我院2006—2008年肠内营养药物应用情况调查分析

目的：了解我院肠内营养药物的应用情况和趋势,为临床合理用药提供参考。方法：采用限定日剂量法,以销售金额、用药频度、日均费用为统计指标,对我院2006—2008年肠内营养剂的应用情况进行统计和分析。结果：我院2006—2008年肠内营养药物的销售金额和用药频度逐年上升,其中肠内营养粉剂（TP）、肠内营养乳剂（TPF-D）、肠内营养混悬液（SP）、肠内营养混悬液（TPF）在临床肠内营养的治疗中占主导地位。结论：临床医生应重视肠内营养剂的使用,提供合理的营养支持方案。     

2013-2015年南京地区29家医院肠内营养药物用药分析

目的：分析2013-2015年南京地区肠内营养药品的使用情况及用药趋势,为肠内营养药品的合理使用提供参考。方法：采用金额排序法和用药频度排序法,对南京地区29家医院2013-2015年临床使用的肠内营养药品进行统计和分析。结果：肠内营养药品用药金额逐年递增,肠内营养混悬液SP（百普力）一直保持销售金额和用药频度第一位。结论：2013-2015年南京地区肠内营养药品销售金额呈上升趋势,用药结构基本合理。     

我国六城市重症医学科患者肠内营养药物应用现状

目的 分析2014—2020年我国6城市重症医学科患者营养支持药物的应用现状,评价重症医学科患者肠内营养药物使用的合理性。方法 抽取医院处方分析合作项目课题组收集的全国6城市各级医疗卫生机构重症医学科使用肠内营养药物的医嘱信息,对药品使用量、使用人次、药品品种进行分析与计算。结果 共调查全国6城市94家医疗机构,其中三级医院79家（84.04%）、二级医院12家（12.77%）、一级医院3家（3.19%）。2014—2020年6城市重症医学科患者营养支持药物的使用率为36.05%,使用呈增长的趋势。其中肠内营养药物的年均增长率为6.77%,肠外营养药物的年均增长率为2.04%。2014—2020年我国6城市重症医学科内肠外营养/肠内营养的总比值为1∶1.09。肠内营养药物使用量排在前3位的药物分别是整蛋白型-通用型肠内营养药物、整蛋白型-糖尿病型肠内营养药物和整蛋白型-肿瘤型肠内营养药物,其使用量分别为227 087瓶（袋/桶）、144 376瓶（袋/桶）、114 317瓶（袋/桶）。2类疾病特异型肠内营养药物（糖尿病型、肿瘤型）的使用量总和显著大于通用型肠内营养药物的使用量。结论 重...     

眼科超说明书用药现状及其影响因素分析

目的：对我院2015年眼科住院患者超说明书用药现状及其影响因素进行回顾性调查,促进眼科临床合理用药。方法：从我院9个临床科室随机抽取2015年住院病历各100份,共计900份,抽查用药医嘱14324条,涉及药品152种。对病历中的用药医嘱逐条进行分析,判断是否超说明书及超说明书用药的类型,分析各年龄组、各类药品、各科室超说明书用药情况以及与患者年龄、性别、科室、医师级别的关系,采用Micromedex的Thomson分级系统进行超说明书用药的证据查询。结果：按患者、用药医嘱与药品品种计,超说明书用药发生率分别为78.67%、14.45%和17.11%。χ²检验结果表明,超说明书用药发生率最高的科室为白内障科（21.2%）和玻璃体视网膜科（20.59%）,抗肿瘤药及免疫调节剂超说明书发生率最高（100%）。经查证,所抽查的2070项超说明书用药医嘱均有证据支持,其中证据构成比排名前两位的是专家共识（41.45%）和国际指南（37.39%）。超说明书用药的logistic多因素分析结果表明,患者科室和年龄的OR（95% CI）分别为0.96（0.941~0.980）和1.182（1.128~1.239）。结论：眼科超说明书用药的药物种类相对较少,相关影响因素为住院患者所在科室和年龄。为规避医师职业风险并为患者提供更多的治疗机会,超说明书用药需要提供循证医学证据,同时建议将合理的超说明书用药及时载入药品说明书。     

