肺部感染患者药物治疗依从性调查分析及其影响因素的Logistic回归分析

目的 探讨肺部感染患者药物治疗依从性调查分析及其影响因素的Logistic回归分析。方法 选择2020年5月至2022年6月肺部感染患者178例为对象,所有患者均给予药物治疗,参考Morisky-Green标准及国内二相关评分标准设计调查表,根据调查结果分为治疗依从性好组（得分≥12分）和治疗依从差组（得分<12分）。查阅两组病历资料,对患者药物治疗依从性可能的影响因素进行单因素和多因素Logistic回归分析。结果 178例肺部感染患者均完成药物依从性调查,37例患者治疗依从性差,占20.79%。单因素及多因素Logistic回归分析结果表明：病程（OR=3.582,95%CI=2.482～6.313）、服药时间（OR=6.413,95%CI=5.682～8.452）、用药种类（OR=4.083,95%CI=3.235～4.572）、药物不良反应（OR=1.034,95%CI=0.283～4.394）、健康教育（OR=1.246,95%CI=0.987～1.583）、用药指导（OR=1.632,95%CI=1.231～1.986）均是影响肺部感染患者药物治疗依从性的危险因素（P...     

接受药师用药宣教后的慢性气道炎性疾病患者吸入剂用药依从性的影响因素分析

目的：了解用药宣教后慢性气道炎性疾病患者院外使用吸入剂依从性的情况，探讨其影响因素，为进一步开展针对性的用药宣教提供参考依据。方法：以2016年因慢性气道炎性疾病急性加重入院，出院后需规律使用长效吸入剂治疗的患者为研究对象（所有患者住院期间均经临床药师反复用药宣教），调查这类患者的人口学特征、家庭状况、患者自身患病情况及用药等现实情况，探讨其与吸入剂使用依从性关系，找出影响依从性的独立危险因素。结果：共有108例患者入组，在研究实施过程中因故死亡患者11例，实际患者97例，其中50例依从性好，47例依从性差。单因素分析示文化程度、1年内急性加重次数、对吸入剂治疗效果满意程度、方便取药程度、家庭关心、经济收入、合并用药种数、合并慢病种数、使用期间有无不良反应、1年随访次数对用药依从性有统计学意义（P<0.05）。多因素回归分析显示，1年急性加重次数（OR=20.394）、家庭关心（OR=40.442）、1年内随访次数（OR>999.999）为影响患者使用吸入剂依从性的独立因素（P<0.05）。结论：尽管住院期间进行了吸入剂使用的宣教，出院后定期随访督促，但仍有近一半患者未坚持规律使用吸入剂。临床药师必须采取更加积极的干预措施提高这类患者长期规范用药的依从性。     

再住院精神分裂症患者药物依从性相关因素分析

目的 探讨再住院精神分裂症患者药物依从性的相关因素。方法 回顾性分析2016年5月至2018年5月北京市怀柔安佳医院收治的180例再住院精神分裂症患者的年龄、性别、病程、婚姻、就业、文化程度、家族史、居住环境、药物类型、自知力、严重精神疾病危险性分级、免费服药、经济情况、残疾鉴定资料。采用Morisky服药依从性问卷（MAQ-8）将评分<6分者分为依从性差组（112例）,6～8分者分为依从性较好组（68例）,并用logistic回归分析再住院精神分裂症患者药物依从性的相关因素。结果 单因素分析结果显示,两组患者的就业情况、居住环境、药物类型、自知力、严重精神疾病危险性分级比较,差异有统计学意义（P<0.05）。logistic回归分析结果显示,自知力缺乏（β=1.338,OR=3.811,95%CI=2.362～6.148）、严重精神疾病风险性分级≥2级（β=1.213,OR=3.363,95%CI=1.558～7.262）是再住院精神分裂症患者服药依从性的独立危险因素（P<0.05）。结论 精神分裂症患者自知力越差,则依从性越差;严重精神疾病风险评估分级越高,依从性...     

