妊娠合并急性重症胰腺炎患者的药学服务分析

目的:分析妊娠合并急性胰腺炎患者的药学服务,探讨临床药师在药物治疗中的作用。方法:临床药师参与妊娠合并急性胰腺炎患者的药物治疗,与临床医师一起制订用药方案,监护用药过程。结果:临床药师参与急性胰腺炎的治疗方案,关注药物对妊娠的影响,提供药学监护。结论:临床药师参与临床急性胰腺炎的治疗,通过制订用药方案和药学监护,减少了药物对妊娠的影响,保证了胎儿的健康发育。     

临床药师参与急性重症胰腺炎的药学服务实践

急性胰腺炎（acute pancreatitis,AP）为临床常见病,一经诊断应立即予以禁食、胃肠减压、静脉补液、止痛、抗感染、抑酸、减少胰液分泌等对症支持治疗。近年来,由于种种原因导致治疗AP药物的不规范使用、滥用现象明显增加,极大增加了AP患者的治疗成本,且由此带来了一系列不良反应,因此有必要对AP患者实施药学服务。     

临床药师对1例急性重症胰腺炎患者的药学服务

临床药师对1例急性重症胰腺炎患者进行药学监护,与医师共同制订治疗方案：在抑酸、抗菌、抑制胰腺外分泌药物和胰酶制剂、营养支持和中药的合理使用方面提供用药建议。确保了患者用药安全有效。     

重症急性胰腺炎1例抗感染治疗及药学监护

重症急性胰腺炎(SAP)是由多种因素诱发、多脏器受累的疾病,是胰腺组织自身消化炎性反应性疾病,可伴有休克、多器官功能衰竭、胰腺脓肿、消化道大出血、胰瘘等多种并发症。笔者对临床药师参与的1例急性胰腺炎患者应用抗菌药物的治疗情况进行分析并进行药学监护,现报道如下。1病历概要患者,男,47岁。于入院前6h因进食及少量饮酒后出现上腹部疼痛、恶心、呕吐,无呕血,伴背部疼痛,无腹股沟放散     

药学服务在临床用药中的作用

1987年,美国学者Hepler提出了药学服务（pharmaceutical care）的概念,1990年Hepler和Strand将其定义为：“药学服务是围绕提高生活质量这一既定目标,直接为公众提供负责任的、与药物治疗相关的服务”。药学服务的核心是药学技术服务,药学服务的对象是广大公众（包括病人及其家属、医护人员、卫生工作者、药品消费者和健康人群）。     

重症急性胰腺炎治疗现状

重症急性胰腺炎(severe acute pancreatitis,SAP)病情凶险、病死率高,是高危急腹症.近20年来,经过国内外学者多方面的研究,SAP的治疗方法不断改进,患者存活率逐步提高.本文结合相关文献对此综述如下.     

重症急性胰腺炎治疗现状

重症急性胰腺炎(severe acute pancreatitis,SAP)病情凶险、病死率高,是高危急腹症.近20年来,经过国内外学者多方面的研究,SAP的治疗方法不断改进,患者存活率逐步提高.本文结合相关文献对此综述如下.     

临床药师参与1例妊娠合并重症急性胰腺炎治疗的药学实践

目的 探讨临床药师在妊娠合并重症急性胰腺炎患者药物治疗中的作用。方法 临床药师参与1例妊娠合并重症急性胰腺炎患者的药物治疗,建议医师根据临床疗效和病情变化及时调整用药方案,并关注药物对妊娠患者的影响,提供更为全面的药学服务。结果 临床药师为患者提供个体化药学服务,提高了临床治疗效果,减少了药品不良反应。结论 临床药师参与药物治疗实践,有利于提高药物治疗水平。     

