耳鼻喉科住院患者用药知识需求调查

目的了解耳鼻喉科患者的用药知识需求，为更好地为耳鼻喉科患者开展健康教育提供依据。方法根据临床所遇问题自行设计住院患者用药知识需求调查问卷，对300例耳鼻喉科患者进行调查。结果愿意了解药品情况占89．3％；认为医护人员有必要进行药品情况介绍占86．3％；希望由医生介绍用药知识62．3％，护士介绍33．7％，自己看说明书4．0％；希望通过语言讲解占36．3％，书面介绍22．0％，两者结合41．7％；希望了解所用药品的作用。43．7％、价格27．0％、不良反应18．3％、用法6．0％、名称5．0％、疗效5．0％；关心能否报销13．7％；认为了解所用药品情况是自己应有的权利占72．0％，对今后的用药有指导20．3％，监督医护人员工作7．7％；认为医护人员介绍所用药品情况是尊重患者的权利占57．0％，避免差错事故发生29．0％，履行公事14．0％；认为医护人员能认真介绍药品情况占88．3％，应付差事11．7％；认为通过用药知识指导对自己非常有帮助占73．3％，对今后用药有指导20．7％，没有帮助6．0％。结论耳鼻喉科住院患者用药知识教育需求较高，应在合适的场合、合适的时间，以合适的方式，传授合适的内容，以得到最佳的健康教育效果。     

我院148例药品不良反应报告分析

目的:了解我院药物不良反应(ADR)发生特点及规律,促进临床合理用药.方法:采用回顾性分析方法,对我院2009年1月至2010年12月发生的148例ADR报告进行分析.结果:148例ADR中,涉及药物67种,抗感染药的发生率居首位,其次为免疫抑制剂及维生素类药物,循环系统用药等;抗感染药以头孢菌素类药物ADR发生率居首位;ADR的临床表现以皮肤及其附件损害为首,其次为消化系统反应,呼吸系统反应等;严重不良反应9例.结论:在临床药品使用过程中,加强药物不良反应的监测以及药品不良反应相关知识的宣传,重视对临床表现隐匿的不良反应的监测,以促进临床合理用药,减少药品不良反应的发生.     

北京市社区老年人用药知识及行为调查

目的了解北京市社区老年人安全用药知识掌握情况及用药行为现状。方法采用便利取样方法抽取北京市社区110名≥60岁老年人进行问卷调查，了解其疾病及用药情况，用药知识及用药行为。结果85．5％老年人正在使用药物，平均每人服用2．96种药物。对安全用药知识掌握较低的内容依次为注射用药不一定比口服用药更好、更安全（50．9％）；老年人合用多种药物易发生不良反应（60．0％）；中药有不良反应（67．3％）。不良用药行为主要有用药前不太关心药物的不良反应（72．7％），患病时多药并用（69．1％），要求医生输液（52．7％），病情好转时自行停药或减少药量（52．7％）。结论社区老年人对用药安全的认识不足，存在一些不良用药行为。护士应利用各种机会为社区老年人提供相关信息并进行指导，同时帮助他们进行自我药物管理，使其更加规范、合理地用药。     

我院196例药品不良反应报告分析

目的：为了进一步了解我院药品不良反应（ADR）发生特点,切实保障公众用药安全,为临床用药和安全监管提供进一步参考。方法对我院2011年上报的196例不良反应报告进行分析统计。结果发生药品不良反应最多的药物是抗微生物类药物,其中多为头孢菌素类,其次是喹诺酮类;药品不良反应的发生男性多于女性,且60岁以上的老人容易发生药品不良反应;药品不良反应发生最多的给药途径为静脉给药。结论临床对老年患者用药时应格外谨慎;尽量避免静脉给药。     

我院2009～2010年药品不良反应147例分析

目的:分析我院2009～2010年药物不良反应(ADR)发生的规律和特点,为临床安全用药提供参考.方法:汇总统计2009～2010年我院上报的ADR,分别从患者性别、年龄、给药途径、药品品种、累及器官或系统及临床表现等进行统计分析.结果:147例ADR报告中,男性76例(51.70％),女性71例(48.30％)；静脉给药ADR127例(86.39％)；抗感染药物121例(82.31％),其中头孢菌素类最高.ADR多为一般性,严重的ADR仅1例.转归良好率100％.临床表现中皮肤及附件损害为主要症状.结论:我院ADR发生无明显的性别差异;静脉给药较其他给药途径易发生ADR抗感染药物引起的ADR较高；年龄0～9岁较易发生ADR.     

