抗心律失常药导致室性心律失常187例临床分析

目的分析抗心律失常药导致室性心律失常的原因。方法应用动态心电图分析187例抗心律失常药致室性心律失常。结果各种抗心律失常药都有不同程度致心律失常不良反应,尤其Ic类抗心律失常药致室心律失常作用较强。结论当左室射血分数降低(LVEF40%),联合应用利尿剂及/或地高辛,和/或应用抗精神类药物,用药后QT间期离散度增加等都可出现致室性心律失常不良反应。     

635株鲍曼不动杆菌的分布及耐药性分析

目的分析南京第一医院鲍曼不动杆蒯的分布及对抗菌药物的耐药情况,指导临床合理用药。方法时南京第一医院2006年10月至2009年5月检出的635株鲍曼不动杆菌的分布及药敏结果作回顾性分析。结果共分离到革兰阴性非发酵菌2472株,其中鲍曼不动杆菌635株,占25．69％,是非发酵菌中仅次于铜绿假单胞菌位于第2位的感染菌,标本主要来源于痰液（85．04％）,病房集中于ICU（51．34％）。该菌对头孢哌酮／舒巴坦的敏感性较高,而对其他抗菌药物耐药严重,并出现多重耐药的菌株。结论南京第一医院鲍曼不动杆菌所占比例越来越大,应定期监测其分布和耐药情况,为临床合理使用抗菌药物提供依据。     

尼群地平对阿替洛尔在健康志愿者体内药代动力学影响

目的探讨在健康人体内联用尼群地平和阿替洛尔时，尼群地平对阿替洛尔药代动力学的影响。方法24名健康受试者随机分成A、B、C三组，每组8人，A组口服阿替洛尔片40mg，B组同时口服尼群地平片20mg和阿替洛尔片40mg，C组口服复方尼群地平片4片（每片含尼群地平5mg，阿替洛尔10mg）。用高效液相色谱法测定血浆阿替洛尔的浓度。结果A组与B组比较，尼群地平使阿替洛尔的AUC0-∞降低了11．7％，Cmax降低了8．6％；A组与C组比较，尼群地平使阿替洛尔的AUC0-∞升高了4．4％，Cmax升高了8．4％；其余药代动力学参数均无明显变化。结论在健康受试者体内单次服药时，尼群地平未对阿替洛尔的药代动力学参数产生显著性影响。     

308株鲍曼不动杆菌感染分布及耐药性分析

目的了解鲍曼不动杆菌的临床分布及其耐药性,为临床合理使用抗生素提供依据。方法对临床分离的308株鲍曼不动杆菌进行回顾性分析,计算对常用的16种抗生素耐药率。结果 308株鲍曼不动杆菌中,2008年72株(占22.38%),2009年109株(占35.39%),2010年127株(占41.23%)。科室分布:以呼吸科(70株)、老年干诊科(69株)、烧伤科(43株)为主。标本分布:以痰标本为主(210株),其次创面分泌物(39株);药敏试验除对头孢哌酮/舒巴坦和米诺环素耐药率较低外,对其余14种抗生素耐药率较高,表现为多药耐药,并呈逐年上升趋势。结论鲍曼不动杆菌多药耐药现象严重,应加强耐药性监测,了解耐药变迁情况,以指导临床合理用药。     

不同保肝药物预防性治疗对抗结核药所致肝损伤的影响

目的探讨不同保肝药物预防性保肝治疗对抗结核药所致肝损伤发生的影响。方法初治肺结核患者256例,其中对照组(n=62)行常规抗结核治疗,在此基础上,水飞蓟宾组(n=85)加用水飞蓟宾胶囊预防性治疗,双环醇组(n=109)加用双环醇片。结果治疗结束时,水飞蓟宾组、双环醇组、对照组病灶吸收有效率分别为95.29%(81/85)、95.41%(104/109)和88.71%(55/62),3组差异无统计学意义(P>0.05);水飞蓟宾组、双环醇组、对照组空洞缩小有效率分别为69.41%(59/85)、66.06%(72/109)和56.45%(35/62),3组差异无统计学意义(P>0.05);3组治疗2、4、8周末DILI发生率差异无统计学意义(P>0.05)。8周内水飞蓟宾组、双环醇组、对照组DILI总发生率分别为15.29%(13/85)、15.60%(17/109)和22.58%(14/62),3组差异无统计学意义(P>0.05)。除肝功能损伤外,3组不良反应发生率差异无统计学意义(P>0.05)。结论对无肝损伤易感患者采取抗炎保肝药及降酶药进行预防性保肝治疗的疗效不确切,在没有获得确切循证医学证据前,普遍开展预防性保肝用药应慎重。     