住院患者质子泵抑制剂使用情况调查

目的：调查住院患者质子泵抑制剂（PPIs）使用情况,为临床合理用药及制定管理措施提供参考。方法：通过医院计算机信息管理系统,从2011年1月-12月全部36741例住院患者中统计：住院总人次及药品销售总金额;使用PPIS人次及销售金额;各种PPIs使用人次及销售金额;PPIs针剂使用人次及销售金额;PPIs片剂使用人次及销售金额;各病区住院总人次及使用PPIS人次。然后随机抽取40个临床科室使用了PPIs的病历240份进行统计与分析。结果：住院患者中PPIs使用率34.86%,药占比为4.29%;使用率超过50%的科室有消化内科、急诊科、重症监护病房、肿瘤科、神经外科、呼吸内科和神经内科等; PPIs使用人次及销售金额以泮托拉唑肠溶片居首;不合理使用的病历数161份（67.08%,161/240）,其中以超适应症用药最多（占80.74%,130/161）。结论：我院住院患者中PPIs的使用情况存在不少不合理使用情况,严格按药品说明书用药、国家和医院应制定PPIs使用指南或行政规定是规范PPIs使用的根本措施。     

我院开展病区用药医嘱点评模式探讨

目的：探索适合我院病区用药医嘱点评的模式,促进临床合理用药。方法：根据我院用药与临床药师水平实际情况,初步制定医嘱点评模式及干预措施,并对我院2012年3月-2013年10月月使用金额排序前十位且异常增长的药品选两种随机抽取一时间段架上病历进行点评。结果：共点评病区用药医嘱单487份,涉及药品30种,39品次,平均不合理医嘱率为30.0%,其中,不合理医嘱主要为超说明书适应证用药（54.1%）,不良反应预防及监测不当（20.6%）,品种选择不当（11.6%）,用法用量不适宜（11.0%）,超禁忌证使用（2.7%）,医务科每月将不合理结果纳入医疗质量整改通知书发至各科室,要求各科室进行整改回复,各个科室将整改情况于规定时间内反馈至内网专栏。结论：该模式可有效评价不合理医嘱,丰富临床药师用药经验,借以引起临床医生警惕,减少不合理医嘱的产生。     

某院静脉用药调配中心医嘱用药适宜性回顾分析

目的 了解某三级甲等医院静脉用药集中调配中心（PIVAS）静脉用药医嘱的适宜性,以促进静脉用药的合理使用。方法 采用回顾性分析法,通过医院信息系统（HIS）抽取该院PIVAS 2019年7月至2020年6月的长期静脉用药医嘱,分析医嘱的适宜性,以及不适宜医嘱错误类型、科室分布、药品分布等,并根据产生原因提出有针对性的改进措施。结果 共收集到长期静脉用药医嘱113 550条,其中不适宜医嘱1 298条,不适宜率为1.14%。其中,错误类型主要为用法用量不适宜（75.19%）,其次为溶剂选用不适宜（16.64%）,配伍禁忌（0.39%）、遴选药品不适宜（0.15%）占比较低;分布科室中,产科（包括一病区和二病区）、妇科的医嘱不适宜率较高,分别占8.24%和3.04%;药品分布中,蔗糖铁注射液（36.59%）及注射用帕瑞昔布钠（21.57%）为占比较高的2种药品。针对以上分析,建议PIVAS药师深入临床,掌握临床静脉用药现状,制订风险防范措施,对高风险科室及药品加强宣教;药师审方时严格把关,并将处方点评结果纳入医师考核指标,建立奖惩制度;优化临床用药路径,慎用易出错药品;借助医嘱录入系统等软...     