罗格列酮对重症急性胰腺炎合并肺损伤的防治作用

目的 研究抵抗素在过氧化物酶增殖物激活受体(PPAR-γ)激动剂(罗格列酮)对大鼠重症急性胰腺炎(SAP)及其合并肺损伤防治中的作用及其作用机制.方法 用ELISA法检测大鼠血清淀粉酶(AMY)、抵抗素、肿瘤坏死因子(TNF-α)、白细胞介素-1β(IL-1β)和C.反应蛋白(CRP)的水平变化,检测肺组织髓过氧化物酶(MPO)、肺湿/干重比值、胰腺/体质量比值、胰腺和肺组织病理变化;免疫组化检测胰腺组织中抵抗素的表达;实时定量PCR法检测胰腺组织中抵抗素mRNA的水平.结果 罗格列酮预防组和治疗组大鼠血清AMY、抵抗素、TNF-α、IL-1B和CRP水平较SAP组均明显下降(均P＜0.01),预防组和治疗组与对照组相比均有明显升高(均P＜0.01),预防组和治疗组之间相比较有所变化,但两者之间无统计学意义;罗格列酮预防和治疗组胰腺/体质量比、胰腺病理评分、肺组织MPO含量和肺的病理评分较SAP组均明显降低(均P＜0.01);对照组、SAP组、预防组和治疗组大鼠的胰腺组织抵抗素mRNA相对表达量(RQ值)较SAP组明显降低(均P＜0.01),而与对照组相比较均明显升高(P＜0.01),但预防组与治疗组之间差异无统计学意义.结论 罗格列酮对SAP及合并肺损伤有明显的预防和治疗作用.     

Under-reporting of serious adverse drug reactions in Sweden

INTRODUCTION: Adverse drug reactions (ADR) constitute a major problem, both from a medical point of view and as an economical burden. Spontaneous reporting of ADRs is one of the methods for post marketing surveillance of drug safety. Under-reporting can also provide an important obstacle to rapid and relevant signal detection. AIM: To investigate the rate of under-reporting serious ADRs of selected ICD 10 diagnoses. METHOD: In order to investigate the under-reporting rate we investigated at five hospitals within the county of Norrbotten in Sweden the total number of diagnosed cases during a period of 5 years (1996-2000) with the following diagnoses: cerebral haemorrhage (I 61.0-I 61.9), pulmonary embolism (I 26.0 and I 26.9), embolism or thrombosis (I 74.0-I 74.9), phlebititis, thrombophlebitits or venous thrombosis (I 80.0-I 80.3, I 80.8 and I 80.9) and portal vein thrombosis and other thrombosis or emboli (I 82.0-I 82.3, I 82.8 and I 82.9). The identity of these patients was obtained through a database search. The patients' case records were then scrutinized by a specially trained nurse and the drugs used at the time of the event were noted. An assessment of the possibility of an ADR was performed using standard WHO causality criteria. Later, database search in the Swedish ADR registry was performed in order to investigate whether these suspected ADRs had been reported to the national authority in Sweden or not. RESULTS: In total 1349 case records were found and scrutinized. Of these, 107 patients had received drugs that could have been a probable or possible cause to the diagnoses. Of these 92 cases had not been reported and only 15 patients were found in the database, giving an overall under-reporting rate of all ADRs of 86%.The most commonly occurring diagnoses were cerebral haemorrhage followed by venous thrombosis, 545 and 468 respectively. Among those cases that should have been reported according to the existing rules for spontaneous reporting of suspected ADRs the most frequently occurring diagnosis was cerebral haemorrhage (I 61.0) in connection to treatment with anticoagulants. CONCLUSION: The rate of spontaneous ADR reporting is very low, also for serious and fatal reactions.     

Incretin-mimetics associated pancreatitis: evidence from the spontaneous adverse drug reactions reporting in Italy

Objective: New incretin-mimetics increased the treatment options for type 2 diabetes mellitus. Studies on the safety of incretin-based therapy showed a risk of hypersensitivity reactions, acute pancreatitis, renal failure, infection, thyroid and pancreas cancer. We contributed to safety assessment of these new drugs by evaluating the spontaneous adverse drug reactions (ADRs) reporting in Italy.

