急性心肌梗死患者应用质子泵抑制剂的利用评价及用药分析

目的：分析急性心肌梗死患者质子泵抑制剂（PPI）的使用情况,建立药物利用评价标准。方法：收集我院心血管内科2013年1月~2014年6月出院的急性心肌梗死患者的病例资料,对PPI的使用情况进行分析。结果：共纳入291例患者,PPI使用率91.4%,平均用药（10.3±4.2） d,给药方式口服、静脉继以口服为主,静脉途径多用泮托拉唑,平均剂量（54.0±19.2） mg·d^-1,口服途径多用雷贝拉唑,平均剂量（18.1±4.2） mg·d^-1。结论：我院心梗患者PPI使用率高、疗程较长,选药品种及用法用量基本合理;需加强对给药剂量和疗程的控制。     

侵袭性真菌感染患者采用伏立康唑静脉和口服给药对血药浓度和临床疗效影响的对比分析

目的：比较侵袭性真菌感染患者采用伏立康唑静脉和口服两种给药途径对血药浓度、临床疗效以及安全性的影响。方法：选取2021年9月 ~ 2023年3月就诊于东部战区总医院并接受伏立康唑治疗的侵袭性真菌感染患者，按给药途径分为静脉组和口服组，比较两组的血药浓度、临床疗效和安全性。结果：研究纳入104例患者进行分析，共收集231例伏立康唑血药浓度。静脉组的稳态谷浓度平均值略高于口服组，差异无统计学意义[（3.44 ± 2.45）mg·L-1 vs （2.90 ± 2.55）mg·L-1，P ＞ 0.05]，两组间的目标浓度达标率相近（71.70% vs 76.80%），但静脉组高于目标范围上限的比例大于口服组（22.64% vs 12.80%）。两组之间的临床有效率和总体药物不良反应发生率相近，差异无统计学意义（68.75% vs 77.78%，P ＞ 0.05；40.62% vs 52.38%，P ＞ 0.05）。结论：侵袭性真菌感染患者使用伏立康唑静脉给药的血药浓度有大于口服给药的趋势，但两组间的目标浓度达标率，以及临床疗效和安全性均无统计学意义上的差异。     

我院门诊小儿急性上呼吸道感染治疗抗菌药物应用分析

目的：分析我院门诊小儿急性上呼吸道感染治疗抗菌药物应用合理性。方法：随机抽取2014年1～10月我院门诊收治的1000例小儿急性上呼吸道感染患者的处方。结果：1000例小儿急性上呼吸道感染患者的1000张处方中,应用抗菌药物的662张,抗菌药物的使用率为66.2%,抗菌药物使用疗程为3～7d,平均使用疗程（4.8±1.5）d;口服给药498张,所占比例为75.23%;静脉给药137张,所占比例为20.69%;肌注给药27张,所占比例为4.08%。单一抗菌药物的处方597张,所占比例为90.18%;二联用药的处方为65张,所占比例为9.82%。结论：我院门诊小儿急性上呼吸道感染治疗抗菌药物应用存在不合理性,抗菌药物的使用率过高,静脉给药的比例也很高,但联用情况基本合理。     

住院患者质子泵抑制剂应用合理性分析

目的：探讨住院患者质子泵抑制剂（PPI）应用的合理性,为临床合理用药提供参考。方法：采用回顾性分析方法,选取2015年及2017年徐州市儿童医院和徐州市肿瘤医院住院患者病历共314份,对PPI类药物的使用情况、用法用量、适应证等进行分析。结果：314份病历中使用PPI的共241份,总使用率76.8%,PPI品种主要为奥美拉唑（47.7%）和泮托拉唑（52.3%）。预防性用药196例（81.3%）均为注射剂,治疗用药31例（12.9%）,无指征用药14例（5.8%）。成人预防用药日剂量>40 mg和每日两次给药均为60例,其中泮托拉唑47例,奥美拉唑13例。用药疗程>7天共64例,其中泮托拉唑52例,奥美拉唑12例。31例预防用奥美拉唑儿童患者每日两次给药3例,用药疗程>7天共5例,无适应证1例。结论：住院患者PPI应用存在预防用药使用率高、日剂量大、疗程偏长、无指征及不合理联合用药和超说明书等问题。     

