天津市各级医疗机构输液相关不良事件与滴注速度相关性分析

目的:研究输液相关不良事件与滴注速度间的相关性,确证影响输液相关不良事件的主要因素,以期降低输液相关不良事件的发生率。方法:以前瞻性及回顾性的队列研究方法对输液相关不良事件与滴注速度因素的相关性进行研究。根据纳入及排除标准筛选研究对象,接受输液治疗的患者中暴露于某一研究因素(滴注速度合理性)的为暴露组(滴注速度不合理组),未暴露于这一因素的为非暴露组(滴注速度合理组)。观察两组中不良反应的发生情况。利用SPSS15.0软件对研究数据进行χ2检验。分析两组间ADR发生率及计算相对危险度(RR)。结果:两组输液不良反应发生率有明显差异(P<0.05)。结论:滴注速度合理性与输液不良反应发生率相关。     

3869人次静脉输液不良事件的相关性分析

目的:了解输液相关不良事件与药物配伍因素之间的相关性,促进临床安全用药。方法:采用随机分层抽样方法,采集各级医疗机构中接受输液治疗的患者情况,集中监测不良事件发生情况,并采用Excel建立数据库,采用SPSS15.0对数据进行统计学分析。结果:共纳入来自天津市30家医院的患者3 869人次,收集输液相关不良事件301例次。药物配伍合理组(非暴露组)与药物配伍不合理组(暴露组)比较,不良反应及不良事件发生率有统计学差异(P<0.01)。常见的不良反应及不良事件为变态反应、心血管系统、输液反应及消化系统损害。结论:提高药物配伍合理性,有利于减少输液相关不良事件的发生。     

抗菌药物不合理用药致不良反应发生的相关因素分析与干预策略

目的:分析抗菌药物致不良反应(ADRs)发生的相关因素与干预策略。方法:采用回顾性分析的方法,分析2009年1月—2013年12月间深圳市龙华新区中心医院抗菌药物所致ADRs患者病历资料、不合理用药种类、ADRs表现形式、ADRs分类以及不合理用药与ADRs的相关性。结果:677例ADRs患者中,抗菌药物ADRs患者544例占80.35%,男性患者的发生率为58.27%高于女性41.73%,<18岁的发生率为55.51%高于其他年龄段;头孢菌素类药物为27.45%高于其他类抗菌药物;头孢菌素类所致ADRs的发生率为56.07%高于其他类抗菌药物;不合理用药原因居前3位的分别是给药时间过长、给药浓度过高和滴速过快,其中给药时间过长所致ADRs发生率为59.38%高于其他不合理给药方式;ADRs居前3位的分别是泌尿系统、消化系统、皮肤及软组织,其中泌尿系统的发生率为61.03%高于其他系统;经Person相关性分析表明,抗菌药物给药时间过长、给药浓度过高、滴速过快、剂量不当均与泌尿系统、心血管系统等各类ADRs呈正相关性。结论:医院抗菌药物致ADRs现象不容乐观,应深入分析其发生原因,从社会层面与医院层面入手,给予针对性干预措施,以减少抗菌药物的ADRs发生。     

天津市各级医疗卫生机构静脉输注给药间隔与不良反应发生率间的队列研究

目的:探讨给药间隔因素对输液不良反应发生率的影响。方法:采用随机分层抽样的方法抽样,选取天津市一、二、三级医院各10家进行研究。采用队列研究的方法,对研究对象其他因素进行合理干预的前提下,按给药间隔合理与否分为非暴露组和暴露组,分析2组不良反应发生率的差别。结果:非暴露组和暴露组不良反应发生率分别为7.86%和14.57%,差异有统计学意义(P<0.01)。结论:给药间隔因素对输液不良反应发生率有影响,正确的给药间隔可有效降低患者不良反应发生率。     

SARS患者药品不良反应的分析研究

目的　研究SARS患者治疗期间发生药品不良反应的相关危险因素。方法　回顾性分析小汤山医院临床确诊的6 80例SARS患者的病案、用药纪录及药品不良反应发生情况 ,研究年龄、性别、病情、给药途径和各大类药物对药品不良反应发生的影响。结果　女性患者的ADRs发生率要略高于男性患者 ;老年和重症型患者的ADRs发生率明显高于中青年和普通型患者 ;免疫调节剂、糖皮质激素、抗病毒药和抗菌药四大类药物的ADRs发生率较高 ;各种给药途径对ADRs发生率无明显影响。结论　年龄、病情和性别等为药品不良反应发生的相关危险因素。     

119例药品不良反应报告的调查与分析

目的:了解我院药品不良反应(ADRs)的发生规律及诱发因素.方法:对我院1998年～2004年收集的119例ADRs报告进行统计分析.结果:女性患者ADRs比例较大;注射给药ADRs发生率明显高于口服给药;抗感染药物ADRs发生率最大、中药类次之;主要不良反应类型为皮肤变态反应,其次是心脑血管系统反应;结论:加强对用药过程的ADRs观察,强调合理用药和ADRs监测,减少药品不良反应的发生.     