聚乙二醇干扰素致患儿不良反应的特点及护理

目的了解聚乙二醇干扰素治疗过程中发生不良反应．尤其是发热的特点,做好预见性护理,提高抗病毒治疗患儿的依从性。方法对聚乙二醇干扰素治疗的167例患儿治疗后4周内进行观察,记录患儿不良反应发生时间及特点。结果治疗过程中出现的不良反应包括发热、头痛头晕、关节肌肉酸痛等．其中发热是最常见的症状;体温多集中在37．3～38．9℃,第1次注射后9～12h发热者最多（占39．8％）,体温升高多持续3～4h;大多数患儿只发热1次,在处理发热时,第1周有53．4％的患儿未进行任何处理,但第2～4周有67．1％的患儿使用了对乙酰氨基酚进行药物降温。结论聚乙二醇干扰素治疗时有不良反应的发生,但其所致的发热多为一过性,使用对乙酰氨基酚药物降温后,体温可降至正常。     

966株尿路感染病原菌的分布

目的分析尿路感染的病原菌分布及耐药性特点,为临床选用抗菌药物提供依据。方法采用VITEK-32细菌鉴定仪鉴定菌种,对尿路感染患者的1978份尿液标本中分离的966株泌尿系感染病原菌进行鉴定及药物敏感试验。结果在分离的966株病原菌中,革兰阴性菌675株（占69．9％）,主要为大肠埃希菌;革兰阳性菌183株（占18．9％）,主要为粪肠球菌;真菌108株（占11．2％）,主要为白色念珠菌。分离数在前5位的病原菌依次为大肠埃希菌（占49．0％）、粪肠球菌（占9．6％）、肺炎克雷伯菌（占7．ooA）、白色念珠菌（占6．8％）、奇异变形杆菌（占3．9％）。大肠埃希菌产超广谱争内酰胺酶（ESBLs）检出率为47．3％,肺炎克雷伯菌产ESBLs检出率为33．8％。甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率为44．8％,耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为50％。结论引起尿路感染病原菌的分布广泛,大肠埃希菌为尿路感染的主要病原菌。有些菌株产生多重耐药性,大肠埃希菌产ESBLs检出率较高。应尽量根据药物敏感试验选用抗菌药物,减少耐药菌株的产生和医院感染的爆发流行。     

急性呼吸窘迫综合征患者应用咪达唑仑的疗效观察

目的提高亚急性湿疹疗效。方法对66例亚急性湿疹患者在抗组织胺药物治疗的基础上采用中药离子喷雾局部治疗,连续2个疗程。结果临床治愈44例,占66．67％;显效12例．占18．18％;有效9例．占13、64％;无效1例,占1．51％;总有效率98．48％,未发生不良反应。结论中药离子喷雾治疗亚急性湿疹疗效好．安全;护理中注意充分暴露皮损区及防止烫伤。     

超高龄患者急性化脓性胆管炎49例临床特点

目的：讨论75岁以上老年人急性化脓性胆管炎的临床特点。方法：对49例手术治疗的超高龄患者病例资料进行回顾分析。结果：本组病例治愈率为93．9％(46／49),病死率为6．1％(3／49)。发生合并症的占91．8％(45／49)。本组ENBD成功率为88．9％(8／9)。结论：急性化脓性胆管炎在超高龄患者容易被忽视,预后差。加强固手术期处理,积极手术或ENBD可以提高生存率。     

颅骨牵引和抗自由基药物治疗早期脊髓型颈椎病

目的：探讨颅骨牵引和抗自由基药物对早期脊髓型颈椎病的治疗作用。方法：回顾分析130例早期脊髓型颈椎病经颅骨牵引和抗自由基药物的治疗和疗效。结果：有效率86．9％，治愈率66．9％，50岁以上治愈率71．4％，有效率87．6％；5年内无复发68例，占总病例数的52．3％。结论：早期脊髓型颈椎病经颅骨牵引和抗自由基药和治疗，有半数以上获得治愈而不复发，且50岁以上者效果更好。     

阿托伐他汀临床用药常见问题及合理用药分析

目的：分析阿托伐他汀临床常见问题，为合理用药提供科学依据。方法通过对我院2008年1月～2012年12月期间出现的29例阿托伐他汀不良反应的患者临床资料进行分析，总结阿托伐他汀临床用药常见问题，并提出合理用药措施。结果60岁以上老年患者出现阿托伐他汀不良反应者较高，所占比例为69.0%；患者不良反应发生时间均为药物服用后30min～3个月之内。联合用药患者中服用2～4种药物的患者有21例，所占比例为72.4%。临床不良反应以骨骼、肌肉损害最为常见，所占比例为48.3%。结论阿托伐他汀临床实际用药过程中应加强对患者血液、皮肤、肝、胆等方面的观察与监测，避免患者出现不良反应问题。     

Association Between Readmission After Liver Transplant and Adverse Immunosuppressant Reactions: A Prospective Cohort With a 1-Year Follow-up

Objective

To measure the association between readmission after liver transplantation and corresponding adverse drug reactions.