阿立哌唑治疗精神分裂症42例

目的评价阿立哌唑治疗精神分裂症患者的疗效和不良反应。方法将83例精神分裂症随机分为两组，治疗组42例，口服阿立哌唑片起始剂量为10 mg·d 1，最大剂量30 mg·d 1，平均（20.3±3.2）mg·d 1；对照组41例，口服利培酮片，起始剂量为1 mg·d 1，最大剂量6 mg·d 1，平均（3.5±1.6）mg·d 1。疗程均为6周。用阳性与阴性症状量表（PANSS）评定疗效，不良反应量表（TESS）评定不良反应。结果治疗组显效率和有效率分别为66.7%和88.1%，对照组分别为68.3%和90.2%（均P＞0.05）。结论阿立哌唑对精神分裂症有较好疗效，不良反应少而轻，是一种安全有效的抗精神分裂症药。     

急性心肌梗死早期足量应用美托洛尔的临床观察

目的：观察早期应用不同剂量美托洛尔对急性心肌梗死患者的临床疗效及安全性。方法：选择262例急性心肌梗死患者，随机分为治疗组和对照组。治疗组（131例）尽快给予口服美托洛尔50mg，每隔6h给予1次，持续2d，后根据心率情况口服维持25～100mg·d-^1（目标心率55～60次·min^-1）。对照组（131例）按常规保守剂量给予口服美托洛尔25～50mg·d^-1。其他治疗遵循急性心肌梗死诊治指南，两组治疗30d。比较两组治疗后心脏事件（室性心律失常、梗死后心绞痛、再梗死和猝死）的发生率，心功能的变化和药物的不良反应。结果：治疗组心脏事件的发生率均低于对照组（P〈0．05），两组心功能无显著性差异。结论：急性心肌梗死患者早期足量口服美托洛尔不仅安全，而且可以明显降低急性期心脏事件的发生率。     

我院质子泵抑制剂应用情况分析

目的：调查目前临床上质子泵抑制剂（PPI）的给药方式，探讨常用给药方案的合理性：方法：统计2007年4月～9月半年内我院住院患者中服用PPI的情况：结果：临床上最常用的给药方式为1日2次，占给药方案的54．52％，其中93．3％（埃索美拉唑和奥美拉唑．20mg，bid）是应用于非幽门螺杆菌根除的其他适应证治疗。结论：本研究证明目前临床PPI给药方案与说明书中规定用法用量存在较大差异。     

氢溴酸加兰他敏缓释片人体药物动力学研究

目的：建立HPLC-MS方法分析人血浆中氢溴酸加兰他敏的含量，并研究氢溴酸加兰他敏缓释片在健康人体内的药物动力学特征。方法：12名健康受试者口服单剂量（10mg）或多剂量氢溴酸加兰他敏缓释片（10mg×7d）后，分别在不同时间点收集血样，HPLC—MS法测定，采用DASS2．0软件计算给药后的药物动力学参数。结果：健康受试者单剂量口服氢溴酸加兰他敏缓释片的tmax为（4．0±1．4）h；Cmax为（27．2±3．3）μg·L^-1；t1／2为（10.3±0．9）h；MRT为（15．4±1．3）；AUC0-60h为（483.1±70．4）μg·h·L^-1。多剂量口服氢溴酸加兰他敏的AUC0→∞为（916．0±99．0）μg·h·L^-1，Cmax^ss为（56．8±11．6）μg·L^-1，Cmin^ss为（15．5±4．0）μg·L^-1，Css为（38．2±4．1）μg·L^-1，DF为（1．1±0．3），tmax为（3.6±1．9）h，t1/2为（11．7±1．4）h。结论：氢溴酸加兰他敏缓释片主要药动学参数单剂量和多剂量之间无显著性差异，具有明显的缓释特征，多剂量给药后体内无蓄积。     

