药学干预在小儿复方氨基酸注射液规范化应用中的作用

目的：探讨小儿复方氨基酸注射液（19AA-I）的合理使用方法,提高含19AA-I制剂肠外营养处方合格率。方法：分析2018年2月至2019年2月我院患儿肠外营养处方中19AA-I和复方氨基酸注射液（18AA-II）使用情况,明确19AA-I的使用规范,对其适应证、用法用量进行药学干预,为临床安全、有效、经济地应用氨基酸注射液提供参考。结果：根据我院制定的19AA-I使用规范,实施药学干预后,含19AA-I的肠外营养处方不合格率由49.3%下降为5.3%,氨基酸用量不适宜处方由30.7%下降至4.0%。结论：通过制定19AA-I使用规范,临床药师对不合格处方进行干预,取得了较好成效,19AA-I在临床使用中更规范、合理,药学干预在保障患者用药安全、避免资源浪费等方面发挥了关键作用。     

某院2012年至2014年肠外营养药物利用分析

目的分析评价医院2012年至2014年肠外营养药物使用情况,为合理使用该类药物提供参考。方法统计、分析2012年至2014年医院肠外营养药物的销售金额、用药频度(DDDs)、日均费用(DDC)及排序比。结果医院肠外营养药物的销售金额逐年增加,但构成比的增长趋势不明显,肠外营养药物中维生素类药物的销售金额及构成比均增长较快;近3年医院注射用脂溶性维生素(Ⅱ)、小儿复方氨基酸注射液(19AA-Ⅰ)销售金额排序均位居前5位,复方氨基酸注射液(18AA)、小儿复方氨基酸注射液(19AA-Ⅰ)DDDs排序均位居前3位,丙氨酰谷氨酰胺注射液、六合氨基酸注射液、脂肪乳氨基酸(17)葡萄糖(11%)注射液、脂肪乳氨基酸(18)注射液、注射用12种复合维生素的DDC值均高于100元,复方氨基酸注射液(3AA)、复方氨基酸注射液(15AA)、复方氨基酸注射液(9AA)、脂肪乳注射液(C14-24)、复方维生素注射液(4)的排序比均接近1。结论医院肠外营养药物的使用基本合理,医生和药师应共同努力促进该类药物的合理使用。     

复方氨基酸注射液（18AA-V-SF）住院医嘱专项点评分析

目的 促进重点监控药物复方氨基酸注射液(18AA - V - SF)的临床合理、规范应用。方法 临床药师从医院药品上市后安全性研究(PASS)临床药学管理系统随机抽取 2020 年 12 月(干预前)和 2021 年 9 月(干预后)使用复方氨基酸注射液(18AA - V - SF)作为全合一肠外营养成分的住院医嘱各 300 条,根据相关共识及药品说明书对其进行专项点评,参数包括非蛋白热氮比,氨基酸浓度,谷氨酰胺占比,一价、二价阳离子浓度,以及使用复方氨基酸注射液(18AA - V - SF)作为全合一肠外营养成分的住院医嘱的应用率。结果 干预后,使用复方氨基酸注射液(18AA - V - SF)的非蛋白热氮比偏高 3 个程度(> 200∶1,> 400∶1,> 600∶1)的住院医嘱不合理率分别为 12. 33%,3. 33%,0,分别显著低于干预前的 23. 00%,7. 33%,3. 33%(P < 0. 05);干预后,氨基酸浓度偏低 3 个程度(< 1. 50%,< 1. 94%,< 2. 50%)的住院医嘱不合理率分别为 6. 33...     

临床药师参与胃肠外科住院患者肠外营养支持的效果分析

目的 探讨临床药师参与胃肠外科营养支持小组工作模式，评价临床药师对肠外营养支持的干预效果。方法 选取2020年7至12月胃肠外科使用肠外营养支持的病例作为对照组（n=85）,2021年7至12月临床药师参与营养支持小组后胃肠外科使用肠外营养支持的病例作为干预组（n=86），分析肠外营养处方合理性及不合理类型分布。结果 胃肠外科干预前使用肠外营养支持患者85例共144张处方，干预后使用肠外营养支持的患者86例共149张处方，干预前后肠外营养医嘱不合理率由63.89%(92/144)降至29.53%(44/149)，差异具有统计学意义（P <0.05）；氨基酸浓度不合理率由36.11%(52/144)降低至10.07%(15/149)，其他药物添加不合理率由20.83%(30/144)降低至8.05%(12/149)，糖脂比不合理率由34.72%(50/144)降低至15.44%(23/149)，热氮比不合理率由31.25%(45/144)降低至6.04%(9/149)，差异均具有统计学意义（P <0.05）；肠外营养无适应证用药发生率由5.56%(8/144)降低至2.68%...     

临床药师参与肠外营养相关性肝损害患者治疗的药学监护

目的:探讨临床药师在肠外营养相关性肝损害(PNALD)患者的临床营养治疗中的作用,促进临床营养药物的合理应用。方法:临床药师参与1例PNALD患者的治疗过程,建议将原有的"全合一"营养液配方中的5%葡萄糖氯化钠注射液500 m L调整为0.9%氯化钠注射液500 m L,30%长链脂肪乳剂250 m L调整为20%中/长链脂肪乳剂250 m L,8.5%复方氨基酸注射液(18AA)1 000 m L调整为8%复方氨基酸注射液(15AA)750 m L,并加用20%丙氨酰谷氨酰胺注射液100 m L和10%ω-3鱼油脂肪乳注射液100 m L,其余配方不变。另加用保肝药物还原型谷胱甘肽、S-腺苷蛋氨酸进行保肝退黄治疗,并逐渐减少肠外营养(PN)的量,过渡到肠内营养(EN)。结果:医师采纳临床药师的调整建议,该患者的肝功能逐渐恢复正常。结论:PN使用时间,PN中脂质种类、摄入量,营养物过剩等是造成PNALD的主要因素。临床药师在患者的临床营养治疗中开展药学监护可确保营养药物安全、有效地利用,减少并发症及药物不良反应的发生。     