Effects of voriconazole on tacrolimus metabolism in a kidney transplant recipient

Infection occurs frequently in the organ transplant recipients during the post-transplant period because of immunosuppression. Therefore, prophylactic antimicrobial agents are often used. The azole antifungals, widely prescribed prophylactically, are known to have many drug–drug interactions. This report presents a case of drug–drug interaction between voriconazole and tacrolimus in a kidney transplant recipient. Voriconazole treatment led to a dramatic increase in tacrolimus concentration that required its discontinuation in spite of the manufacturer's guidelines that recommend a reduction of tacrolimus dosage by one-third. The present drug–drug interaction can be attributed to a strong inhibitory effect on cytochrome P450-3A4 activity by voriconazole. When voriconazole and tacrolimus are coadministered, close monitoring of tacrolimus blood levels is recommended as the rule-of-thumb reduction of tacrolimus dose by one-third may not be satisfactory.     

Influence of acetaminophen on antipyrine kinetics in rats

Studies have suggested that acetaminophen may inhibit the liver metabolism of several drugs. Due to the expected clinical relevance of these findings, the present study was undertaken to examine acetaminophen effects on in vivo drug metabolism in the rat, using the model substrate antipyrine. Oral doses of 15 mg/kg acetaminophen were administered twice daily for 7 days. Antipyrine kinetics were determined before and immediately after acetaminophen treatment in rats (used as their own control). Acetaminophen treatment significantly increased antipyrine half-life by 29% and reduced its clearance by 24%, without affecting its volume of distribution. Further studies are warranted to determine the relevance and mechanism of these findings.     

小剂量阿司匹林致不良反应的文献分析及护理

[目的]了解小剂量阿司匹林(75mg/d~150mg/d)致不良反应发生的特点、趋势及相关因素。[方法]检索《中国期刊全文数据库》2000年—2013年收载的有关小剂量阿司匹林致不良反应文献,筛选出符合卫生部不良反应诊断标准的文献27篇,共125例不良反应病例,并进行分类、统计、分析。[结果]小剂量阿司匹林不良反应以消化系统、血液系统的损害例数较多,占总例数的80.0%和5.6%。消化系统损害以上消化道出血为主,血液系统损害以血小板减少为主要表现。[结论]临床上小剂量使用阿司匹林过程中可能出现药物不良反应,应加强病人用药教育,密切关注不良反应,及时调整给药方法,以确保用药安全。     

临床分离主要细菌耐药监测结果统计分析

目的统计分析宜昌市中心人民医院2009年临床分离主要细菌耐药情况。方法细菌鉴定采用法国生物梅里埃API系统鉴定。药敏试验采用K-B法,抗菌谱遵照美国临床实验室标准化协会(CLSI)M100-S18指南。药敏结果以WHONET5.4软件进行统计分析。结果 2009年细菌室从临床共分离菌株1835株,其中革兰阴性杆菌占55.68%,革兰阳性球菌占34.05%,真菌占10.27%。大肠埃希菌和克雷伯菌属的超广谱β-内酰胺酶(ESBLs)产生率分别为68.2%和59.4%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)分别占金黄色葡萄球菌(MSSA)和凝固酶阴性葡萄球菌的60.4%和65.8%。屎肠球菌的耐药率高于粪肠球菌,但分离率低于粪肠球菌。氨基糖苷类对高度耐药肠球菌的产生率为58.1%。结论宜昌市中心人民医院产ESBLs的大肠埃希菌和克雷伯菌、MRSA、MRCNS的检出率较高,特别是泛耐药的鲍曼不动杆菌的耐药率明显高于国内其他医院,应引起重视。     

