摆放静脉输液和加药过程中的小窍门

在日常护理工作中,加强各班次之间的配合,防止差错,避免药液污染的发生非常重要。现将笔者在治疗班摆放静脉输液和加药过程中的小经验介绍如下。     

静脉输液终末减少药液丢失方法的探讨

在临床护理实践中,我们通过对输液完毕拔针后输液瓶及输液管残留药液的观察,发现药物浪费现象严重,特别是贵重药物,严重影响了疾病的治疗。在临床工作中,护理人员对输液完毕的概念往往是感官判断,于是经常导致液体剩余过多而将输液头皮针拔除。为减少输液终末至输液结束这段时间内药液的丢失,提高护理质量,促进病人的早日康复,本文对输液终末的处理措施进行了探讨,现报告如下。     

不同加药环境对输液微粒影响的探讨

目的探讨不同环境加药对输液微粒数的影响。方法分别测定A(100级净化台内)、B(10万级洁净房间)、C(治疗室清洁消毒后10min)、D(治疗室清洁消毒后240min)环境空气的微粒、细菌数,并在相应环境下进行输液加药,然后分别检测加药后输液的不溶性微粒数。结果A为净化环境;B较一类洁净环境;C接近二类环境标准;D细菌数超出三类环境3.13倍;A、B加药后输液的微粒数符合药典要求,C加药输液的微粒数接近药典要求,D加药后输液的微粒数超出药典要求数倍(10pm以上超4.37倍,25μm以上超8.31倍)。结论A环境是最理想的加药环境,B环境是良好的加药环境;在没有净化条件的情况下,C环境可作为加药环境,D环境不可作为加药环境。     

输液过程中药液丢失的原因分析和方法研究

静脉输液是临床上主要的给药途径 ,也是护理人员最基本的一项技术操作。在整个操作过程中 ,长期存在着一定量药液的“合理”丢失现象 ,使进入机体内的药液有时不能达到所要求的总量[1] 。既影响疾病的治疗 ,又造成药物资源的浪费。为此 ,我们对临床输液过程中的药液丢失现状进行了系统观察和测试 ,并对操作方法进行了探讨和改进 ,旨在最大程度地减少药液丢失量 ,提高护理质量和治疗效果。1　对象与方法1 1　对象。对本地区的 182名护士 ,采用直接观察和采访调查相结合的方法 ,对静脉输液过程中药液丢失现状进行了解和分析。1 2　分组。从 18…     

开展品管圈活动控制小儿静脉输液药液外渗发生率的效果探讨

目的 探讨开展品管圈活动控制小儿静脉输液药液外渗发生率的实践效果。 方法 2014年5月开展品管圈活动,确定活动主题为“降低小儿静脉穿刺药液渗透率”,通过定期组织圈员会议全面查找导致静脉药液外渗的原因并制定对策。比较开展活动前后静脉输液药液外渗及其他相关不良护理事件的发生率以及护理人员的理论、操作水平。 结果 开展品管圈活动3个月后,小儿静脉输液一次穿刺不成功率为1%,药液外渗率为3.3%,较开展前显著降低;护理人员的理论及操作考核成绩也获得了显著提升。 结论 开展品管圈活动对控制小儿静脉输液药液外渗发生率非常有益,值得长期深入开展。     

抗高血压药物门诊处方用药分析

目的：了解门诊抗高血压药的使用情况,分析门诊处方中抗高血压药物之间的联合用药规律,促进高血压药物的合理应用,更好地选择用药方案。方法：随机抽查山西省煤炭中心医院2010年10月的门诊处方4589张,筛查出抗高血压药物处方305张,按不同年龄段分组。统计患者总用药量及用药天数,将不同降压药按用药频度（DDDs）排序计算药物利用指数（DUD值,根据《中国高血压指南》、《新编药物学》（第15版）的相关标准分析抗高血压药使用的合理性。结果：经过筛查,抗高血压药处方中男性159张（52．1％）,女性146张（47．9％）;随着年龄的增高,降压药处方有增加的趋势,降压药处方最多的年龄段为71岁以上。用药频度最高的为氢氯噻嗪;联合用药以血管紧张素转换酶抑制剂＋钙拮抗药;钙拮抗药＋复方制剂（厄贝沙坦／氢氯噻嗪）最多,血管紧张素转换酶抑制剂＋钙拮抗药有15张,占联合用药处方的19．7％。结论：抗高血压药物使用基本合理。     

2013年本院抗菌药物临床使用情况与细菌耐药性分析

目的了解该院2013年抗菌药物临床使用情况及分离菌株对常用抗菌药物的耐药性。方法对该院2013年抗菌药物临床用药频度及细菌耐药情况进行统计分析。结果该院在2013年未使用哌拉西林。未检出耐药溶血性链球菌。大肠埃希菌对哌拉西林耐药率为33.22%。结论细菌耐药情况与抗菌药物品种配置、用药频度的高低存在一定的相关性。     

The interpretation of hair analysis for drugs and drug metabolites

Introduction: Head hair analysis for drugs and drug metabolites has been used widely with the aim of detecting exposure in the weeks or months prior to sample collection. However, inappropriate interpretation of results has likely led to serious miscarriages of justice, especially in child custody cases.

