乳腺癌患者超说明书用药方案的评价分析

摘 要 目的：对乳腺癌患者治疗方案中符合说明书和超说明书用药分别进行有效率、安全性、经济性评价。 方法: 根据药品说明书将1 206例次住院乳腺癌患者分为超说明书用药组和符合说明书用药组。依据《中国抗癌协会乳腺癌诊治指南与规范（2017版）》和《NCCN乳腺癌临床实践指南（2017版）》进行治疗方案评价,有效性评价按照实体瘤的反应评价标准（RECIST）评价,不良事件评价按照CTACE4.03标准,经济性评价包括住院费、药费和抗肿瘤药物费用分析。 结果: 超说明书用药组有效率高于符合说明书用药组（100% vs. 83.53%,P<0.05）;超说明书用药组的低蛋白血症、白细胞降低、中性粒细胞降低、碱性磷酸酶升高、γ 谷氨酰胺转肽酶升高、胆红素升高发生率高于符合说明书用药组（P<0.05或P<0.01）;符合说明书用药组患者抗肿瘤药物费用、总药费、住院费均明显低于超说明书用药组（P<0.01）。 结论: 超说明书用药组的有效率高于符合说明书用药组,但治疗费用和不良反应发生率均明显高于符合说明书用药组。     

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。     

PDCA循环干预Ⅰ类切口手术围手术期预防使用抗菌药效果分析

摘 要 目的：评价PDCA循环干预某院Ⅰ类切口手术围手术期预防使用抗菌药的效果。方法: 采用回顾性分析方法,随机抽取某院PDCA循环干预前（2015年1~6月）、第一轮PDCA循环干预后（2016年1~6月）,第二轮PDCA循环干预后（2017年1~6月）各600例行Ⅰ类切口手术患者的出院病历,比较分析围手术期抗菌药的预防使用情况。结果: 第二轮PDCA循环干预后,该院Ⅰ类切口手术围手术期抗菌药预防使用率由80.1%降至24.5%（P＜0.05）,药物选择、用药时长、用药时机、用法用量的不合理率均较PDCA循环干预前明显下降（P＜0.05）,人均抗菌药费用、抗菌药占药品费用、抗菌药占住院费用比例明显下降(P＜0.05)。结论: PDCA循环干预能有效地促进Ⅰ类切口手术围手术期预防用抗菌药合理使用。     

超声引导锁骨上臂丛神经阻滞用于上肢手术效果观察

摘 要 目的：观察超声引导锁骨上臂丛神经阻滞用于上肢手术的效果。方法: 选取我院上肢手术治疗患者80例,随机分为超声引导组（n=40,采用超声引导锁骨上臂丛神经阻滞）和神经刺激器组（n=40,采用神经刺激器辅助定位锁骨上臂丛神经阻滞）。比较两组患者的阻滞效果、麻醉效果,麻醉完成时间、神经阻滞起效时间、神经阻滞持续时间,并发症等指标。结果: 超声引导组阻滞完全率为97.5%,显著高于神经刺激器组的65.0%;阻滞不全率则显著低于神经刺激器组;麻醉效果优良率为95.0%,也显著高于神经刺激器组的75.0%;差异均有统计学意义（P<0.05）。超声引导组麻醉完成时间、神经阻滞起效时间均显著短于神经刺激器组（P<0.05）,神经阻滞持续时间显著长于神经刺激器组（P<0.05）;并发症发生率显著低于神经刺激器组（P <0.05）。结论:超声引导较神经刺激器辅助定位锁骨上臂丛神经阻滞用于上肢手术效果优于采用神经刺激器辅助定位锁骨上臂丛神经阻滞。     

右美托咪定与丙泊酚联用于老年患者无痛胃镜麻醉的临床观察

摘 要 目的： 观察右美托咪定与丙泊酚联用在老年患者无痛胃镜麻醉中的效果及安全性。方法: 拟行无痛胃镜检查的老年患者70例随机分为观察组（35例）和对照组（35例）;观察组给予右美托咪定联合丙泊酚麻醉,对照组给予丙泊酚麻醉。比较两组患者的麻醉诱导时间、苏醒时间,患者不同时点的生命体征,术中并发症、药品不良反应等指标。结果: 观察组麻醉诱导时间、苏醒时间均短于对照组（P<0.01）。两组患者平均动脉压（MAP）在T2、T3、T4阶段均明显低于T1阶段（P<0.05或P<0.01）;对照组的HR在T3阶段、R在T2阶段均低于T1阶段（P<0.05）;观察组的RR在T2阶段明显低于T1阶段（P<0.05）;观察组MAP在T2、T3阶段明显高于对照组（P<0.01）,在T4阶段低于对照组（P<0.05）;观察组的HR在T3阶段明显高于对照组（P<0.05）。观察组患者术中并发症显著低于对照组（P<0.05）。结论:右美托咪定联合丙泊酚的麻醉效果与安全性均高于单用丙泊酚,值得临床推广应用。     