Adverse drug reactions of intravesical bacillus Calmette–Guérin instillation and risk factors of the development of adverse drug reactions in superficial cancer and carcinoma in situ of the bladder

BACKGROUND: We examined the incidence and severity of adverse drug reactions following intravesical bacillus Calmette-Guerin (BCG) instillation for superficial bladder cancer including carcinoma in situ. We investigated the relationship between adverse drug reactions and patient background to clarify risk factors for the development of adverse drug reactions. METHODS: A total of 123 patients who underwent intravesical BCG instillation for treatment and prophylaxis between April 1997 and June 2000 were included in this study. Adverse drug reactions were divided into local and systemic categories and the severity of reactions was classified according to the presence or absence of postponement or discontinuation of instillation, with or without treatment for the reaction itself. RESULTS: Of 123 patients, 95.9% showed adverse drug effects and 50.4% needed some sort of treatment. Discontinuation of instillation due to adverse drug reactions was observed in nine patients. Regarding the necessity of treatment for adverse drug effects, the purpose of instillation and BCG dose were independent significant factors on multivariate analysis. CONCLUSION: Although there was a high rate of adverse drug reactions after intravesical BCG instillation, the rate of discontinuation of instillation was not high and serious adverse reactions were rare. The scale of the present study was small, but these results suggest that BCG instillation was well tolerated. When instillation is being performed for the purpose of treatment, and the BCG dose is 80 mg, greater attention might be needed to monitor for the development of adverse drug effects.     

Adverse reactions of nitrofurantoin, trimethoprim and sulfamethoxazole in children

PURPOSE: Many children with urological disease require long-term treatment with antibiotics. In many cases the choice of medical instead of surgical management hinges on the implied safety of certain drugs. Recently some groups have advocated subureteral injection procedures to avoid long-term antibiotics for low grade reflux. We present a concise and relevant review on the use and adverse reactions of nitrofurantoin, trimethoprim and sulfamethoxazole in children. MATERIALS AND METHODS: We reviewed the literature regarding the safety and toxicity of these drugs. Information regarding absorption, excretion and dosing was also gathered to explain better the mechanisms of toxicity. RESULTS: Adverse reactions in children reported in the literature related to nitrofurantoin are gastrointestinal disturbance (4.4/100 person-years at risk), cutaneous reactions (2% to 3%), pulmonary toxicity (9 patients), hepatoxicity (12 patients and 3 deaths), hematological toxicity (12 patients), neurotoxicity and an increased rate of sister chromatid exchanges. Adverse reactions in children related to trimethoprim/sulfamethoxazole are almost exclusively due to the sulfamethoxazole component, including cutaneous reactions (1.4 to 7.4 events per 100 person-years at risk), hematological toxicity (0% to 72% of patients) and hepatotoxicity (5 patients). The majority of adverse reactions were found in children on full dose therapy and not prophylaxis. CONCLUSIONS: The use of nitrofurantoin, trimethoprim and sulfamethoxazole is safe in children for long-term prophylactic therapy. The antibiotic safety issue should not be misconstrued as an argument for surgical therapy, whether minimally invasive or not. Adverse reactions exist to these medicines but they are less common than seen in adults, presumably because of the lower dose used for therapy, and the lack of significant comorbidities and drug interactions in children. Serious side effects are extremely rare and most are reversible by discontinuing therapy. The extremely low potential for significant adverse reactions should be discussed with parents.     

291例儿童药物不良反应的临床分析

目的：分析儿童药物不良反应的情况,指导临床合理用药.方法：对我院2007年1月-2009年12月共291例药物不良反应（ADR）情况,进行分析.结果：引起ADR的药物以抗菌药物为主,占全部ADR的48.8%（142例）ADR类型以皮肤及其附件的损害为主,占49.1%（143例）.结论：加强儿童ADR监测,有利于指导临床合理用药.     