Objective: The aim of this review is to assess critically what can, and perhaps more importantly, what cannot be claimed as regards the interpretation of hair test results in a given set of circumstances in order to inform future testing.

Methods: We searched the PubMed database for papers published 2010–2016 using the terms “hair” and “drug” and “decontamination”, the terms “hair” and “drug” and “contamination”, the terms “hair” and “drug-facilitated crime”, the terms “hair” and “ethyl glucuronide”, and the terms “hair”, “drug testing” and “analysis”. Study of the reference lists of the 46 relevant papers identified 25 further relevant citations, giving a total of 71 citations.

Hair samples: Drugs, drug metabolites and/or decomposition products may arise not only from deliberate drug administration, but also via deposition from a contaminated atmosphere if drug(s) have been smoked or otherwise vaporized in a confined area, transfer from contaminated surfaces via food/fingers, etc., and transfer from sweat and other secretions after a single large exposure, which could include anesthesia. Excretion in sweat of endogenous analytes such as γ-hydroxybutyric acid is a potential confounder if its use is to be investigated. Cosmetic procedures such as bleaching or heat treatment of hair may remove analytes prior to sample collection. Hair color and texture, the area of the head the sample is taken from, the growth rate of individual hairs, and how the sample has been stored, may also affect the interpretation of results.

Toxicological analysis: Immunoassay results alone do not provide reliable evidence on which to base judicial decisions. Gas or liquid chromatography with mass spectrometric detection (GC- or LC-MS), if used with due caution, can give accurate analyte identification and high sensitivity, but many problems remain. Firstly, it is not possible to prepare assay calibrators or quality control material except by soaking “blank” hair in solutions of appropriate analytes, drying, and then subjecting the dried material to an analysis. The fact that solvents can be used to add analytes to hair points to the fact that analytes can arrive not only on, but also in hair from exogenous sources. A range of solvent-washing procedures have been advocated to “decontaminate” hair by removing adsorbed analytes, but these carry the risk of transporting adsorbed analytes into the medulla of the hair therefore confounding the whole procedure. This is especially true if segmental analysis is being undertaken in order to provide a “time course” of drug exposure.

Proposed clinical applications of hair analysis: There have been a number of reports where drugs seemingly administered during the perpetration of a crime have been detected in head hair. However, detailed evaluation of these reports is difficult without full understanding of the possible effects of any “decontamination” procedures used and of other variables such as hair color or cosmetic hair treatment. Similarly, in child custody cases and where the aim is to demonstrate abstinence from drug or alcohol use, the issues of possible exogenous sources of analyte, and of the large variations in analyte concentrations reported in known users, continue to confound the interpretation of results in individual cases.

Conclusions: Interpretation of results of head hair analysis must take into account all the available circumstantial and other evidence especially as regards the methodology employed and the possibility of surface contamination of the hair prior to collection.     

2005-2007年某院铜绿假单胞菌耐药监测结果分析

目的分析2005年1月至2007年12月分离的铜绿假单胞菌耐药性与耐药趋势。方法采用BIOKONT鉴定软件检索微生物鉴定药敏分析系统进行菌株鉴定及药物敏感性测试,耐药性数据分析采用统计学方法。结果3年间分离的铜绿假单胞菌对12种抗菌药物活性较好的是亚胺培南、阿米卡星、哌拉西林／他唑巴坦,耐药率分别为0．9％、5．6％、6．5％;耐药率较高的是头孢曲松钠63．6％、头孢噻肟钠38．3％,氨曲南25．2％。其对头孢噻肟钠的耐药率从2005年33．3％升至2007年的44．4％,同期对头孢曲松钠的耐药率从48．1％升至68．9％,升幅达11．1％和20．8％。β-内酰胺类抗生素哌拉西林耐药率有下降趋势,从22．2％降至15．6％。结论铜绿假单胞菌对碳青霉烯类、氨基糖苷类、β-内酰胺酶抑制剂复合药物保持较好的敏感性,但第3代头孢菌素的耐药率高于国家细菌耐药监测研究组20005和2006年的统计结果,应加强对铜绿假单胞菌耐药率有计划地连续监测。     

抗肿瘤血管生成靶向药物不良反应机制与处理进展

血管生成在恶性肿瘤的发生发展以及转移的过程中发挥着重要作用,在肿瘤的分子靶向治疗中抗血管生成已成为重要的治疗手段.目前临床中常用的抗血管生成药物包括单克隆抗体类(代表药物贝伐单抗)、酪氨酸激酶抑制剂类(代表药物索拉菲尼、舒尼替尼)以及内皮细胞生长抑制剂等.不同类别的抗肿瘤血管生成靶向药物其不良反应各不相同,掌握该类药物的不良反应发生机制以及相关不良反应的处理措施,对接受该类药物治疗患者的耐受性会得到提高,同时也使患者预后得到进一步改善.     

