某三甲医院专项整治前后住院患者抗菌药使用及医院感染情况对比

摘 要 目的:了解专项整治前后某三甲医院住院患者抗菌药使用情况及医院感染率的变化,为抗菌药的管理提供依据。方法： 调取某三甲医院2010年7～12月（整治前）和2012年7～12月（整治后）住院患者抗菌药使用数据,并进行统计分析。结果：该院专项整治前后抗菌药8项指标发生明显变化：住院患者抗菌药使用率分别为75.84%和54.46%、使用强度（AUD）分别为82.63和52.77 DDD/100人天、特殊使用类抗菌药使用量占抗菌药总使用量比例分别为21.33%和12.73%、Ⅰ类切口手术预防用抗菌药比例分别为100%和45%、介入诊疗手术预防用抗菌药比例分别为100%和0%、治疗用药微生物检验样本送检率分别为38%和43%、住院患者人均使用抗菌药费用分别为1 455元和812元、抗菌药费用占药物总费用比例分别为28.98%和14.38%,手术科室的变化尤为明显,医院感染率有所降低。结论：某三甲医院通过实施抗菌药物专项整治和双重干预措施,各项抗菌药应用指标发生明显改善,且多项指标已符合卫生部规定,专项整治的效果比较明显。重症医学室（ICU）的抗菌药使用方面仍然需要提出更具效果的措施,加强监管。     

药品零差率政策的实施对新农合住院费用及其基金的影响

摘 要 目的: 探讨我区实施药品零差率政策对新农合住院费用及其基金的影响。方法: 对2009～2012年我区药品零差率政策实施前后各级定点医疗机构收治住院患者的相关数据进行对比分析。结果:零差率政策实施后卫生院次均住院费用大幅下降,2012年住院患者流向不合理,区医院和区外三级住院次均费用和次均补偿费用均高于往年,导致我区该年新农合基金出现透支。结论:应增加新农合用药范围、改革支付方式,合理利用卫生资源,控制医疗费用不合理增长,确保新农合基金安全运行。     

某医院成人社区获得性肺炎住院费用分析

摘 要 目的：分析某医院社区获得性肺炎成人患者的住院费用及其结构,探讨单病种付费及按日付费方法。方法: 分别调查某医院2007年、2010年、2013年、2016年等年份中1～3月社区获得性肺炎成人患者的住院费用及其构成情况。引入基础住院费概念,分析不同年份总费用及其各组成的变化。结果: 2007～2016年人均住院费用由5 038.80元上升到13 453.10元,日均住院费用由482.79元上升到1 244.27元,其中药费占比最大,平均为63.06%。日均费用中基础住院费占总费用比例逐年减少,药费占基础住院费用比例较平稳。 结论: 成人社区获得性肺炎住院费用中药费占主要,单纯控制药占比不能降低药费。基础住院费按病种付费方法和按日付费方法有其合理性,有待进一步研究。     

我院重点监控药品监管前后合理用药指标变化

摘 要 目的：加强监管医院重点监控的药品,在新医改形势下降低药品费用,提升临床用药管理水平。方法：通过制定医院重点监控药品目录、药师监控全方位覆盖、结合医保每日点评、三级培训、厂家约谈、停药公示、目录优化调整、信息化管控、绩效考核等措施建立重点监控药品合理使用长效管理体系,并对我院建立重点监控药品监管前（2017年5月）与监管后（2018年5月）药占比、重点监控药品占比、基本药物使用比例、重点监控药品不合理用药比例、销售金额前10位药品排序进行统计分析。结果：与监管前比较,监管后我院药占比从45.52%降至32.46%,降幅为28.69%;重点监控药品占比的降幅为37.03%,不合理用药比例的降幅为41.35%;抗菌药物使用强度的降幅为11.6%;基本药物使用比例的增幅为6.64%;人均住院用药品种数量从8.17种降至6.96种,降幅为14.81%;销售金额前10位药品中出现了临床治疗指南推荐的治疗用药。结论：医院应结合院内用药特点、当地重点监控药品监管办法及医保政策从停药、针对性的医师处方权限制、信息化监管、重点监控药品目录调整、合理用药点评及培训等环节进行相应监管,从而促进重点监控药品的监控管理,降低药占比,提高合理用药水平。     

加速康复外科理念对某院患者围手术期麻醉用药费用的影响

摘 要 目的：分析加速康复外科（ERAS）理念对某院外科手术麻醉用药的影响,为临床合理用药提供依据。方法: 采用回顾性分析的方法,选取2016年6～12月耳鼻咽喉科、妇科、泌尿外科手术患者中实行ERAS的患者,进入ERAS组;从同期相同科室手术患者中选择传统外科手术患者（传统组）进行配对。对两组患者围手术期的麻醉用药情况进行分析比较。结果:ERAS组的麻醉用药费用、镇痛泵使用率及费用、人均住院药品费用均明显低于传统组（P<0.05或P<0.01）。结论:ERAS理念的推广,在使患者得到优质诊疗的同时,能够降低外科手术患者的麻醉用药费用,降低患者的住院药品费用,降低药占比。     

