main attentions for such interventions are focused on inhibiting the glycoprotein IIb/IIIa receptor. So far, they are limited to intravenous usage. Adenosine diphosphate receptor inhibitors are available for intravenous and oral usage. Their effect is, at least partly, also exerted via the counteraction of adenosine diphosphate-mediated activation of the glycoprotein IIb/IIIa complex. An oral direct thrombin inhibitor is under clinical evaluation. This review focuses on atherothrombotic disorders, but recent advances within new fields of anticoagulation (i.e. treatment of severe septic shock and a novel approach to prevent thromboembolic disorder during surgery) should not be overlooked.     

Pharmaceutical thrombosis prevention in cardiovascular disease

Cardiovascular diseases are a leading cause of morbidity and mortality in modern society. As a result of this, great efforts have been made to establish regimens for prophylaxis and treatment of such disorders. Pharmacological intervention is also a prerequisite for the success of other therapeutic approaches, e.g. coronary angioplasty. Prevention of platelet aggregation is a goal that can be achieved by counteracting various receptors on the platelet surface. The main attentions for such interventions are focused on inhibiting the glycoprotein IIb/IIIa receptor. So far, they are limited to intravenous usage. Adenosine diphosphate receptor inhibitors are available for intravenous and oral usage. Their effect is, at least partly, also exerted via the counteraction of adenosine diphosphate-mediated activation of the glycoprotein IIb/IIIa complex. An oral direct thrombin inhibitor is under clinical evaluation. This review focuses on atherothrombotic disorders, but recent advances within new fields of anticoagulation (i.e., treatment of severe septic shock and a novel approach to prevent thromboembolic disorder during surgery) should not be overlooked.     

清洁手术的药学监护

目的调查我院普外科清洁手术围手术期抗菌药物应用情况,探讨临床药师在其中的药学监护作用。方法抽取我院普外科2008年7月至2009年6月行乳腺手术和甲状腺手术的638例出院病历,对抗菌药物种类、用法用量、用药时间等进行分析统计。结果 638例中,预防性应用抗菌药物的使用率为100%。抗菌药物中青霉素类应用最多,其次为头孢菌素类,术后应用抗菌药物时间长。结论我院普外科清洁手术围手术期抗菌药物预防性应用率高,存在不合理应用现象,医院应加强管理,保证患者用药安全、有效、经济。     

专科护士联合查房对合并心血管疾病产妇产后抑郁症的影响

目的 探讨心血管内科与产科专科护士联合查房对合并心脏疾病产妇产后抑郁症的影响.方法 人选2007年7月至2009年7月我院产科435例合并有心血管疾病（先天性心脏病、高血压、风湿性心脏病、心律失常、其他）的产妇,分为联合查房组（327例）及无联合查房组（108例）.联合查房方法为在产科护理人员查房的基础上,心血管内科专科护理人员对患者心血管状况、心率、心律及心功能进行评估,对心血管疾病的一些基本知识、注意事项进行宣教.产后第3天对产妇使用产后抑郁评分表（EPDS）进行测评：EPDS总分＜12分为阴性,≥13分为阳性,即诊断为产后抑郁症,同时记录每组剖宫产率.结果 联合查房组产妇院后剖宫产率及产后抑郁症的发生率分别为51.4%及9.2%;非联合查房组产妇院后剖宫产率及产后抑郁症的发生率分别为67.6%及17.6%;与非联合查房组比较,联合查房组剖腹产率及产后抑郁症发生率明显降低,两组间比较,差异有统计学意义,P＜0.05.结论 与非联合查房组比较,联合查房组剖腹产率及产后抑郁症发生率明显降低,在实际护理工作中,科间协作,护理人员的适当整合是一种值得探讨的工作方法.     

普外科病房中应用循证护理的临床疗效

目的探讨普外科病房中应用循证护理的临床疗效。方法选取2010年6月～2011年11月本院普外科收治的207例住院患者,按照随机数字表法将其随机分为对照组（105例）和观察组（102例）。对照给予常规护理,观察组在常规护理的基础上给予患者循证护理。观察两组患者的满意度、疾病知识普及率、疼痛程度。结果对照组患者满意度为（72.1±10.1）分、疾病普及情况得分为（60.5±9.3）分;观察组患者满意度为（93.7±4.7）分、疾病普及情况得分为（85.4±11.2）分,观察组显著高于对照组（P〈0.05）;观察组疼痛程度显著优于对照组（P〈0.05）。结论普外科病房在常规护理的基础上实施循证护理的效果显著好于常规护理,能够显著地提高患者的满意度及疾病普及率,减少患者的疼痛感,值得临床推广。     

临床药师在外科病区和ICU开展药学服务的经验总结

重症监护室(intensive care unit,ICU)的各种危、急、重病例较多,包括普外科、骨科、泌尿外科,抢救、治疗用药及围手术期预防使用抗菌药物品种繁多,抗菌药物使用率基本达到100%。临床抗菌药物的不合理使用,导致细菌耐药率的增长,并产生多重耐药条件致病菌与真菌。为此,上海市第     

临床药师对心血管围术期发生肝素诱导性血小板减少症的用药监护

探讨临床药师参与心血管围术期抗凝治疗发生肝素诱导性血小板减少症的应对模式及监护要点。临床药师参与1例主动脉夹层患者发生肝素诱导性血小板减少症及围术期抗凝治疗的过程,并提出治疗与监护建议。通过4Ts评估法及相关实验室检测,关注抗凝药物的不良反应和更换方案,避免心血管不良事件发生。临床药师有必要开展心血管围术期抗凝药物的药学监护工作,优化抗凝治疗方案,确保临床用药安全。     

整体护理在普外科病房中的应用效果分析

目的 探讨整体护理在普外科病房的应用效果.方法 选取2013年1～12月来本院普外科治疗的172例患者为研究对象,将其随机分为观察组和对照组各86例,对照组实施常规基础护理,观察组在实施常规基础护理上实施整体护理.比较两组患者的心理反应良好率及护理满意度.结果 观察组心理反应良好率（93.02％）明显高于对照组（84.88％）,差异有统计学意义（P＜0.05）;观察组护理满意度（97.67％）明显高于对照组（77.91％）,差异有统计学意义（P＜0.05）.结论 普外科实施整体护理使患者对医院的信任感增强,患者的心理反应有较大改善,也提高了护理满意度.     