临床药师持续干预泌尿外科清洁手术预防用抗菌药合理使用的效果评价

摘 要 目的： 调查某院临床药师实施持续干预前后泌尿外科清洁手术预防用抗菌药（简称“预防用药”）的应用情况,为临床合理预防用药提供参考。方法: 提取我院泌尿外科2010年7月~2014年6月所有行清洁手术患者,根据干预时间和干预措施分别纳入干预前组（n=141）、第1阶段干预组（n=139）、第2阶段干预组（n=162）和第3阶段干预组（n=137）,对各组患者的预防用药情况进行统计分析。结果:实施持续干预后,第1阶段干预组、第2阶段干预组和第3阶段干预组的预防用药率由干预前的100%降至34.5%,18.5%和14.6%,预防用药的选药合理率由干预前的36.9%升至58.3%,63.3%和85.0%,预防用药时间由干预前的（138.2±31.6）h缩短至（89.9±48.0）h,（72.8±32.5）h和（45.1±29.5）h,差异均有统计学意义（P<0.01）。感染发生率呈下降趋势,从干预前的2.8%分别降至2.1%,1.8%和1.4%。结论: 临床药师的持续干预措施得力,干预效果显著,明显促进了泌尿外科清洁手术围手术期预防用药合理性。     

右美托咪啶复合麻醉对硬膜外血肿清除术患者脑保护效应

摘 要 目的:观察右美托咪啶复合麻醉对颅内硬膜外血肿清除术对患者的脑保护效应。方法：硬膜外血肿手术患者60例随机分成两组,分别给予丙泊酚复合麻醉和右美托咪啶复合麻醉,比较两组患者手术前后的神经功能、血清学指标及药品不良反应发生情况。结果：观察组患者术后24 h格拉斯哥昏迷评分(GCS评分)明显高于对照组(P<0.05),术后24 h的血清神经元特异性烯醇化酶（NSE）和内皮素（ET）水平均明显低于对照组(P<0.05);观察组患者药品不良反应发生率明显低于对照组（P<0.05）。结论：硬膜外血肿清除术患者采用右美托咪定复合麻醉,术后GCS评分与血清NSE、ET水平均明显优于采用丙泊酚复合麻醉的患者,且不良反应明显较少,提示右美托咪定复合麻醉对患者的脑保护效应更佳,且安全性高。     

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。     

复方亚甲蓝联合利多卡因骶管麻醉对肛肠手术患者术后应激指标的影响

摘 要 目的：探讨复方亚甲蓝联合利多卡因骶管麻醉对肛肠手术患者术后应激指标的影响。方法：采用回顾性研究方法,收集90例肛肠手术患者临床资料,根据麻醉用药不同分为观察组（n=45,行骶管注射复方亚甲蓝+利多卡因麻醉）和对照组（n=45,行骶管注射利多卡因麻醉）。对比两组术毕、术后3 h、12 h、24 h以及48 h时VAS评分差异,以及两组患者术前、术毕以及术后2 d时血清皮质醇（Cor）、去甲肾上腺素（NE）及肾上腺素（E）水平;观察两组术后胃肠功能恢复及并发症情况。结果：观察组患者术后各时点VAS评分均显著低于对照组（P<0.05）。与术前相比,两组患者术毕及术后2 d时血清Cor、NE以及E水平均显著升高,而观察组术毕及术后2 d时各应激指标均低于对照组（P<0.05）。观察组术后肠鸣音恢复时间、肛门排气时间以及排便时间均短于对照组（P<0.05）,术后肛门失禁、肛门灼痛感以及肛缘水肿发生率均明显低于对照组（P<0.05）。结论：复方亚甲蓝联合利多卡因骶管麻醉能够有效降低肛肠手术患者术后疼痛,减轻机体应激反应,促进术后胃肠功能恢复和减少并发症的发生。     

慢性阻塞性肺疾病患者全程化药学服务模式的建立与效果评价

摘 要 目的：建立慢性阻塞性肺疾病（COPD）住院患者全程化药学服务模式，考察其对患者用药安全性和有效性的影响。方法：采用随机、对照、前瞻性试验方法，将COPD住院患者随机分至试验组和对照组中。对照组患者接受传统的住院医疗服务项目，试验组患者在此基础上实施全程化药学服务。考察两组患者入院时和出院1个月随访时的用药依从性，患者满意度、用药偏差、药品不良事件(ADE)发生率和12个月后的非预约再入院率。结果：试验组出院1个月随访时的用药依从性较本组入院时明显提高（P<0.01），且显著高于同时期的对照组（P<0.01）。试验组对医疗过程及用药指导的满意度均显著高于对照组(P<0.01)，1年后非预约入院1次的比例和总的用药偏差发生率均明显低于对照组(P<0.01)。试验组发生的ADE（2例）少于对照组（9例），但差异无统计学意义（P>0.05）。结论：临床药师对患者进行全程化药学服务可显著改善患者的用药依从性和满意度、减少非预约再入院率、降低用药偏差，保证患者用药的安全性和有效性。     

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.