医院床位周转率对药占比的影响

摘 要 目的： 探讨住院患者费用在整个住院期间的分布走势,找出其占最大权重的住院时间段,为医院控制患者住院天数提高床位周转率、保障医疗安全提供有效依据。方法: 分析我院2013年9月～2013年11月出院的2 444例住院时间在1～20d的病例,对其进行分组（内科组、外科手术组与外科非手术组）统计住院费用、药品费用等指标,并进行比较。结果: 内科与外科手术组及外科非手术组日费用总体比较,差异有统计学意义（P<0.01),而外科手术组与外科非手术组日费用总体比较,差异无统计学意义(P>0.05);手术组日费用呈直线下降趋势,内科及外科非手术组呈对数曲线下降趋势;各组内前后10 d费用比较,差异有统计学意义（P<0.05）, 药占比在内、外科组均显示随着住院天数的延长而逐渐上升。 结论:缩短住院天数是降低药占比的有效方法。外科最为明显,药品比例随住院天数延长而上升。     

ABC-VED分类法在传染病医院药库药品管理的应用

摘 要 目的： 探讨ABC VED分类法在传染病医院药品库存管理的应用效果。方法: 基于2012年数据应用ABC VED分类法对药库库存药品进行分类管理和采购。采集2012～2014年医院药库药品出入库数据,统计分析方法实施前后药库月周转率和缺药率变化。结果: 药库药品基于ABC VED矩阵分析实施分级管理后,月库存周转率由2012年的约（143.4±10.1）%显著提升至2013年的（190.1±8.9）%和2014年的（208.8±11.5）%（P<0.05）;缺药率由2012年的约(0.62±0.04)%显著下降至2013年的（0.44±0.03）%和2014年的（0.39±0.04）%（P<0.05）。结论:基于VED的ABC分类法可以降低药品库存成本和减少缺药情况。     

北京市85家二、三级公立医院心血管类原研药与仿制药利用分析

摘 要 目的：以心血管类药物为例,分析原研药和仿制药在公立医院的销售量、销售价格和销售金额,为促进仿制药的使用提供证据支持和提出政策建议。方法：从国家食品药品监督管理总局南方医药经济研究所医药数据库及北京市医药阳光采购综合管理平台提取数据,选择其中包含的北京市全部公立医院（共计85家二级和三级医院）的11种心血管类药物,分析2015年每种药物的原研药和仿制药销售量占比、销售金额占比、价格比和仿制药替代原研药的潜在费用节省率。结果：11种目标心血管类药物原研药与仿制药的平均销售金额占比分别为81.07%和18.93%;平均销售量占比分别为74.68%和25.32%;价格比在1.01~5.77之间,价格比平均值为2.09,中位数为1.61;仿制药替代原研药潜在可节省费用总计4.10亿元,费用节省率达59.21%。结论：11种目标心血管类药物的仿制药2015年在北京市二、三级公立医院中占有的市场份额很少。在公立医院中以质量和疗效有保障的仿制药替代原研药将节约大量药品费用。建议加快仿制药质量和疗效一致性评价,增强公众对仿制药质量和疗效的信心,以便尽快建立仿制药替代制度,通过医保支付配套政策鼓励仿制药的采购、处方和使用,以节省医药费用支出     

476例药品不良反应报告分析

摘 要 目的：分析某三甲医院2015年药品不良反应(ADR)发生的特点和规律,促进临床安全用药。方法：采用回顾性调查方法,对该院2015年上报的476例有效ADR报告,按照患者性别、年龄、给药途径、药品种类、涉及的器官或系统及其临床表现等进行统计分析。结果：476例ADR报告中,年龄分段在0～10岁的婴幼儿患者 ADR构成比较高,占49.16%;静脉给药导致ADR占87.39%;ADR构成比最高的为抗感染药,占66.15%,其次为中药制剂,占10.12％;临床表现以皮肤及其附件损害最为常见,占60.81%。结论：医务人员应重视 ADR的监测与报告,促进临床合理用药,保障患者用药安全。     

中药临床药师参与骨科中医临床路径制定与实施效果的对照研究

摘 要 目的：探讨中药临床药师在骨科中医临床路径的制定与实施中发挥的作用和效果。方法: 选择2009~2011年入组桡骨骨折临床路径的患者60例作为对照组,2015~2016年桡骨骨折患者54例作为观察组,观察组实施的中医临床路径由中药临床药师与医师共同制定,并全程由中药临床药师进行药学监护。对比两组临床疗效并通过观察两组中药的合理使用率、平均住院时间、平均中药费用和药品不良反应（ADR）发生率的变化,评价中药临床药师参与临床路径制定与实施的效果。结果: 中药临床药师参与中医临床路径制定和实施后,较参与前患者的治疗总有效率由80.0%提高至92.6%,中药合理使用率由60.0%提高至85.2%（P＜0.05）;平均住院时间由(14.0±2.3) d缩短至(11.0±3.1) d,平均中药费用由(887.07±186.44)元降低至(437.14±127.32)元（P＜0.05）;ADR发生率由16.7%下降至11.1%。结论: 中药临床药师在临床路径的制定与实施中发挥了重要的作用,通过中药临床药师的参与,可明显促进患者安全、有效、合理和经济用药,有利于缩短患者住院时间,减少住院费用。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.