雷贝拉唑钠肠溶胶囊Beagle犬体内药动学及生物等效性研究

目的：建立HPLC-MS测定方法分析Beagle犬血浆中雷贝拉唑的含量,并作不同厂家两种雷贝拉唑钠肠溶胶囊的药动学及生物等效性研究。方法：6只Beagle犬随机分为两组,采用单剂量双周期交叉试验,分别口服给予60 mg雷贝拉唑钠肠溶胶囊受试制剂或参比制剂,给药后不同时间点采血,测定血药浓度,利用DAS3.0软件计算药动学参数,并比较两个厂家生产的制剂的生物等效性。结果：Beagle犬单次给予雷贝拉唑钠肠溶胶囊受试制剂和参比制剂后的tmax分别为（3.57±0.91）h和（3.43±0.87）h,Cmax分别为（539.03±129.13）ng·mL-1和（554.90±135.75）ng·mL-1,t1/2分别为（2.20±0.90）h和（2.09±0.78）h,药时曲线下面积AUC（0→24 h）分别为（1341.40±442.03）ng·h·mL-1和（1319.41±402.29）ng·h·mL-1。结论：结果表明不同厂家的两种雷贝拉唑钠肠溶胶囊具有生物等效性。     

肾移植科伏立康唑血药浓度监测结果分析

目的：分析肾移植患者伏立康唑血药浓度监测结果，为伏立康唑的临床合理应用提供参考。方法：采用回顾性研究方法，对某院肾移植科使用伏立康唑治疗并测定浓度的住院患者进行信息归纳，从浓度分布情况，质子泵抑制剂（PPIs）、钙调磷酸酶抑制剂（CNI）、给药途径及产地对伏立康唑血药浓度的影响等方面进行分析探讨。结果：肾移植科伏立康唑谷浓度在2~4 μg·mL^-1范围内仅占33.9%；联用PPIs可显著增加伏立康唑谷浓度（U=4578.5，Z=–3.096，P=0.002）；联用他克莫司和环孢素可以显著降低伏立康唑日剂量（U=5420，Z=–1.618，P=0.106；U=754.5，Z=–2.905，P=0.004）；口服组伏立康唑血药浓度中位数低于静脉组，但组间差异无显著性（U=6474.5，Z=–1.553，P=0.120）；给药途径为静脉给药者，进口组的血药浓度显著高于国产组（P=0.005）；给药途径为口服者，进口组和国产组差异无显著性（P=0.949）。结论：伏立康唑血药浓度个体差异大，受药物相互作用影响大，个体化治疗时需要进行血药浓度监测。     

Risk of recurrent myocardial infarction with the concomitant use of clopidogrel and proton pump inhibitors

Aliment Pharmacol Ther 2011; 33: 77–88

Summary

Background The association between myocardial infarction (MI) and co‐administration of proton pump inhibitors (PPIs) and clopidogrel remains controversial. Aim To quantify the association between concomitant use of PPIs and clopidogrel and occurrence of recurrent MI. Methods We conducted a case–control study within a cohort of acute MI patients in PHARMO Record Linkage System (1999–2008). The cases were patients readmitted for MI. PPI exposure was categorized as current (3–1 days before MI), past (30–3 days before MI), or no use (>30 days before MI). We used conditional logistic regression analyses. Results Among 23 655 patients hospitalized following MI, we identified 1247 patients readmitted for MI. Among clopidogrel users, current PPI use was associated with an increased risk of recurrent MI (OR: 1.62, 95% CI: 1.15–2.27) when compared with no PPI use, but not when compared with past PPI use (OR: 0.95, 95% CI: 0.38–2.41). Among clopidogrel non‐users, current PPI use was associated with an increased risk of recurrent MI (OR: 1.38, 95% CI: 1.18–1.61) when compared with no PPI use. Conclusions The apparent association between recurrent MI and use of PPIs with clopidogrel depends on the design, and is affected by confounding by indication. The association is not present when (un)measured confounding is addressed by design.     