肝移植受者术后服药依从性相关因素研究

目的：探讨肝移植患者术后服药依从性的影响因素。方法回顾性分析肝移植患者68例,随访调查其移植术后用药情况并分析其影响因素,应用二元logistic回归统计方法进行服药依从性影响因素分析。结果68例肝移植受者服药依从性良好者比例为79烫．4％,服药依从性与性别、是否医保、受教育程度均密切相关,且差异有统计学意义（ P ＜0．05）。 logistic回归显示肝移植患者术后服药依从性影响因素依次为性别（ OR＝0．014）、学历（ OR＝0．0105）。结论肝移植患者术后服药依从性受多因素的影响,应加强健康教育和经济支持力度,提高药物治疗依从性,减少因服药依从性差导致的相关并发症发生。     

癫痫患儿用药依从性现状及影响因素调查分析

目的：探讨癫痫患儿的用药依从性现状,并分析其影响因素。方法：选取2021年1-9月在我院门诊或住院治疗的癫痫患儿,按自愿原则,由癫痫患儿监护人完成Morisky用药依从性问卷,自行设计的患儿一般情况调查问卷以及监护人用药知识、用药信念及用药支持问卷,采用多因素Logistic回归分析用药依从性情况的影响因素。结果：通过微信平台共收集有效问卷107份,患儿年龄（6.75±2.76）岁,用药依从性水平为（6.42±1.20）分,用药依从性较低34例（31.78%）,依从性中等54例（50.47%）,依从性较高19例（17.76%）。患儿监护人用药知识得分（19.85±4.77）分,56.07%监护人用药知识处于中等水平。30.84%患儿监护人用药信念处于低水平,认为用药弊大于利;31.78%监护人用药支持行为差。Logistic回归分析结果显示,用药支持度影响用药依从性（OR=1.225,P=0.034）。结论：癫痫作为一种慢性疾病,大部分患儿的用药依从性有待提高,主要表现为漏服药物、擅自改变药物剂量及患儿监护人担心药物不良反应而自行减量或停药等,提高监护人对患儿的用药支持度对提高患儿用药依从性具有重要作用     

住院抑郁症患者抗抑郁药联合治疗的影响因素分析

目的：探讨住院抑郁症患者抗抑郁药联合治疗的影响因素，为临床安全用药提供参考。方法：回顾性分析374例住院抑郁症患者的社会人口学资料、临床疾病相关资料，比较抗抑郁药单一治疗（单用组）和联合治疗（联用组）的患者在出院日处方信息资料上的差异，并利用Logistic回归分析探讨抗抑郁药联合治疗的影响因素。结果：与单用组相比，联用组在年龄、居住地、婚姻状况、教育年限、起病年龄、汉密尔顿抑郁量表（HAMD）评分、合并躯体疾病、规律服药、联用抗精神病药等方面存在差异，且差异具有统计学意义（P<0.05）。多因素Logistic回归分析显示，患者的HAMD评分（OR=1.018，95% CI：1.003~1.034，P=0.022）、规律服药（OR=0.476，95% CI：0.306~0.740，P=0.001）、起病年龄（OR=2.260，95% CI：1.419~3.598，P=0.001）以及联用抗精神病药物（OR=0.411，95% CI：0.261~0.649，P<0.001）是住院抑郁症患者接受抗抑郁药物联合治疗的独立影响因素。另外，单用组和联用组不良反应发生率分别为27.0%和43.2%，两组相比差异具有统计学意义（χ²=10.860，P=0.001）。结论：HAMD评分高、起病年龄晚、不规律服药、未联用抗精神病药物是住院抑郁症患者抗抑郁药联合治疗的独立影响因素。抗抑郁药联合治疗增加不良反应发生风险，临床药师应加强对住院患者的用药监护及健康教育，有必要采取措施提升患者的用药依从性。     

我国AECOPD患者继发肺部真菌感染危险因素的Meta分析

目的：探讨我国慢性阻塞性肺疾病急性加重期（AECOPD）患者继发肺部真菌感染的危险因素,为预防和治疗肺部真菌感染提供科学依据。方法：检索2000年1月至2018年12月PubMed、Embase、Cochrane Library、万方数据库、VIP、CBM、CNKI收录的关于AECOPD继发肺部真菌感染危险因素的病例对照研究,采用采用纽卡斯尔-渥太华量表（NOS）进行文献质量评价,应用Review Manager 5.3进行Meta分析法计算相关危险因素的合并OR 值及其95%置信区间。结果：共纳入文献21篇,共4 738例患者。Meta分析显示,共有9个危险因素,分别是糖皮质激素累积用量>833 mg（泼尼松）（OR=14.94,95%CI：8.91~25.06）、糖皮质激素用药时间≥14 d（OR=9.55,95%CI：5.63~16.19）、抗菌药物用药时间≥14 d（OR=8.97,95%CI：5.21~15.43）、抗菌药物联用（OR=7.08,95%CI：5.17~9.69）、机械通气（OR=8.96,95%CI：5.09~15.78）、糖尿病（OR=4.07,95%CI：3.33~4.99）、AECOPD程度分级（OR=3.66,95%CI：2.11~6.33）、低蛋白血症（OR=3.42,95%CI：2.73~4.29）和呼吸衰竭（OR=3.05,95%CI：2.53~3.69）。结论：糖皮质激素用药时间超过14 d及累积剂量大于833 mg（泼尼松龙）、抗菌药物用药时间超过14 d、抗菌药物联用、机械通气、糖尿病、呼吸衰竭、低蛋白血症、AECOPD分级是我国AECOPD患者继发肺部真菌感染的危险因素。临床中应结合相关危险因素,有针对性的予以抗真菌治疗。     

