社区获得性肺炎住院患者抗菌药物应用分析

目的调研2009上半年我院部分社区获得性肺炎（CAP）住院患者抗菌药物应用情况,依据《抗菌药物指导原则》和《社区获得性肺炎诊断与治疗指南》评价其合理性。方法采用回顾性调查方法,对254例CAP患者按使用抗菌药物的种类、使用频率、疗程、给药途径、联合用药、治疗结果、细菌培养和药敏试验、用药合理性等进行统计分析。结果抗菌药物使用频率前3位的是广谱青霉素／酶抑制剂、喹诺酮类、二代头孢。抗菌药物费用占住院费用的13．6％,处方者按药敏试验结果调整用药方案的42例,联合用药以二联为主占27．2％。结论我院CAP住院患者抗菌药物使用基本合理,但临床处方用药水平仍可进一步提高。     

社区获得性肺炎患儿门诊抗菌药物处方分析

目的:了解社区获得性肺炎(CAP)患儿门诊抗菌药物不合理使用情况,促进CAP患儿抗菌药物的合理使用.方法:抽取某院2018年第四季度CAP门诊患儿病例,对抗菌药物使用情况进行合理性评价与分析.结果:本次调查的10998例儿科门诊CAP患儿使用的抗菌药物处方中,抗菌药物使用前三位的分别是阿奇霉素、头孢地嗪、头孢替唑,联合使用抗菌药物处方共494例,其中两种药物联合493例,有1例是三种药物联合使用,频次最高的联合使用抗菌药物是头孢替唑+阿奇霉素;抗菌药物通过静脉途径给药的4671例(96.39％),通过口服给药的175例(3.61％);不合理使用情况为用药频次不适宜、联合用药不适宜、遴选药品不适宜和无指征用药.结论:该院CAP门诊患儿抗菌药物使用存在不合理现象,需进一步规范医师用药行为,提高CAP患儿抗菌药物合理用药水平.     

不同抗菌药物对社区获得性肺炎患者抗感染用药的合理性分析

目的分析不同抗菌药物对社区获得性肺炎患者进行抗感染用药的合理性。方法本文以2017年1月至2018年8月接收的社区获得性肺炎患者60例作为研究对象,对所有患者的临床资料进行分析,调查不同抗菌药物,对于社区获得性肺炎进行治疗的效果和合理用药。结果社区获得性肺炎60例患者,对患者进行抗感染治疗的前5位药物分别是头孢曲松、头孢替安、头孢唑林、阿奇霉素、左氧氟沙星;药物的使用频率分别为53.33%(32/60)、50.00%(30/61)、43.33%(26/60)、38.33%(23/60)、31.67%(19/60);本文60例患者当中单一用药32例,占53.33%,联合用药当中主要以喹诺酮类药物和大环内酯类药物为主,用药前后落实痰液的微生物培养和药敏试验分别为83.33%(50/60)和93.33(56/60);对患者用药合理性进行分析,患者的抗菌药物用药合理性均超90%。结论通过抗感染药物对社区获得性肺炎患者进行治疗基本符合用药规则,但现如今临床用药之前进行病原学培养和检验工作仍存在一定的不足,应该强化干预,杜绝不合理用药情况出现。     

基于《社区获得性肺炎诊断和治疗指南(2016版)》对医院成人CAP患者抗菌药物使用的相关因素分析

目的:分析医院成人社区获得性肺炎(CAP)住院患者的抗菌药物使用情况,为CAP的诊治和合理使用抗菌药物提供参考。方法:抽取2017年-2018年收治的CAP患者151例临床数据,依据《社区获得性肺炎的诊疗指南(2016版)》(以下简称《指南》)并结合患者临床症状,分析和衡量其使用抗菌药物的限定日剂量(DDD)和药物利用指数(DUI)合理性。结果:151例病例中,青壮年患者占比最大,且大多数病例伴随基础疾病,抗菌药物的使用率均为100%;所用抗菌药物以喹诺酮类和头孢菌素类酶抑制剂复合物为主,二联用药也常以上述两类药物联用;多数药物DUI值接近于1.00,用法用量较为合理;不良反应发生率低且多为常见反应。结论:医院CAP患者抗菌药物的使用基本符合《指南》要求,部分药物DUI值波动大,联合用药不合理的问题需引起临床重视。     

我院CAP住院患者抗菌药物应用分析

目的：调研2006年我院CAP住院患者抗菌药物应用情况,依据《抗菌药物临床应用指导原则》和《社区获得性肺炎诊断与治疗指南》评价其合理性。方法：采用回顾性的调查方法,对103例CAP患者按使用抗菌药物的种类、使用频率、疗程、费用金额、给药途径、联合用药、静脉给药时间、治疗结果、细菌培养和药敏试验、不合理用药等进行统计分析。结果：注射用抗菌药物使用频率前3位的是氟喹诺酮类、林可霉素与克林霉素类和青霉素类;人均抗菌药物费用1178.58元,平均每例住院患者每日使用抗菌药物费用98.79元,住院总费用与抗菌药物费用比为2.76：1;本组病例以静脉给药＋出院带口服药治疗途径为主;静脉给药时间平均（6.94±4.32）d;处方者按药敏试验结果调整用药方案的仅1例;联合用药以二联为主,占94.16%。结论：我院CAP住院患者抗菌药物临床使用趋于合理,但临床处方者用药水平仍需进一步提高。     