Health-related quality of life in patients after the acute myocardial infarction

Introduction

Acute myocardial infarction has a negative impact on patient’s quality of life. The aim of this paper was to evaluate the health-related quality of life in patients one month after the acute myocardial infarction.

Material and method

The study involved 160 patients of both sexes, 30 to 79 years of age. The health-related quality of life in patients was assessed at the admission at the coronary care unit, and one month after. The following questionnaires were used: EuroQuolVAS and EuroQuol 5 Dimension. Angina pectoris was ranked according to the Canadian Cardiovascular Society Classification. Results: Men and women evaluated their health condition in a similar way (60.48±11.98 vs 60.55±12.24). Patients who (have) undergone primary coronary intervention had significantly higher average scores on EuroQuolVAS than the patients who were treated with thrombolytic therapy (68.69±9.67 vs 52.31±7.87, p<0.001). Modest and severe problems were the most presented in answers to those questions: pain/discomfort, anxiety/depression and self-care. Both men (0.92±0.43 vs 3.27±0.59, p<0.001) and women (0.89±0.46 vs 3.19±0.55, p<0.001) had significiantly lower average marks of angina pectoris one month after the acute myocardial infarction than at the admission to the hospital.

Conclusion

One month after the acute myocardial infarction the quality of life in patients was very impared. Patients who undergone to the primary coronary intervention evaluated their health condition as better than the patients who were treated with thrombolytic therapy. Those patients also had the lower average marks of angina pectoris and the higher health-related quality of life.     

Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial

BACKGROUND: The proportion of proton pump inhibitor users on long-term therapy who can discontinue proton pump inhibitor (PPI) medication without developing symptoms is unknown. AIM: To determine the proportion of patients on long-term PPI therapy who are able to discontinue PPIs without developing symptoms. METHODS: Patients on long-term PPIs, without a history of peptic ulcer or esophagitis underwent upper endoscopy. Patients were randomized double-blindly to taper down or continue a constant dosage of omeprazole for three weeks. Thereafter, all patients discontinued PPIs. RESULTS: Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p < 0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p < 0.05). GERD and serum gastrin were independent predictors of PPI requirement. CONCLUSIONS: Discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPIs than non-GERD patients.     

Pre-endoscopic proton pump inhibitor therapy reduces recurrent adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding

BACKGROUND: Proton pump inhibitors (PPIs) following endoscopic haemostasis reduce rebleeding rates in patients with high-risk acute non-variceal upper gastrointestinal bleeding. Many advocate the use of PPIs prior to endoscopy, although its incremental benefit is unproven. AIM: To determine if providing PPIs before endoscopy reduces adverse gastrointestinal outcomes in acute non-variceal upper gastrointestinal bleeding patients. METHODS: We performed a retrospective review to identify patients presenting to two tertiary care centres with acute non-variceal upper gastrointestinal bleeding between 1999 and 2004. Subjects receiving PPI therapy before endoscopy were compared with those not receiving pre-endoscopic PPI therapy. The primary outcome measure was the development of any adverse bleeding outcome (rebleeding, surgery for control of bleeding, in-hospital mortality, readmission within 30 days for acute non-variceal upper gastrointestinal bleeding). RESULTS: 385 patients were included in our study [132 (12 intravenous/120 po) pre-endoscopic PPI vs. 253 no pre-endoscopic PPI]. Patients receiving pre-endoscopic PPI therapy were significantly less likely to develop adverse outcomes compared with those not given pre-endoscopic PPIs (25% vs. 13%, P = 0.005). Rebleeding, upper gastrointestinal surgery, mortality and length of hospital stay were also significantly lower in patients receiving pre-endoscopic PPI. CONCLUSIONS: The use of PPIs before endoscopy significantly reduces the risk of developing adverse gastrointestinal outcomes in patients with acute non-variceal upper gastrointestinal bleeding. Future studies are required to better characterize this relationship.     

