我院纤维蛋白原使用情况调查分析

摘 要 目的：调查我院纤维蛋白原临床使用情况,为促进纤维蛋白原的合理用药提供参考。方法: 回顾性调查分析我院2016年全年纤维蛋白原临床使用情况,对用药适应证、用法用量等进行统计分析。结果: 2016年489例患者使用纤维蛋白原,其中手术和非手术患者各243和246例;使用科室主要为心血管外科、心内科、急诊科、重症医学科、妇产科、消化内科、神经外科。用药适应证合理率为80.0%,心血管外科和心内科手术患者中存在无适应证用药。用法用量不合理为3例配伍不宜和17例用量过小,不合理率为17.9%。结论: 纤维蛋白原临床应用基本合理,但心脑血管手术患者围术期尚存在无指征用药情况,用法用量中也存在不规范的情况。建议进一步加强纤维蛋白原等血液制品的处方点评工作,促进其规范合理使用。     

二甲双胍临床不合理用药调查

摘 要 目的:了解我院住院患者二甲双胍使用情况,总结二甲双胍的不合理用药现象,促进临床合理用药。方法：收集2014年应用二甲双胍的住院患者病历,对二甲双胍临床应用的适应证、用法用量、禁忌证、不良反应及药物相互作用等进行系统的回顾性调查分析。结果：二甲双胍主要应用于2型糖尿病患者。使用最多的剂型为缓释片,约占65.17%。二甲双胍用药不合理率为38.87%,其中用法用量不合理59.83%、存在用药禁忌39.3%和无适应证用药0.87%。用法用量不合理主要表现为肠溶片餐中或餐后服用,占83.45%。二甲双胍的应用禁忌证主要为应用碘造影剂前后未停用二甲双胍（47.47%）,肝、肾功能不全（21.21%）。二甲双胍的不良反应发生率为6.98%。结论：目前二甲双胍在临床应用中仍存在一些不合理现象,应积极开展二甲双胍临床药学服务,加强其合理用药,降低临床用药风险。     

止血药在蛛网膜下腔出血患者中的应用调查和合理性评价

摘 要 目的：调查止血药预防蛛网膜下腔出血患者再出血的使用现状并展开合理性评价。方法: 抽取某院2016年1～12月蛛网膜下腔出血患者的病例,调查患者使用止血药的种类、用法用量、疗程、药品不良反应等情况,根据药品说明书或相关指南推荐评价、药物利用研究及药品不良反应监测综合方法,探讨止血药临床使用合理性与安全性。结果:91例患者中有81例(89.01%)使用止血药,涉及3个品种,联合用药比例达16.05%。依照药品说明书或相关指南推荐,用法用量符合说明书的有70例(86.42%),给药途径合理率为100%,溶媒选用正确的有80例(98.77%),疗程≤72h的有72例(88.89%)。酚磺乙胺注射液和氨甲苯酸注射液的药物利用指数＞1,提示用药剂量不合理。81例使用止血药的患者未出现不良反应。结论:止血药在蛛网膜下腔出血患者中应用较为普遍,且仍存在部分不合理现象,应注意止血药的的用法用量和使用疗程等。     

某三甲医院100例住院患者万古霉素临床应用分析

摘 要 目的：调查评价某院万古霉素临床使用情况,为促进万古霉素的合理应用提供参考。方法: 采用回顾性研究方法,调查某院2015年9月~2016年2月使用万古霉素的100例住院患者病历资料,对药品的使用情况、病原学检查及血药浓度监测等情况进行统计汇总,并根据按有关指南制定的“万古霉素应用合理性评价标准”进行用药合理性评估,对用药不合理情况进行分类统计分析。结果: 100例使用万古霉素住院患者,男性61%,女性39％,平均年龄（55.69±19.88）岁;治疗有效率为81%;发生不良反应1例（1%）;药物利用指数DUI为0.66;微生物标本送检率为69.4%,根据药敏结果选用万古霉素23例;进行血药浓度监测15例（占15%）,对其中6例血药浓度＞20μg·mL^-1者进行剂量调整;给药方案基本合理,但有疗程不合理者11例;不合理使用万古霉素20例（占20%）。结论:该院万古霉素使用基本合理,不存在过度使用现象。但仍存在某些不适宜用药问题。     

某院1 435例单唾液酸四己糖神经节苷脂钠应用合理性分析

摘 要 目的：了解某院单唾液酸四己糖神经节苷脂钠（GM1）的使用情况,分析其使用合理性,为临床合理用药提供参考。方法：采用回顾性分析方法,统计某院2018年1~6月住院患者的GM1使用情况,参照说明书及相关指南、共识进行合理性分析。结果：某院GM1平均药物利用指数（DUI）为1.22,使用量最多的为老年病科;1 435例患者中,适应证不合理242例（16.86%）,给药剂量不合理150例（10.45%）,用药疗程不合理206例（14.35%）,溶媒选择不合理52例(3.62%),配伍不合理4例（0.28%）,联合用药不合理16例（1.65%）。结论：GM1的使用存在不合理现象,其中适应证、给药剂量、用药疗程不合理问题较为突出,应提高GM1使用的合理性。     