系统健康教育对老年抑郁症患者服药依从性的影响

目的：探讨系统健康教育对老年抑郁症患者服药依从性的影响。方法对52例老年抑郁症患者在药物治疗的基础上联合系统健康教育,观察1个月。于健康教育前后评定服药依从性。结果健康教育后,入组患者服药依从性较干预前显著提高（P＜0．01）。结论系统健康教育能有效提高老年抑郁症患者的服药依从性,对提高生活质量、促进患者早日康复具有重要作用。     

Consequences of adolescent drug use on psychiatric disorders in early adulthood

This article summarizes the existing literature on the relationship between adolescent drug use and abuse and the development of psychiatric disorders in adulthood. In recent years, there has been increased awareness of the co-occurrence of drug abuse and psychiatric disorders in adolescence and young adulthood. Few longitudinal studies, however, have examined specifically the impact of earlier drug use and abuse on later psychiatric disorders. The literature suggests three possible models to explain the relation between drug use and abuse and psychiatric disorders. According to the first model, adolescent psychiatric disorders precede drug use and abuse. A second model postulates that psychiatric disorders and drug use are correlated because they share one or more common aetiological factor(s). The third model posits that drug use and abuse predict or precede certain psychiatric disorders. We present data from a recent longitudinal study to support this latter model. As drug use and abuse have been shown to increase the likelihood of psychiatric disorders, it is clear that medical attention needs to be given to adolescents who use drugs of abuse. It is expected that a decrease in adolescent drug abuse should lead to an accompanying reduction in later psychiatric disorders.     

新型冠状病毒肺炎合并心血管疾病的临床治疗观察

目的 探讨新型冠状病毒肺炎(COVID-19)合并心血管疾病患者治疗措施.方法 收集155例COVID-19患者临床资料,分析155例患者治疗用药情况,并对21例合并心血管疾病患者临床治疗进行分析.结果COVID-19合并心血管疾病单中心发病率13.5％,其中高血压患者较多(95.2％),老年COVID-19患者合并心...     

286株金黄色葡萄球菌临床分布及耐药性分析

目的：分析2013年住院及门诊患者送检微生物培养标本分离得到的金黄色葡萄球菌临床分布及耐药性情况。方法对2013年分离得到的金黄色葡萄球菌进行细菌培养鉴定及药敏试验,并对结果进行分析。结果共分离得到286株金黄色葡萄球菌,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为46．85％。呼吸道标本中的金黄色葡萄球菌和MRSA检出率均为最高。金黄色葡萄球菌主要分布于ICU、神经外科、创伤骨科、呼吸内科等临床科室。金黄色葡萄球菌对青霉素和氨苄西林耐药率较高,多数抗菌药物对甲氧西林敏感的金黄色葡萄球菌（MSSA）与MRSA的耐药率存在差异。结论监测金黄色葡萄球菌耐药性,对临床合理选择抗菌药物十分重要。     

心血管内科患者的合理用药及用药安全的探讨

目的：探讨该院心血管内科患者的合理用药及用药安全问题，为合理治疗提供依据。方法对2010年9月至2013年9月期间该院心血管内科收治的83例高血压患者，使用自行设计的调查问卷进行患者的用药情况及用药依从性进行调查，并对临床用药中出现的问题进行分析。结果（1）降压治疗方案中使用较多的是钙通道阻断剂（CCB）和血管紧张素转换酶抑制剂（ACEI）。（2）病程小于10年的患者用药依从率（22．2％）明显低于病程大于或等于10年的患者（35．7％），差异具有统计学意义（ P＜0．05）。（3）抗菌药物应用不合理所占比例最大，达到38．5％，联合应用不合理达到30．1％。结论该院心内科高血压患者临床用药中出现的问题主要是抗菌药物使用不合理及配伍不合理等，应积极总结经验，构建合理安全的治疗方案以提高药效。     

某高校大学生不合理用药的现状及对策

目的了解高校大学生不合理用药现状,探讨不合理用药的对策。方法采用自制问卷,随机抽取300名在校大学生,对不合理用药状况进行调查。结果高校大学生不合理用药率达27.7%,无论病情是否需要,要求输液者达65.3%,用药只关心疗效占69.7%,用新药、贵药、进口药占36%。结论加强大学生药物基本知识教育刻不容缓,普及用药知识对大学生的身心健康和学业的顺利完成有重要的意义。     