我国6省7家县级公立医院高血压患者用药依从性及影响因素研究

目的：了解我国部分县级公立医院高血压患者用药依从性现状并探究其影响因素。方法：采用方便抽样，对6省7家县级公立医院高血压患者进行问卷调查，应用Morisky-4用药依从性量表调查患者用药依从性，采用多因素Logistic回归模型分析相关因素。结果：共回收问卷1685份，纳入有效问卷1378份，其中依从性好的高血压患者878例(63.7%)，使高血压患者用药依从性更好的主要因素包括参保城镇职工医保 (OR=1.932，95%CI:1.239~3.013)、不喝酒(OR=2.389，95%CI:1.654~3.450)、年龄较大(OR=1.409， 95%CI:1.075~1.845)和身体质量指数较大(OR=1.913，95%CI:1.292~2.833)，使高血压患者用药依从性更差的主要因素包括不与子女同住(OR=0.633，95%CI:0.492~0.813)、生活不能自理(OR=0.228， 95%CI:0.153~0.340)、性别为女性(OR=0.714，95%CI:0.543~0.938)和收入较高(OR=0.564， 95%CI:0.420~0.756)。结论：改善高血压患者用药依从性应加强对年轻患者高血压相关知识的教育和宣传，提高医保保障能力，鼓励患者家庭成员加大配合和支持力度，并督促患者养成健康的生活习惯。     

影响慢性阻塞性肺疾病患者吸入噻托溴铵粉雾剂依从性因素及预防措施

目的 探讨影响慢性阻塞性肺疾病（COPD）患者吸入噻托溴铵粉雾剂依从性因素及预防措施。方法 对117例COPD患者吸入噻托溴铵粉雾剂依从性进行评价,比较不同依从性COPD患者相关因素上的差异。结果 117例COPD患者中,依从性好82例（70.09%）,依从性差35例（29.91%）。吸入噻托溴铵粉雾剂依从性差患者年龄≥75岁、小学以下文化、抑郁自评量表（SDS）评分≥50、未婚、COPD病程≥15年、[健康指数（体重指数、梗阻、呼吸困难、运动能力）]（BODE指数）≥5、未随访、自费、经济较差比例高于依从性好组（P <0.05）,Logistic回归分析影响吸入噻托溴铵粉雾剂依从性因素为：小学以下文化（OR=6.414,95%CI:1.014～21.654）、SDS评分≥50(OR=5.923,95%CI:1.125～23.562)、年龄≥75岁（OR=4.543,95%CI:1.643～12.765）、经济较差（OR=3.910,95%CI:2.018～13.675）、COPD病程≥15年（OR=3.246,95%CI:1.976～16.227）。结论 COPD患者吸入噻托溴...     

深圳市糖尿病患者服药依从性及相关危险因素分析

目的了解本地区糖尿病患者服药依从性及其影响因素,为进一步开展糖尿病预防控制工作提供依据。方法对就诊于本院门诊的547例糖尿病患者进行调查,对其基本情况、糖尿病患病情况以及服药依从情况进行调查,并进行单因素和多因素分析。结果从糖尿病服药依从性单因素分析发现,依从性与居住情况、并发症情况、文化程度、监测血糖次数、病程长短、糖尿病知晓率、服药种类等因素相关。Logistic多因素回归分析发现病程(OR=1.776,P=0.011),DM知识知晓率(OR=1.634,P=0.009)和治疗复杂程度(OR=3.867,P=0.013)是影响糖尿病患者用药依从性的独立相关因素。结论糖尿病患者用药依从性与多种因素相关,而加强糖尿病患者健康教育、简化治疗方案、加强社会支持、长期规律用药等有利于患者治疗用药依从性的提高。     

Novolizer: how does it fit into inhalation therapy?