132例患者使用替加环素的用药合理性分析

摘 要 目的：评价临床使用替加环素的合理性,为加强替加环素使用的规范化管理,促进合理用药提供依据和参考。方法: 采用回顾性研究方法,抽取我院2014~2016年出院患者病历,收集使用替加环素的病历132份,对患者的性别、年龄、疾病类型、感染部位、病原学检查、替加环素用法用量、给药疗程、联合用药、临床疗效以及用药合理性、不良反应等方面进行统计分析。结果: 我院近3年来使用替加环素抗感染治疗的患者病原学送检率86.37%,临床有效率81.82%,替加环素合理使用率63.64%,基本合理使用率13.64%,不合理使用率为22.72%,药品不良反应发生例数较多,达20例（15.15%）。结论: 医疗机构对替加环素的使用必须严格管理,并对其适应证、给药方案、不良反应和处方权加以控制,减少经验性用药,提高合理用药水平。     

某院神经外科住院患者醒脑静注射液使用情况调查

摘 要 目的： 调查某院神经外科醒脑静注射液（XNJI）使用情况,为促进XNJI的临床合理应用提供参考。方法: 回顾性抽查某院2014年1月~2015年6月神经外科200份使用XNJI的住院病历,对其用药适应证、用法用量、疗程、联合用药、不良反应等进行统计分析。结果: 该科室XNJI存在超说明书用药情况,其中超说明书适应证者达34.50%,超剂量给药者达92.50%,而单次用药剂量为40 ml的患者占90.00%。临床使用中也存在着XNJI与西药联合使用的问题,主要与氯化钾（74.00%）合用或与氯化钾和胰岛素（11.00%）联合使用。结论:临床使用醒脑静注射液存在着某些不合理的情况,应加强其规范使用的管理。     

我院217例中成药不良反应报告中不合理用药情况分析

摘 要 目的：了解中成药不合理使用对用药安全性的影响。方法: 回顾性分析我院2013年1月~2016年10月上报的中成药（含中药注射剂）不良反应报告。从适应证、用法用量、中成药联用、中西药联用、用药疗程等5个方面分析评价处方或医嘱中的用药合理性,计算不合理用药比例。 结果: 共收集中成药不良反应报告217份,涉及患者217例,用药原因排前3位为心脑血管疾病、消化系统疾病及呼吸系统疾病。共涉及药品81个品种,发生例数最多的为参麦注射液（37例）。217份不良反应报告中适应证、用法用量、中成药联用、中西药联用、用药疗程的不合理比例分别为6.45%,5.99%,2.76%,0.92%,1.84%,共计17.97%。结论: 不合理用药可能是引起中成药不良反应的重要因素之一。中成药使用需根据中医辨证,规范使用,加强用药监护,降低ADR的发生率。     

2021年遂宁市中心医院住院患者应用利伐沙班的合理性分析

目的 调查2021年遂宁市中心医院住院患者临床应用利伐沙班的合理性,为临床合理用药提供参考。方法 回顾性调查分析遂宁市中心医院2021年1月—12月住院患者使用利伐沙班抗凝的病例共2 405份,对其应用的适应症、禁忌症、用法用量、用药时机、用药疗程、药物转换的合理性进行分析。结果 2 405例应用利伐沙班的病历中,适应症不合理306例,存在用药禁忌84例;2 099例具有应用利伐沙班适应症的病历中,用法用量不合理741例,给药时机不合理15例,疗程不合理31例,药物转换不合理104例。结论 遂宁市中心医院住院患者应用利伐沙班主要存在无适应症用药、用法用量不合理等用药现象,应加强宣教。     

2020年郑州市第七人民医院大株红景天注射液的使用合理性分析

目的 分析2020年郑州市第七人民医院住院患者大株红景天注射液的临床应用情况,为促进中药注射剂在临床上的合理应用提供参考。方法 采用回顾性分析方法,抽取郑州市第七人民医院2020年1月—12月使用大株红景天注射液的住院患者病历1 078份,对其适应症、用法用量、用药疗程、溶媒选择、联合用药等进行合理性分析。结果 1 078份病历中,不合理使用例数774例,占总例数的71.80%,表现为适应症不适宜（12.34%）、用法用量不适宜（7.05%）、疗程不适宜（36.64%）、溶媒选择不当（43.51%）、联合用药不适宜（7.14%）。结论 2020年郑州市第七人民医院大株红景天注射液的临床使用不合理情况广泛存在,建议出台有针对性的相关政策,并加强监测和管控,促进临床合理用药。     

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.     

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.     

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.