A patient's perspective: the impact of adverse drug reactions on patients and their views on reporting

What is known and objective: Adverse drug reactions to prescribed medication are relatively common events. However, the impact such reactions have on patients and their attitude to reporting such events have only been poorly explored. Previous studies relying on self‐reporting patients indicate that altruism is an important factor. In the United Kingdom, patient reporting started in 2005; though, numbers of serious reports remain low. Method: A purposive sample of fifteen patients who had been admitted to an inner city hospital with an adverse drug reaction were interviewed using a semi‐structured questionnaire. Patients were asked to relate in their own words their experience of an adverse drug reaction. Patient’s reactions to the information leaflet, adherence to treatment and use of other sources of information on medication were assessed. Interviews were recorded, and a thematic analysis of patients’ responses was performed. Results and discussion: Analysis of the patient interviews demonstrated the reality of being admitted to hospital is often a frightening process with a significant emotional cost. Anger, isolation, resentment and blame were common factors, particularly when medicines had been prescribed for acute conditions. For patients with chronic conditions, a more phlegmatic approach was seen especially with conditions with a strong support networks. Patients felt that communication and information should have been more readily available from the health care professional who prescribed the medication, although few had read the patient information leaflet. Only a minority of patients linked the medication they had taken to the adverse event, although some had received false reassurance that the drug was not related to their illness creating additional barriers. In contrast to previous studies, many patients felt that adverse drug reporting was not their concern, particularly as they obtained little direct benefit from it. The majority of patients were unaware of the Yellow Card Scheme in the UK for patient reporting. Even when explained, the scheme was felt too cold and impersonal and not a patient’s ‘job’. What is new and conclusion: Patients having a severe adverse drug reaction following an acute illness felt negative emotions towards their health care provider. Those with a chronic condition rationalized the event and coped better with its impact. Neither group felt that reporting the adverse reaction was their responsibility. Encouraging patients to report remains important but expecting patients to report solely for altruistic purposes may be unrealistic.     

精神科门诊首发精神分裂症患者首次用药状况调查

目的 了解精神科门诊首发精神分裂症患者首次用药状况,为提高临床合理用药水平提供依据.方法 将2000年1月-10月在我院精神科门诊治疗的180例首发精神分裂症患者设为A组,2010年1月-10月治疗的182例首发精神分裂症患者设为B组,对两组一般资料及用药状况进行调查分析.结果 A组73.89%单用一种抗精神病药物治疗,26.11%联合用抗精神病药物治疗,12.78%预防性应用盐酸苯海索,25.56%联合应用苯二氮艹卓类药物;B组93.96%单用一种抗精神病药物治疗,6.04%联合用抗精神病药物治疗,54.95%预防性应用盐酸苯海索,34.07%联合应用苯二氮艹卓类药物.B组单用抗精神病药物频度显著高于A组(χ2=27.08,P＜0.01).结论 我院精神科门诊首发精神分裂患者单用一种抗精神病药物治疗频度明显增高,首次用药状况趋向合理,新型非典型抗精神病药已成为临床用药主流,但仍存在预防性用药现象.     

瑞舒伐他汀对血脂正常老年单纯收缩期高血压患者动脉弹性的影响

目的观察瑞舒伐他汀对血脂正常老年单纯收缩期高血压（ISH）患者动脉弹性的影响。方法102例ISH患者,随机分为安慰剂组（60例）和瑞舒伐他汀治疗组（62例）,在服用降压药物基础上分别加服安慰剂1片或瑞舒伐他汀20 mg,每晚睡前服用,疗程6个月。每2个月随访1次,测量血压,检测踝肱脉搏波传导速度（baP-WV）。结果在治疗4个月后,治疗组baPWV及收缩压（SBP）、脉压（PP）较对照组降低（P〈0.05）;经6个月治疗后,治疗组baPWV及SBP、PP较对照组明显降低（P〈0.01）。结论瑞舒伐他汀对ISH患者具有降低baPWV,改善动脉弹性的作用,也有益于降低SBP、缩小PP。