Role of follow-on drugs and indications on the WHO Essential Drug List

Introduction: The World Health Organization's Essential Drug List (EDL) contains first‐in‐class drugs and subsequent class entrants (follow‐on drugs) deemed necessary to combat diseases prevalent throughout the world, with a special emphasis on developing nations. The EDL also includes originally approved and follow‐on indications. There are opposing views regarding the value of follow‐on drugs and indications. Critics suggest many follow‐on drugs and indications offer little or no benefit to patients. Advocates counter that follow‐on drugs offer advantages in terms of improved effectiveness, compliance and patient satisfaction. Objective: In order to inform this debate on the value of follow‐on drugs and indications we examined the numbers of follow‐on drugs on the EDL and the extent to which follow‐on indications are recommended. Methods: We identified all 312 drugs on the 14th edition of the EDL, omitting 72 non‐pharmaceutical entities. For the 240 pharmaceutical entities we ascertained whether the Food and Drug Administration (FDA) had approved them, and, if so, when each was approved. We chose a validated therapeutic classification system – the United States Pharmacopeia's Model Guidelines for Medicare formulary management – in order to distinguish first‐in‐class and follow‐on drugs on the EDL. Specifically, we selected the formulary key drug type as our benchmark therapeutic class. We assigned each EDL drug to a formulary key drug type. We defined first‐in‐class drugs as the first in each formulary key drug type, and follow‐on drugs as all other drugs in each formulary key drug type. We identified follow‐on indications by comparing WHO‐listed indications with the original approved indication(s) by the FDA. Finally, we examined the therapeutic rating (priority vs. standard) given by the FDA to follow‐on drugs on the EDL. Results: Sixty‐three per cent of the EDL drugs were follow‐ons; 15% of the indications were follow‐on indications. Fourteen drugs were listed in multiple WHO (sub) groupings; and 49% of follow‐on drugs were given a priority rating by the FDA. Conclusions: In light of the fact that the EDL only includes drugs and indications deemed essential, the large number of follow‐on drugs, follow‐on indications, and priority‐rated follow‐on drugs on the EDL suggest their importance. From a public policy perspective, it may prove counterproductive to erect hurdles that impede follow‐on research and development.     

2020年新乡市某三级医院病原菌分布与耐药情况分析

目的 了解新乡市某三级医院各临床科室2020年所有标本分离病原菌的分布及耐药情况,为临床经验性抗感染治疗及医院感染防控提供理论依据.方法 分析本院2020年临床送检标本分离出的病原菌及药敏试验结果.结果 2020年共分离出1465株细菌,送检的阳性标本类型中痰液标本数量居首位,其次是尿液、血液、分泌物、腹水等.革兰阳性...     

The quality of essential antimicrobial and antimalarial drugs marketed in Rwanda and Tanzania: influence of tropical storage conditions on in vitro dissolution

OBJECTIVE: The quality of 33 formulations of essential antimicrobial and antimalarial drugs (amoxicillin capsules, metronidazole tablets, sulfamethoxazole/trimethoprim tablets, quinine tablets and sulphadoxine/pyrimethamine tablets) marketed in Rwanda and Tanzania was assessed and the influence of tropical storage conditions on potency and in vitro dissolution investigated. METHODS: Drug content and in vitro dissolution were determined immediately after purchase and during 6-month storage under simulated tropical conditions (75% relative humidity, 40 degrees C) using the methods described in the USP 24 monographs on the drugs concerned. RESULTS AND DISCUSSION: At the time of purchase, the drug content of all the formulations was within the limits recommended by the USP 24, but after 6-month storage, the drug content of one sulfamethoxazole/trimethoprim and one quinine formulation were found to be substandard. Immediately after purchase, four formulations (three sulfamethoxazole/trimethoprim and one sulphadoxine/pyrimethamine combination) failed the USP 24 dissolution test. Except for three metronidazole and one quinine formulations, dissolution tests performed after 6 months of storage under simulated tropical conditions showed that drug release remained within the USP 24 recommended values. CONCLUSION: In both countries, essential drug formulations met pharmacopoeial potency requirements, but some had a poor in vitro drug release profiles. Some of the formulations tested were not stable upon storage under simulated tropical conditions.