某医院84例药品不良反应报告及其护士监测作用分析

目的:分析某基层医院药品不良应发生规律、特点及相关因素,供临床合理用药参考。方法:对某基层医院2016年1—12月报告的84例药品不良反应(ADRs)报告,分析了发生ADRs患者性别与年龄、药品与种类、给药途径、联合用药、临床表现、转归等,并结合文献分析了ADRs发生规律、特点及相关因素。结果:84例报告中护士报告的66例占78.57%,医生报告的11例占13.09%,药师报告的7例占8.33%;注射给药ADRs发生率为91.67%明显高于口服给药为8.33%;所有ADRs患者经停药相应处理而治愈或未经处理而自愈,对原患疾病无影响;引发ADRs的药品中抗感染药物占45.10%,心血管药物占24.70%;ADRs主要累及皮肤及附件和心血管系统。结论:抗菌药物引起的ADRs仍是监测的重点,护士在ADRs监测工作中的作用不可忽视。     

某院2018年—2020年454例药品不良反应病例报告的相关因素分析及其对策

目的:分析医院上报的药品不良反应(ADRs)病例的发生特点及其原因,为临床合理用药提供参考.方法:抽取医院信息系统中2018年-2020年3年间上报的ADRs病例454份报告,统计其发生不良反应患者的性别、年龄等相关信息,以及涉及的给药方式、ADRs严重程度、疑似药品种类和ADRs累及器官/系统等相关因素,分析其ADRs发生的原因与特点,并提出解决对策.结果:454例ADRs病例报告中,男性多于女性,且45岁以上的中老年患者ADRs发生率为最高(212例,46.70％);ADRs涉及药品种类构成比TOP 3的药品分别为抗感染药物(38.77％)、血液系统药物(8.59％)和消化系统药物(6.17％),给药途径中静脉滴注给药引发的ADRs发生率达66.08％,皮下注射给药引起的ADRs为最少(0.44％);454例ADRs报告中以一般不良反应为最多(299例,占65.86％);ADRs累及系统/器官以皮肤及其附件损害较为常见(占58.37％).结论:在日常ADRs监测中,应重点监测抗感染药物、60岁以上人群和静脉滴注给药途径等因素,ADRs所导致的皮肤及附件产生的病变,属于ADRs重要信号特征;临床用药治疗过程中,应重点监测上述因素,以确保临床用药的安全性.     

奥氮平所致药物不良反应的发生率及相关影响因素研究

目的：调查奥氮平所致药物不良反应的发生情况,并探讨其影响因素,为预防和减少ADRs的发生提供科学依据。方法：选取厦门市精神卫生中心接受治疗的1691例精神障碍患者,监测治疗过程中奥氮平不良反应的发生情况,采取单因素和多因素分析方法,研究奥氮平不良反应发生的相关影响因素。结果：奥氮平不良反应发生率较高,为33.83%。多因素非条件 Logistic 回归分析发现有肝病史、服用高剂量药物 (＞10mg)是奥氮平所致ADRs发生的危险因素,OR值分别为1.837(95% CI:1.162~2.905)和4.841(95% CI:3.874~6.049)。结论：有肝病史及服用高剂量药物 (＞10mg)的精神疾病患者是奥氮平ADRs发生的高危人群。     

98例药物不良反应报告分析

目的 探讨药品不良反应（ADRs）发生相关因素以及ADRs对病人身体造成的损害.方法 收集本院2009年1月至2010年12月药物不良反应报告98例进行总结分析.结果 静脉给药途经发生的ADRs有95例,占总例数的96.9%.其中抗菌药物的ADRs发生率最高,有44例,占44.90%.ADRs的临床表现以皮肤及附件系统损害最为常见.联合用药引起的ADRs 10例,占10.20%.结论尽可能减少 ADRs发生相关因素、合理用药,可以减少或避免ADRs的发生,保证病人安全.     

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.     

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.