临床药师参与的抗菌药物医嘱用药干预情况分析

目的：分析由临床药师主导的抗菌药物医嘱用药干预情况,为临床抗菌药物的合理使用提供参考。方法：利用医院信息系统,收集2019年6月—2020年9月有临床药师实施用药干预的1 226条抗菌药物医嘱,分析所涉及抗菌药物医嘱的不合理原因和干预结果,以及干预成功医嘱的科室分布、药物品种分布和抗菌药物使用变化情况。结果：实施用药干预的1 226条抗菌药物医嘱中有1 140条干预成功,其中医嘱的不合理原因主要为用药疗程过长（369条,占32.37%）、药品选择不适宜（190条,占16.67%）、单次用药剂量过大（172条,占15.09%）、联合用药不适宜（148条,占12.98%）和给药频次过高（130条,占11.40%）;1 140条干预成功的抗菌药物医嘱涉及的科室主要为骨科（212条,占18.60%）、口腔科（152条,占13.33%）、肝胆外科（107条,占9.39%）和手外科（103条,占9.04%）,骨科、口腔科、手外科的医嘱不合理原因主要为用药疗程过长,而肝胆外科的医嘱不合理原因主要为药品选择不适宜;1 140条干预成功的抗菌药物医嘱涉及的药物主要为五水头孢唑林（252条,占22.11%...     

2011～2015年北京大学第三医院成人住院患者营养药品应用调查

摘 要 目的：调查北京大学第三医院成人住院患者营养药品的临床使用情况。方法：回顾性分析2011～2015年全院住院患者营养药品的使用率、使用结构变化,应用营养药品患者的疾病分布。结果：2011～2015年,住院患者的营养药品占住院药品总金额的比例维持稳定,肠外营养（PN）药品约占2.56%,肠内营养（EN）药品约占1.79%。PN用药人数占同期出院人数的比例自5.90%上升至6.31%,EN用药自1.53%上升至2.15%。PN药品的人均日用量自0.16瓶（袋）上升至0.23瓶（袋）。其中配置全合一三升袋占PN总使用人次的比例自6.55%上升至13.66%,多腔袋自28.84%增至36.58%,单瓶输注现象同比下降,降幅达36.11%。EN人均日用量稳定波动于0.11～0.13瓶（袋）。消化道恶性肿瘤、肠梗阻、梗阻性黄疸、血液肿瘤、急性胰腺炎等是PN的主要患者人群。脑血管疾病、呼吸衰竭、呼吸系统感染以及运动神经元病变等是使用EN的主要患者人群。结论：近5年我院营养药品的使用率逐步提高,不同类型营养制剂的结构变化表明临床选择基本合理。使用营养药品的患者人群符合指南推荐,并有我院特色。未来需进一步提高肠内营养制剂的使用率。     

2014—2016年南京军区福州总医院肠内外营养药物的使用情况分析

目的 分析南京军区福州总医院肠内外营养药物的使用情况,为规范临床合理用药提供参考.方法 提取2014—2016年南京军区福州总医院肠内外营养药物的使用数量和2016年各科室肠内外营养药的应用金额,并从2016年应用肠内外营养药物的住院患者中随机抽取300例进行回顾性分析,分析其用药合理性.结果 2014—2016年,全院肠内外营养药物的数量和使用金额呈上升趋势,肠内外营养药物所占全院药品的构成比相对稳定.整蛋白型肠内营养药物的应用数量远大于短肽型肠内营养药物.肠外营养药物中,18种氨基酸注射液、中/长链脂肪乳注射液(20%)的使用数量位于前列.2016年使用肠内外营养药物较多的科室主要有神经外科、普通外科、肝胆外科.不合理使用比例最高科室为妇产科,构成比为51.86%.不合理用药中无指征用药居多,构成比为27.33%.结论 2014—2016年南京军区福州总医院肠内外营养药物使用基本合理,但仍存在一些问题,需持续改进.     

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.