临床药师对1例胰十二指肠切除术后患者营养支持的药学监护与分析

目的探讨临床药师在胰十二指肠切除术后患者营养支持中的作用,促进临床营养药物的合理使用。方法通过1例胰十二指肠切除术后患者的治疗案例,临床药师协助医师调整营养治疗方案,同时针对患者的营养时机、营养支持方式、肠外营养液的合理性和安全性、用药教育与监护等方面予以关注。结果在临床药师与临床医师、护士的相互合作下,患者在营养支持期间未出现不良事件,术后营养状况得到改善。结论临床药师充分发挥自身专业优势,积极参与到营养支持治疗中,对促进合理用药及患者的加速康复具有重要意义。     

Cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery

In a randomized, prospective study a 2-day course of cefuroxime prophylaxis (Zinacef, 1.5g every 12 h) was compared with 2-day ceftriaxone prophylaxis (Rocephin, 2g i.v. plus 1g i.v. after 24 h). To date 512 patients undergoing cardiac (n = 418) and major vascular surgery (n = 94) entered the study: 258 in the cefuroxime and 254 in the ceftriaxone group. The one-month lethality rate was 1.0%. The total infection rate was 4.7% (12 patients in the cefuroxime and 12 in the cefuroxime group. Septicaemia occurred in 1-4% (cefuroxime n = 4; ceftriaxone n = 3); pneumonia in 2% (5 vs 5 patients). One patient developed diarrhoea due to Clostridium difficile. Plasma concentrations of ceftriaxone were measured (HPLC method) over the first 24 h in 110 patients undergoing cardiac surgery. Plasma concentrations 24 h post-injection were 25.4 +/- 12.7 micrograms/ml. Prophylaxis with either cefuroxime or ceftriaxone was highly effective. The mean plasma levels of ceftriaxone achieved are far in excess of the MICs for the microorganisms commonly associated with infection following cardiovascular surgery, with the exception of Bacteroides and Pseudomonas. A single dose of ceftriaxone should therefore provide adequate prophylaxis for most patients undergoing major cardiovascular surgery.     

杂交技术在心脏外科中的应用进展

摘要： 杂交技术 （hybrid technique） 是将微创心脏外科技术和心内介入技术结合的技术, 具有疗效确切、 视野良好、 创伤微小的优点, 为心血管疾病患者提供了先进的治疗选择。随着技术水平、 诊疗意识、 医疗设备的逐步提高,特别是 “Hybrid手术间” 的逐渐普及, 杂交技术已经在心外科的多个亚专业领域开展应用, 个别领域已成为常规治疗方案。目前主要应用于先天性心脏病、 冠心病、 心脏瓣膜病、 主动脉疾病、 房颤等的治疗。     

1例高龄晚期肺癌合并心血管基础疾病患者的药学监护

1例高龄晚期肺癌合并心血管基础疾病患者,肺癌γ-刀放疗后,3周期TP(顺铂+紫杉醇脂质体)方案化疗3个月的过程中,临床药师积极开展药学监护,协助临床医师优化用药方案.结合高龄晚期肺癌合并心血管基础疾病患者的疾病特点、用药选择、药物不良反应等情况,对患者使用抗高血压药、抗心律失常药提出用药建议.为避免肺癌患者的咳嗽症状加重,停用了对患者呼吸系统影响较大的肾素血管紧张素转换酶抑制剂;对患者化疗后出现低血压、心律失常的情况,及时停用钙离子拮抗剂并换用血管紧张素Ⅱ受体拮抗剂,减量使用抗心绞痛药并加用β-受体阻滞剂;在抗菌药物使用方面选用了对肠道感染效果较好且适用于老年人的左氧氟沙星,合用蒙脱石散治疗腹泻并减轻抗肿瘤药的消化道毒性;对患者使用顺铂、紫杉醇所致消化道不良反应、骨髓抑制进行积极的预防和治疗;并对患者进行出院用药指导.     

Reducing risk of cardiovascular events in noncardiac surgery

Cardiac adverse events are a major cause of complications in noncardiac surgery. The benefit of preventive coronary artery revascularisation in stable patients before noncardiac surgery has recently been clarified: in the short-term there is no reduction in the number of postoperative myocardial infarction, deaths or hospital length of stay. Coronary artery revascularisation should be limited to these patients who have a well-defined need for the procedure, independent of the need of noncardiac surgery. Optimising medical therapy remains the best option for reducing perioperative complications in stable patients: the addition of statin therapy in candidates for noncardiac surgery with known or strongly suspected coronary disease may be conceived. There is compelling evidence for the use of beta-blockers in reducing cardiac risk. This review presents the studies that support the beneficial effect of beta-blockers, pharmacological effects and some practical aspects in noncardiac surgery. In the management of most of these patients, the use of beta-blockers can aid in the avoidance of a preoperative stress test. The remaining problem to solve is the cost-effective identification of the small group of patients in which the protective effect of beta-blocker therapy is insufficient and a cardiac revascularisation should be considered.