Inhalation therapy is the preferred route of administration of anti-asthmatic drugs to the lungs. However, the vast majority of patients cannot use their inhalers correctly, particularly pressurised metered dose inhalers (pMDIs). The actual proportion of patients who do not use their inhalers correctly may even be under-estimated as GPs tend to over-estimate correct inhalation technique. Dry powder inhalers (DPIs) have many advantages over pMDIs. Unlike pMDIs, they are environmentally-friendly, contain no propellant gases and, more importantly, they are breath-activated, so that the patient does not need to coordinate actuation of the inhaler with inspiration. Three key parameters for correct inhaler use should be considered when evaluating existing or future DPI devices and especially when choosing the appropriate device for the patient: (1) usability, (2) particle size distribution of the emitted drug and (3) intrinsic airflow resistance of the device. The Novolizer is a breath-activated, multidose, refillable DPI. It is easy to use correctly, has multiple feedback and control mechanisms which guide the patient through the correct inhalation manoeuvre. In addition, the Novolizer has an intelligent dose counter, which resets only after a correct inhalation and may help to monitor patient compliance. The Novolizer has a comparable or better lung deposition than the Turbuhaler at similar or higher peak inspiratory flow (PIF) rates. A flow trigger valve system ensures a clinically effective fine particle fraction (FPF) and sufficient drug delivery, which is important for a good lung deposition. The FPF produced through the Novolizer is also relatively independent of flow rate and the device shows better reproducibility of metering and delivery performance compared to the Turbuhaler. The low-to-medium airflow resistance means that the Novolizer is easy for patients to use correctly. Even children, patients with severe asthma and patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) have no problems to generate the trigger inspiratory flow rate required to activate the Novolizer. The Novolizer uses an advanced DPI technology and may improve patient compliance.     

药剂师主导的改善COPD患者用药依从性的干预研究（英文）

慢性阻塞性肺疾病(COPD)治疗的用药依从性与疾病控制相关。本文通过调查药剂师对干粉吸入剂(DPI)的使用进行干预后COPD患者吸入技术、满意度和依从性的改善情况,探讨使用干粉吸入剂患者的吸入技术、满意度与用药依从性之间的关系。研究对象为至少使用2个月DPIs的COPD患者,DPIs包括都宝(Turbohaler),准纳器(Discus)和吸乐(Handihaler)。当患者第一次进入研究时,吸入器技术、满意度和依从性等由训练有素的药剂师进行评估。第一次评估后,药剂师通过指导患者吸入剂使用,并针对患者用药满意度调查结果中不满意问题进行解答和干预,并对其进行1个月、3个月进行随访,6个月评估患者干预后吸入技术、满意度和依从性。共有135名患者完成本研究,患者吸入装置使用时间越长错误率越低,依从性越好,而CAT分越高及过去1年内病情加重次数越多,依从性越差。在干预前吸入技术中至少有一个错误的患者比例:都宝86.44%,准纳器76.60%,吸乐54.17%。药师干预后至少有一个错误的患者比例:都宝32.20%,准纳器29.79%,吸乐22.92%。干预后PASAPQ满意度平均分由基线时的74...     

新型肺部给药系统-吸入粉雾剂

吸入粉雾剂 (又名粉雾吸入剂、干粉吸入剂、粉雾剂) 是一种新型的肺部给药系统, 具有稳定性好, 不含抛射剂氟里昂等优点, 近年来受到人们的广泛关注。粉雾剂由粉末吸入装置和供吸入用的干粉组成。本文就近年来粉雾剂的研究进展, 包括吸收机制, 粉雾剂品种, 吸入装置, 制备技术和评价特征参数等进行了综述。     

Achieving asthma control

The number of people with asthma continues to grow around the world. However, despite the availability of highly effective medication it remains a poorly controlled disease. Reasons for this poor control include non-implementation and inherent limitations of the asthma management guidelines, poor compliance with asthma therapy, incorrect use of inhaler devices and insufficient treatment of peripheral airway inflammation. Guidelines may not be efficiently implemented as they may be complicated and difficult to understand. In addition, the scientific evidence upon which they are based, although the best available at the present time, is flawed. Patient non-compliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. Most patients derive incomplete benefit from pressurised metered dose inhalers (pMDIs) as they are unable to use them correctly. Dry powder inhalers (DPIs) have several advantages over pMDIs; they are breath-activated (avoiding coordination difficulties between actuation and inhalation), easy and convenient to use, and environmentally friendly. Although there are many treatments for asthma currently in development, it is unlikely that significant improvements in inhaled medication will occur within the next 15 years. Therefore, improvement in asthma management will be facilitated by improvements in inhaler technology. When choosing an inhaler device it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in the lungs (both central and peripheral airways) and that drug deposition is independent of airflow.     

On the use of dry powder inhalers in situations perceived as constrained.