Leitliniengerechte Abklärung von Arzneireaktionen

Adverse skin reactions to drugs occur in about 3% of hospitalised patients. The underlying mechanisms may depend on pronounced pharmacological effects up to toxicity or are expression of enhanced individual susceptibility. In order to classify an adverse drug reaction as drug allergy, standardized allergy diagnostics are mandatory. This means, that history, skin tests, in-vitro-assays and eventual provocation tests have to be integrated in the final evaluation. The allergy “passport” gives information for avoiding the allergy elicitor and – if previously investigated by provocation – also lists alternative drugs.     

Rocuronium and anaphylaxis – a statistical challenge

Drug induced anaphylaxis is frequently attributed to the use of muscle relaxants during anaesthesia. Recently The Norwegian Medicines Agency recommended that rocuronium bromide (Esmeron) be withdrawn from routine practice due to frequent reports of anaphylaxis. Over a period of two and a half years approximately 150,000 patients received rocuronium as part of their anaesthesia. In this period the Norwegian drug authorities received 29 reports of anaphylaxis or anaphylactoid reactions in patients treated with rocuronium. This is in stark contrast to the situation in other Nordic countries where a total of only seven cases of anaphylaxis in approximately 800,000 patients treated with rocuronium had been recorded by December 2000. This situation highlights the many potential problems of the surveillance of adverse drug reactions: reporting bias may lead to an over-estimate of the risk of one drug compared to another, and the possibility of under-reporting of adverse events (due to a weak reporting culture) further limit the validity of such comparisons. The surveillance of adverse drug reactions also represents a statistical challenge. While adverse event reports may help us to estimate the anaphylaxis rate we need to appreciate the uncertainty of such estimates. Adverse reactions are rare, random, and mostly independent events, resulting from the successive exposure of patients to a low risk intervention. The frequency distribution of adverse events will therefore conform to that of a Poisson process. The resulting Poisson distribution may inform us about the variability of adverse event data. An understanding of these methodological problems and statistical challenges will allow anaesthesiologists to make informed decisions concerning the use of muscle relaxants and other drugs associated with severe adverse reactions.     

Adverse drug reactions

Adverse drug reactions are unwanted reactions to drugs that occur under normal conditions of use, and are probably responsible for 3–5% of all hospital admissions. They are usually classified as Type A (augmented) or Type B (bizarre) reactions. Type A reactions are responsible for 80–90% of all adverse responses to drugs. They are relatively common, well known, and predictable, and have a close temporal relation with drug administration. Although patients vary in their susceptibility, most Type A reactions occur in every patient who is given the drug in sufficient dose. Type B reactions are usually unrelated to the main effects of drugs; they are often dose-independent, uncommon and unpredictable. Although their cause may be obscure, they are sometimes related to genetic predisposition or drug hypersensitivity. In anaesthetic practice, at least three important Type B reactions are directly related to genetic predisposition (malignant hyperthermia, suxamethonium apnoea, hepatic porphyria). Hypersensitivity or allergic responses to drugs depend on immunological factors; there are four types, depending on the mechanism involved. Most severe allergic reactions to drugs are a result of Type I hypersensitivity (anaphylaxis). In anaesthesia, the main aetiological factors are muscle relaxants, antibiotics, latex rubber and chlorhexidine; reactions to these agents may cause hypotension, bronchospasm, facial and laryngeal oedema, or urticaria. Similar effects occur when histamine and other factors are directly released from mast cells by non-immunological mechanisms (anaphylactoid reactions). Finally, drugs that are given during pregnancy may cross the placental barrier and adversely affect the fetus.     

皮肤病医院2021年-2023年门诊处方合理用药分析

目的 分析皮肤病防治所2021-2023年门诊处方合理用药情况。方法 选取宜兴市皮肤病防治所 2021年1月-2023年12月门诊12 000张处方,统计皮肤病门诊药物处方合理率、处方药物的使用种类、处方 金额、抗菌药使用比例,并分析处方开具不合理的类别。结果 2021-2023年皮肤病门诊药物处方开具合理 率依次为58.14%、82.64%、95.77%,处方合理率逐步提高;2023年门诊处方每张处方平均使用种类、每 张处方平均费用及抗菌药物比例优于2021年及2022年（P ＜0.05）;2021-2023年处方开具不合理类别以 疗程时间过长为主,2023年门诊各种不合理处方数量均低于2021年及2022年（P ＜0.05）。结论 皮肤 病门诊药物处方存在用药不适宜的情况,需强化临床中对药物的应用管理,增加医师在药物处方开具的 合理及科学性。