我院2015年普外科肠外营养中氨基酸类药物专项点评

目的 评价我院普外科肠外营中养氨基酸类药物的使用情况,促进医院合理用药,方法 采用回顾性分析方法 ,利用医院信息系统(HIS)功能,按病区,采用随机抽取将2015年1、4、7、10月抽取点评的肠外营养氨基酸类药物医嘱共计120份.依据氨基酸药物说明书、《肠外肠内营养临床指南》2009版.参照《处方管理办法》2012版《医院处方点评管理规范》(2010)08号.填写处方点评表,进行处方点评,评价用药合理性.结果 我院普外科肠外营养中氨基酸类药物使用不合理情况较突出.通过定期点评干预改进2015年4个月不合理比例分别为40.00%、36.67%、23.33%、16.67%、呈明显降低趋势.结论 贯彻执行《肠内肠外营养临床指南》一年定期抽查,并持续干预措施,有助于提高临床正确合理选用肠外营养中氨基酸类药物水平,保障患者用药合理,安全,有效.     

1例肝硬化合并上消化道出血患者肠外营养支持的药学监护

目的:探讨临床营养药师在肝硬化合并上消化道出血患者肠外营养支持中的作用。方法:临床营养药师参与1例肝硬化合并上消化道出血患者的肠外营养支持会诊,结合患者的病因、肝功能状况、并发症、药物对肝功能的影响等,通过两次会诊,建议患者的营养液中不再加入胰岛素,将20%脂肪乳注射液(C14-24)250 m L调整为20%中/长链脂肪乳注射液(C8-24)250 m L、复方氨基酸注射液(18AA-Ⅴ)350 m L调整为六合氨基酸注射液(6AA)350 m L、葡萄糖酸钙注射液1.0 g调整为0.7 g,并增加甘油磷酸钠注射液10 m L、注射用丙氨酰谷氨酰胺10 g,滴注速度由2 m L/min降至1.5 m L/min,葡萄糖注射液(100 m L∶50 g)由300 m L增加至350 m L,同时检测血糖。结果:医师采纳了临床营养药师的建议,患者病情稳定,血糖控制平稳,直至患者上消化道出血症状得到控制,饮食恢复正常,未再出现低血糖症状。结论:临床营养药师参与患者的肠外营养支持等相关药学监护,对改善患者的营养状况及预后具有积极的作用。     

肠内肠外营养处方设计系统的开发和应用

目的：开发肠内肠外营养处方设计系统,降低医务人员开立营养处方的人力成本,提升开立处方的工作效率和合格率。方法：采用C#编程语言在Windows 5平台上,利用Visual Studio 2015软件制作肠内肠外营养处方设计系统。2020年1月至2022年12月营养会诊处方共2 652份,同时采用人工处方开立和软件处方开立,对比2组的平均处方开立时间和处方合格率。结果：临床应用显示,使用肠内肠外营养处方设计系统后,平均处方开立时间由（27.3±6.1） min缩短至（2.6±0.3） min(P<0.05),而处方合格率由（90.2±0.6）%上升至（99.7±0.1）%(P<0.05)。该系统实现了肠内与肠外营养相结合的自动化计算与预警提示及医保限定品种提示。结论：开发的肠内肠外营养处方设计系统提高了工作效率和处方合格率。     

药学干预儿科门诊急性上呼吸道感染处方效果分析

目的：分析药学干预前后医院儿科门诊急性上呼吸道感染处方,对处方用药合理性进行点评,促进临床合理用药。方法：参照WHO/INRUD(合理用药国际网络)选择性用药指标调研方法(SDUIS)设置调研指标,对干预前、后进行干预效果分析。结果：药学干预前平均用药品种数为2.65种,注射剂使用百分率为27.13%,就诊使用抗菌药物百分率为82.95%,抗菌药物费用占处方总费用百分率为61.63%,无指征输液现象普遍;干预后平均用药品种数为1.2种,注射剂使用百分率为16.15/%,就诊使用抗菌药物百分率为80.21%,抗菌药物费用占处方总费用百分率为63.19%,干预效果明显。结论：采取药学干预措施可明显降低儿科门诊急性上呼吸道感染处方注射剂使用百分率、抗菌药物使用百分率等指标。     

肿瘤患者使用复方氨基酸注射液的临床应用分析

目的：对郑州大学附属肿瘤医院的肿瘤患者使用复方氨基酸注射液的情况进行分析与点评,为临床合理用药提供参考。方法：抽取我院2016年6-12月应用复方氨基酸注射液的住院肿瘤患者病历1120例,根据《中国肿瘤营养治疗指南（2015版）》《临床诊疗指南肠外肠内营养学分册（2008版）》《恶性肿瘤患者的营养治疗专家共识（2011版）》和《临床技术操作规范肠外肠内营养学分册（2008版）》等相关标准进行专项点评。结果：1120例患者中,大多为外科围手术期患者,占62.4%,用药不合理病例比例为38.8%。其中,无适应证用药占21.4%,药品选择不适宜占19.6%,用法用量不适宜占63.6%,有配伍禁忌占2.5%。结论：按照以上标准,我院复方氨基酸注射液临床应用存在不合理现象,须进一步规范。     

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.