与抗癫(疒间)药相关的药物相互作用

目的:探讨抗癫药物之间以及抗癫与其他药物之间的相互作用.方法:检索国内外有关文献,归纳总结.结果:抗癫药存在肝药酶诱导、肝药酶抑制以及蛋白置换作用,药物治疗的相互作用不仅表现在抗癫药物之间,也表现在抗癫药物与其他药物之间.结论:掌握常见抗癫药物之间及与其他药物的相互作用,利于临床合理用药.     

癫合并烧伤患者的护理

癫是由于大脑功能紊乱而引起的一种综合病症,具有阵发性、突发性、刻板性,并常伴意识丧失[1]。癫患者发病时常伴有意外损伤,其中6%为烧伤、烫伤[2]。我院2003年10月~2004年10月共收治烧伤病人1 445例,其中癫合并烧伤18例,占1·25%,本组病人全部愈合。现将护理体会总结如下。1临床资料本组18例,男11例,女7例;年龄16~78岁,平均48岁;烧伤面积最小为2%,最大为47%;烧伤原因:热液烫伤8例,火焰烧伤10例,所有患者均在癫发作时接触热源,烧伤深度中Ⅰ~浅Ⅱ度创面占32%,深Ⅱ~Ⅲ度创面占68%。本组均经手术植皮后创面治愈,癫病情得以控制,平均住院38天。2…     

脑卒中继发癫发作临床分析(附520例报告)

目的探讨脑卒中继发癫临床特征及其发病机制。方法对520例住院确诊为急性脑卒中患者的临床资料进行回顾性分析。结果520例患者出现继发癫46例(8.84%)。继发癫的各类型卒中以蛛网膜下腔出血为多(33.33%),脑栓塞次之(19.23%),脑出血与脑血栓形成相近(分别为11.86%与12.00%),腔隙性脑梗死最少(2.08%),脑卒中后癫发作与病灶的部位(皮质或脑叶)密切相关(P<0.01),且以强直-阵挛性发作居多,占56.52%。结论脑卒中急性期癫发生率高,不同类型卒中继发癫发生率不同,病灶在皮质或脑叶者易出现继发性癫,发生机制可能为脑组织缺血缺氧,能量代谢障碍及胶质细胞增生,神经元变性等引起癫发作。     

天麻素调节癫疒间大鼠海马炎症信号通路的抗癫疒间机制研究

目的探讨天麻素调节戊四氮(PTZ)致癫疒间大鼠海马炎症信号通路的抗癫疒间机制。方法将40只成年Wistar大鼠随机分为正常对照组(NC)、癫疒间模型组(PTZ)、天麻素大剂量组(Gh)和天麻素小剂量组(Gs),观察四组大鼠的行为学和脑电图的变化,应用Western blot检测p38MAPK蛋白表达,ELISA方法测定大鼠海马IL-1β、IL-2、IL-6和肿瘤坏死因子(TNF-α)的含量。结果与PTZ组相比,Gh组大鼠癫疒间发作程度、脑电图改变、海马p38MAPK蛋白的表达和部分炎性细胞因子IL-1β、IL-2、IL-6和TNF-α的含量明显减少(P<0.01)。结论天麻素可通过降低癫疒间大鼠海马p38MAPK蛋白的表达、抑制部分炎性细胞因子IL-1β、IL-2、IL-6和TNF-α的分泌,从而影响炎症信号通路,以达到对抗癫疒间的效果。     

癫癎患者及家属的健康教育

我院2 0 0 0年1月～2 0 0 3年4月收治1 76例癫,护理人员通过对患者及其家属进行相关知识教育,使97%的患者顺利完成抗癫规范治疗,病情得到良好的控制,现报告如下。1　临床资料本组1 76例,男1 2 4例,女5 2例;年龄6～5 3岁,平均2 6岁;病程1～2 2年。行手术治疗者1 7例。所有患     

癫癎患者及家属的健康教育

我院2000年1月～2003年4月收治176例癫癎,护理人员通过对患者及其家属进行相关知识教育,使97%的患者顺利完成抗癫癎规范治疗,病情得到良好的控制,现报告如下.     