专项整治前后我院急性化脓性阑尾炎患者围术期抗菌药物应用分析

目的:评价专项整治前、后我院急性化脓性阑尾炎患者围术期抗菌药物的应用情况。方法:对我院实施专项整治前、后急性化脓性阑尾炎手术患者应用抗菌药物的品种、用法用量、用药频度、联合用药等情况进行统计、分析。结果:整治后,我院的用药结构较整治前有所改善,其中抗菌药物种类、品种数分别下降至2类和10个;抗菌药物平均用药时间从整治前的(5.79±1.48)d下降至整治后的(5.03±1.45)d,下降率为13.13%;三联用药率显著下降,由18.67%下降至2.86%。结论:通过开展专项整治活动,我院抗菌药物品种控制情况好转,但仍存在用药时机不当、用药疗程过长等问题,应进一步加大整治力度,促进抗菌药物临床应用合理水平和监督管理能力的持续提升。     

那屈肝素钙治疗不同发病时间的急性脑梗死

目的 :研究那屈肝素钙治疗不同发病时间脑梗死的疗效。方法 :5 0例发病 12h以内的脑梗死病人 ,随机分为治疗A组和对照A组各 2 5例 ;6 0例发病 12～ 4 8h ,随机分为治疗B组和对照B组各 30例。以上各组均予以丹参注射液 2 0mL +氯化钠注射液 2 5 0mL ,ivdrip ,qd。治疗组加用那屈肝素钙4 10 0IU ,sc ,q 12h。 4组疗程均 10d。治疗前、治疗后 1mo和 3mo测定病人神经功能缺损程度评分(NFDS)和日常生活活动能力评分 (ADL)。结果 :1mo和 3mo后 ,治疗A组和B组NFDS为 10± 4 ,5± 4和 13± 6 ,8± 3;与对照A组 (13± 5 ,10± 5 )和B组 (14± 7,12± 4 )比较 ,P <0 .0 5或P <0 .0 1。ADL评分和血液流变学指标各组均有改善 ,但以治疗A组尤为明显 ,P <0 .0 5或P <0 .0 1。结论 :那屈肝素钙能有效治疗急性脑梗死 ,早期应用效果更佳     

西安市中心医院2015年住院患儿使用质子泵抑制剂的情况分析

目的 对西安市中心医院质子泵抑制剂在儿科的应用情况进行分析,为规范和指导临床合理用药、加强儿童用药监护提供依据.方法 采用回顾性调查方法 ,利用医院PASS系统,统计2015年西安市中心医院质子泵抑制剂在住院患儿的使用情况,针对品种选择、适应症、给药剂量、溶媒选择及给药途径等分析合理性.结果 质子泵抑制剂在住院患儿中的使用人次及销售金额均以兰索拉唑粉针剂为首.观察的79份病例中,不合理用药现象主要包括选药品种不适宜、无适应症用药、用法用量及给药途径不适宜、重复用药等.结论 西安市中心医院质子泵抑制剂在患儿中的使用存在不合理现象,建议加强该类药物的规范化管理,以便在提高药效的同时降低患儿的用药风险.     

借助处方前置审核系统实施质子泵抑制剂预防性使用管理

目的:促进质子泵抑制剂(PPIs)的处方前置审核及临床合理使用。方法:借助本院的处方前置审核系统(MINDS系统),对PPI的治疗、预防用药进行个性化设置;统计管控前后药品的使用率、疗程,以及抽样点评中医嘱合理率,评价精细化设置的效果。结果:管控后,PPIs使用率下降,平均疗程缩短,PPIs预防用药明显减少,适应症、用法用量、疗程不适宜等均显著改善。结论:本院对PPIs的信息化设置,促进了前置审方工作的进展和临床合理用药。