Dose delivery from dry powder inhalers (DPIs) are dependent on the inhalation effort of the patient. Some patient groups, including asthmatic children, patients with acute asthma, and patients with advanced chronic obstructive pulmonary disease (COPD) are perceived as having problems in readily inhaling from a DPI in an efficient way; this opinion is based on alleged low inhalation flows. A review of the literature however shows that these groups can use a DPI in an efficient way and gain good clinical effect from its use. Particularly, it has been shown that children can generate a good peak inhalation flow through a DPI, albeit a lower inhaled volume. Similarly, patients with acute asthma can use a DPI in an efficient way, even reaching a better clinical effect with the DPI than with a pressurized metered dose inhaler with a spacer. Finally, it was shown that patients with severe COPD can generate the inhalation flows needed to generate an efficient drug aerosol from a DPI. Collectively, the discussed patient groups seem to perform as well as other subjects when it comes to their ability to generate an adequate inhalation flow through a DPI.     

Latest advances in the development of dry powder inhalers

The current market for dry powder inhalers (DPIs) has over 20 devices in present use and at least another 30 under development. Clinicians recognize that DPIs are a suitable alternative to pressurized metered dose inhalers (pMDIs) for some patients but the relative performance of devices is often unclear. The problem is compounded by the need to reformulate pMDIs with new propellants, introducing further products to the market with associated variations in performance. This article reviews the DPIs currently available, the driving forces governing new designs, and the claimed advantages of DPIs in the development pipeline.     

Measurements of electrodynamic effects on the deposition of MDI and DPI aerosols in a replica cast of human oral-pharyngeal-laryngeal airways

Metered dose inhalers (MDIs) and dry powder inhalers (DPIs) are popular drug delivery devices used in the treatment of respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Integrated effects of electrostatic charges and aerodynamic sizes on the deposition of MDI and DPI particles in a replica cast of human oral-pharyngeal-laryngeal (OPL) airways were examined. Experimental aerosols were generated from commercially available MDI and DPI devices. They are the trademarked brands of the same pharmaceutical company, and contain the same amounts of different drugs. Inhalations were administered as boluses and characterized with an Electronic Single Particle Aerodynamic Relaxation Time (ESPART) analyzer before and after passing through the cadaver-based OPL cast. The MDI and DPI aerosols were not only of different sizes but also carried different positive, negative and zero electrostatic charges; 42.2% of the total number of DPI particles was charged in comparison to 6% of those produced by the MDI. Electrodynamic properties (e.g., charges and sizes) played significant roles on the behavior and deposition of aerosols in the OPL airways. As detailed herein, deposition fractions of the total (charged and uncharged) DPI aerosols were 21.5% in contrast to 2.8% for the MDI aerosols, whereas the charged particle deposition for the DPI was 46.7% in contrast to 22.5% for the MDI. Particle losses in the OPL passages were greater for the DPI than the MDI as the former generated more charged particles than the latter. This finding is consistent with results reported by other researchers but contradicts the observation of another investigator where MDI losses were reported as being higher than those for DPIs. The chief reason for this difference may be that the latter study did not account for the electrical properties of aerosol particles, but only for their mechanical properties. Because the measured deposition efficiencies of MDI and DPI aerosols were different, the data have important implications to inhalation therapy protocols.     

Innovations and perspectives of metered dose inhalers in pulmonary drug delivery.

The phase-out of chlorofluorocarbons (CFCs) has spurred the development of alternative pulmonary drug delivery systems to pressurized metered dose inhalers (MDIs), such as dry powder inhalers and pocket size nebulizers. Reformulation of CFC-MDIs with hydrofluoroalkanes (HFAs) 134a and 227 is also an opportunity to improve these widely accepted systems with respect to ease of handling, compliance, dosing, and more reliable and efficient lung deposition. MDIs have the advantage to protect the drug substance from external parameters such as temperature and humidity and to meter and de-agglomerate the drug independent from patients inspiratory flow rates. Novel formulation technologies combined with improved valves and actuators should help to overcome dose uniformity and priming problems and will increase the percentage of fine particles capable of reaching the deeper regions of the lungs. Spacer mouthpieces can reduce the cold freon effect and undesired oropharyngeal deposition caused by the rapid evaporation of the propellant and plume velocity of the aerosol cloud. More advanced delivery devices may allow the patient to inhale at predetermined flow rates (fast/slow) to target the deposition of fine drug particles (1-6 microm) to specific sites into the lungs. Breath-actuated devices make these systems more effective and patient friendly. The above features in combination with numerical counters showing the remaining number of shots, and built-in blocking mechanisms to avoid tail-off dependent dose uniformity problems of the last labeled shots, should help to improve both acceptance and compliance of pMDIs compared to other inhalation devices. However, only those inhalation systems, which are accepted and appreciated by patients and offering an ambulatory treatment at reasonable cost, will be successful in a more and more competitive market. These issues must be considered in the development of future devices and formulations.