药师参与抗癫治疗药物监测的药学服务模式探讨

治疗药物监测(TDM)是癫患者医疗过程中的一个重要环节,本文通过简述药师在抗癫治疗药物监测工作内容中的作用,探讨药师参与抗癫治疗药物监测的药学服务模式。     

天麻素对癫疒间大鼠海马氧化应激水平的影响

目的研究天麻素对戊四氮(PTZ)致疒间大鼠海马氧化应激水平的影响。方法将30只成年Wistar大鼠随机分为正常对照(NC)组、癫疒间模型(PTZ)组、天麻素(GS)组,观察三组大鼠的行为学和脑电图的变化,采用比色法检测大鼠海马超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活力和丙二醛(MDA)含量的变化。结果与PTZ组比较,GS组大鼠癫疒间发作程度减轻,脑电图明显改变,海马组织中SOD和GSHPx活力增加,M DA含量明显减少(P<0.01)。结论天麻素可通过增加癫疒间大鼠海马SOD、GSH-Px活力、抑制M DA的产生,从而影响氧化应激水平,达到对抗癫疒间的效果。     

医院药师开展用药咨询的现状与思考

随着社会的发展,人们文化素质的提高,在紧张工作之余,健康已成为大众关注的热点、焦点。人们在吃好、穿好的同时,开始更多关注身心健康、养生、保健、疾病预防、合理用药。顺应时代潮流,医院药事学也从以“药物为中心”的药品供应转变为“药学服务”,由“面向药物”到“面向患者”。     

抗癫(癎)药物的选择与应用(Ⅰ)

1 什么是癫(癎)?其临床表现是什么? 癫(癎)(epilepsy)是由于大脑局部病灶神经元兴奋性过高,产生阵发性放电并向周围扩散的大脑功能失调的一组临床综合征.按有关神经元的部位和放电扩散的范围,在临床上可表现为运动、意识、感觉、行为、自主神经等不同的障碍.这些功能障碍在一个患者身上可单一或数种存在,也可全部存在.     

临床药师床旁教育实践及患者依从性评价

目的 通过对老年慢性病患者开展用药教育实践,探讨临床药师床旁教育前后对患者用药依从性影响的评价。方法 临床药师对2017年6至12月在首都医科大学宣武医院急诊一病区住院的老年慢性病患者,使用教育模板制作用药教育材料并进行用药教育。结果 2017年6月至12月共对71名患者进行出院带药教育,出院一个月后对其中62名患者采用服药依从性量表（Morisky）进行依从性评估。结论 通过对患者的出院带药床旁指导,从而提高药物治疗的安全性和有效性,提高患者的用药依从性,并提高患者对药师服务的满意度。也为建立标准化的出院带药流程提供参考。     

The effect of pharmacist education on asthma treatment plans for simulated patients

Objective To determine if an educational program designed for community pharmacists to help patients self manage their asthma could improve pharmacists abilities to facilitate asthma treatment plans. Setting Hamilton and Toronto, Ontario, Canada. Method A randomized controlled trial involving volunteer community pharmacists who received either an asthma education program (AEP; intervention group) or a delayed AEP (control group). The AEP consisted of a one-day workshop and two follow-up telephone calls. Teaching methods progressed from a didactic approach to self-directed learning and role playing with simulated patients (SPs). The primary outcome was measured by SPs who conducted unannounced pharmacy visits. Main Outcomes Measures The number of appropriate (defined a priori) action plans facilitated by the pharmacist was the primary outcome. Facilitated was defined as the pharmacist recommending a specific plan, taking responsibility for telephoning the physician, or ensuring the patient would take responsibility for contacting the physician. Results Thirty-three pharmacists were randomized to the intervention group and 31 pharmacists were randomized to the control group. Pharmacists in the intervention group facilitated an appropriate plan in 44.8% of situations (117 out of a possible 261) compared with 29.3% (79 out of a possible 270) in the control group, (mean difference 15.5% (95% CI: 7.4–23.8%; P = 0.0004)). Intervention group pharmacists were better able to facilitate plans for the ‘under use of inhaled corticosteroids,’ ‘exposure to pet dander as an asthma trigger,’ and ‘overuse of short-acting beta-agonist’ problems. Intervention group pharmacists exhibited better overall communication skills (including empathy, coherence, verbal skills, and nonverbal skills). Conclusion This AEP produced improvements in pharmacists’ abilities to facilitate plans for SPs in a community pharmacy setting.     

The adverse effects of antiepileptic drugs in children

Efficacy of antiepileptic drugs (AEDs) are often equivalent, hence selection of an AED is often determined by the adverse effects (AEs). The development of neurocognitive AEs is almost inevitable with use of AEDs, especially in high-risk groups. Teratogenesis with major or minor malformations is of great concern during the first trimester of pregnancy, but an increasing body of information suggests that potential neurocognitive developmental delay may also occur with use of AEDs in the latter part of pregnancy. Decreased bone mineral density has been found in adults and children receiving both enzyme-inducing AEDs and valproate, an enzyme-inhibiting drug. AEDs may influence the lipid profile, body weight, reproductive, hormonal and other endocrine functions, and sleep architecture. There are age-specific AEs related to pharmacokinetic differences that have been highlighted in this review with emphasis on the pediatric population. A classification of AEs using different parameters is also included.     