112例社区获得性肺炎患者使用抗菌药的分析

目的通过对宁乡县人民医院112例社区获得性肺炎(CAP)患者的抗菌药物的使用情况进行调查分析和合理性研究,提高医院的用药水平和增强临床医师合理用药意识。方法回顾性分析宁乡县人民医院2009年7月至2010年8月住院治疗的112例CAP患者的抗菌药给药途径、抗菌药使用情况、抗菌药费用及相关费用、联用抗菌药物的品种、临床疗效及不良反应发生情况。结果 CAP抗菌药物的主要给药途径为静脉注射;喹诺酮类和头孢菌素类是应用最广的抗菌药种类;112例CAP患者抗菌药物总费用为121453.5元;治疗以两种抗菌药联用居多,占55.4%;治疗总有效率为99.1%,不良反应发生率为5.3%。结论宁乡县人民医院CAP住院病例抗菌药物应用基本合理。     

社区获得性肺炎药物临床应用调查与分析

目的 调查和分析该院社区获得性肺炎(CAP)患者的抗菌药物临床应用情况.方法 抽查该院呼吸内科14例CAP患者的住院病历,对其药物的应用情况进行调查、统计分析,采用选药评价、药动学指标、联合用药评价、药效学指标4个方面、21个分解点进行评价.结果 抗菌药物使用率为100.0%,一联、二联用药占28.57%,三联及以上用药占42.86%.呼吸内科平均药品费用/住院平均费用比例和抗菌药物平均费用/平均药品费用比例偏高.结论 该院CAP住院患者抗菌药物使用基本合理,但用药水平还需进一步提高.     

我院100例社区获得性肺炎患者抗菌药物应用分析

目的:了解我院社区获得性肺炎(CAP)患者抗菌药物的应用情况。方法:采用回顾性调查方法,对我院2009年CAP患者的抗菌药物应用情况进行统计、分析。结果:100例CAP患者中,入院4h内接受抗菌药物治疗的有96例(占96.0%);共涉及8类54种抗菌药物,其中应用最多的是头孢菌素类,达135频次(占51.7%),其次为喹诺酮类,共57频次(占21.8%);联合用药以头孢菌素类+喹诺酮类最常见(占51.0%)。结论:我院对CAP的诊疗基本符合"CAP的单病种质量控制指标",抗菌药物应用基本规范,但在品种选择、应用时机及联合用药方面仍存在个别不合理现象,需进一步加强管理。     

我院社区获得性肺炎患者抗菌药物治疗的回顾性分析

目的:回顾性分析北京大学人民医院2009年4月-2011年2月社区获得性肺炎(CAP)患者抗菌药物的治疗状况,以期为我院CAP患者合理使用抗菌药物提供依据。方法:采用药品用药频度(DDDs)和SPSS 13.0统计分析软件,对我院2009年4月-2011年2月住院治疗的CAP患者临床基本资料及抗菌药物使用情况进行统计和分析。结果:2009年4月-2011年2月我院住院CAP患者的平均住院日为13.32 d,老年患者的平均住院日显著长于中、青年患者。住院的CAP患者痰培养的送检率与阳性率分别为73.36%和33.12%。选用的经验性抗菌药物主要为β-内酰胺类、喹诺酮类和大环内酯类抗菌药物,其选用比率分别为20.37%,20.19%和12.52%。结论:2009年4月-2011年2月我院住院CAP患者痰培养率较高,但培养结果仍需要根据患者的临床体征辩证的分析。经验性抗感染治疗以β-内酰胺类、喹诺酮类和大环内酯类药物单用或联用为主,基本符合了我国《社区获得性肺炎诊断和治疗指南》中的推荐用药。     

市级医院抗菌药物不合理应用的调查分析及对策

目的 调查抗菌药物临床应用现状,探讨抗菌药物的合理应用方法,避免临床上滥用抗菌药物.方法 选择2009~2010年我市某市级医院使用抗菌药物的处方,对照<抗菌药物临床应用指导原则>进行合理性分析.结果 共抽取抗菌药物处方9260张,其中不合理应用抗菌药物处方821张,占8.86%,抗菌药物的不合理应用主要有用法不正确、滥用抗生素、选药不合理、联合用药不合理、用量过大,其中以用法不正确为主.结论 为了使抗菌药物的应用合理化,医疗机构应该根据<抗菌药物临床应用指导原则>,结合本医疗机构实际情况定期举办抗菌药物知识的讲座,加强用药指导,制定抗菌药物临床应用实施细则,建立健全的监督管理制度,是保证抗菌药物合理应用的重要基础.     

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.