抑郁症住院患者用药教育模式的建立

目的：建立抑郁症住院患者用药教育的模式,提高患者用药依从性,并为临床药师开展抑郁症用药教育提供规范化操作流程。方法：临床药师参与抑郁症住院患者的治疗过程,对患者进行全病程跟踪并在治疗过程中对患者进行用药教育。结果：建立系统、规范的抑郁症住院患者用药教育模式。结论：用药教育模式的建立有利于临床药师开展工作,提高患者对抑郁症以及药物治疗的认识和依从性。     

心脏瓣膜置换术后患者的出院健康教育

目的探讨心脏瓣膜置换术后患者的出院健康教育的效果。方法通过对21例患者出院后进行个体针对性的实施健康知识教育,使患者掌握自我护理保健的意识,提高生存质量,重点健康教育是生活护理、心理护理、抗凝药物的正确使用方法及副作用的观察。结果21例患者掌握了自我护理能力、抗凝药物的正确使用方法及副作用的观察方法、及时就诊,未发生死亡病例。结论出院健康教育是患者恢复健康的指南,通过对患者进行针对性出院健康教育,提高患者自我保健和自我护理能力,预防术后远期并发症发生,保证康复质量意义重大。     

临床药师参与社区获得性肺炎药物治疗的分析与体会

目的通过参与社区获得性肺炎患者的药物治疗实践,探讨临床药师参与抗感染治疗和开展药学监护的方法。方法以1例社区获得性肺炎住院患者的诊治过程为例,根据社区获得性肺炎防治指南,分析患者具体病理生理特点,临床药师与临床医师共同制定治疗方案,根据治疗反应和病情变化及时调整方案。结果通过临床药师对患者药物治疗过程的药学监护,使患者获得完善的个体化治疗,及时发现患者的药物治疗问题,促进临床合理用药,提高患者用药的安全性、有效性,并最终获得满意的疗效。结论临床药师深入临床后,努力将药学理论知识优势和临床实践相结合,不断提高药物治疗水平,获得临床认可,在治疗团队中实现自己的价值。     

象形图在患者药学教育中的应用

目的：考察象形图在国内外药学患者教育领域的应用现状。方法：查阅国内外相关象形图在患者药学教育领域应用的文献并进行分析总结。结果：在患者用药教育材料中引入象形图可以提高患者对于药品知识的理解和记忆,进而提高用药依从性和安全性,患者乐于接受。结论：象形图是患者教育的有效工具,值得在我国推广和应用。     

Differences between the concentrations of antiepileptic drugs in normal and pathological human brain

Summary The concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.     

The withdrawal of antiepileptic drugs in patients with non-epileptic seizures: safety considerations

The majority of patients with psychogenic non-epileptic seizures (PNES) do not have epilepsy. There are a number of compelling reasons to take these patients off antiepileptic drugs (AEDs), including drug toxicity and teratogenicity, as well as possibly poorer outcome of PNES and increased risk of iatrogenic harm when patients present to emergency rooms on AEDs as emergencies. However, many patients with PNES who do not have epilepsy remain on AEDs postdiagnosis. Some studies do report patients taken off medication as an outcome measure, but with no assessment of the safety of withdrawal, or specification of the criteria for ‘excluding’ epilepsy. One study has assessed the safety of taking patients satisfying some simple criteria for the absence of an underlying epilepsy off AEDs, and has found the procedure to be safe, given appropriate postwithdrawal follow-up. Patients with PNES who do not have evidence of epilepsy should be referred to a centre with appropriate expertise in epilepsy diagnosis so that AEDs can be withdrawn in safe conditions.     

临床药师参与晚期肺癌患者靶向治疗的药学实践

目的 探讨临床药师在晚期肺癌患者靶向治疗中的作用。 方法 临床药师参与1例晚期肺癌患者靶向治疗的过程,结合药物用法用量、药物相互作用、药物不良反应等提出药学建议,提供个体化的药学服务。 结果 临床药师参与晚期肺癌患者靶向治疗的药学监护,及时发现和处理患者治疗过程中潜在的问题,预防了不良结局的发生。 结论 临床药师参与晚期肺癌患者的靶向治疗,可提高患者治疗的安全性和有效性,促进药物的合理使用。