Research and methods: Reports of suspected ADRs associated with incretin-mimetics were selected from the Italian Spontaneous ADR Reporting Database. For a subgroup of cases belonging to the Hospital of Cento (Ferrara), levels of pancreatic enzymes, amylase and lipase, before and after the therapy with the incretin-mimetics were available.

Results: As of December 2012, the reports of ADR associated with hypoglycemic drugs (excluding insulin) were 2443, 1169 (47.85%) concerned the incretin-mimetics. A total of 90 reports described pancreatitis (44) and elevated pancreatic enzymes (46). Out of 90 cases, 34 were serious (37%). Data on amylase/lipase values for 10 patients were provided and an analysis of the published literature was performed.

Conclusions: Our data from the daily clinical practice add up and confirm the information available on the association between incretin-mimetics and pancreatic damage and suggest caution in the prescribing of these new drugs and a close monitoring of exposed patients.     

临床药师参与1例重症急性胰腺炎患者抗感染治疗的体会

目的 探讨临床药师参与胰腺炎抗感染治疗的方法。方法 通过查阅文献、学习相关指南,临床药师对1例重症急性胰腺炎患者的抗感染治疗提出药学建议,并进行药学监护。结果 药师建议被采纳,患者病情好转出院。结论 临床药师可协助医生,使药物治疗更安全有效,对患者康复有益。     

南京大学医学院附属鼓楼医院2010年698例药品不良反应回顾性分析

目的:分析药品不良反应(ADRs)发生的情况和原因,制定防范措施。方法:运用Excel软件对南京大学医学院附属鼓楼医院698例ADRs报告分类统计分析,计算ADRs发生例数、ADRs例数与其用药频度(DDDs)的比值(相对发生率)。结果:抗感染药引起的ADRs为264例(37.82%),其中左氧氟沙星73例居首位,其次为循环系统药113例(16.19%)和抗肿瘤药92例(13.18%)。用药频度(DDDs)则抗感染药中的左氧氟沙星排序第一,ADRs例数/DDDs比值排序的均值抗肿瘤药为8.5,排序第一。ADRs的临床表现以皮肤及附件损害最为常见,共255例(36.53%)。结论:须进一步加强ADRs的监测,并做好相应的防范措施,减少或避免ADRs发生。     

Attitudinal survey of voluntary reporting of adverse drug reactions

AIMS: Voluntary adverse drug reaction (ADR) reporting schemes have operated since the early sixties in many Western countries. It is generally recognized, however, that only a small proportion of ADRs is actually reported. The current survey was conducted to assess attitudes towards reporting of ADRs, and to study which types of ADRs are reported. METHODS: A questionnaire seeking reasons for nonreporting was sent to a random sample of 10% of medical practitioners in The Netherlands in October 1997. After 6 weeks, a reminder was sent to those who had not responded. RESULTS: One thousand four hundred and forty-two (73%) questionnaires were returned, of which 94% were complete. The percentage of GPs (51%) which had ever reported an ADR to the national reporting centre was significantly higher than the percentage of specialists (35%), who reported more often to the pharmaceutical industry (34% vs 48%). 86% of GPs, 72% of surgical specialists and 81% of medical specialists had ever diagnosed an ADR, which they had not reported. Uncertainty as to whether the reaction was caused by a drug (72%), the ADR being trivial (75%) or too well known (93%) were the most important reasons for not reporting. 18% were not aware of the need to report ADRs, 22% did not know how to report ADRs, 38% did not have enough time, 36% thought that reporting was too bureaucratic and only 26% of Dutch physicians knew which ADRs to report. A serious ADR, an unlabelled ADR, an ADR to a new drug, history of reporting of one or more ADRs, and specialty were all independently associated with reporting of 16 hypothetical ADRs. Surgical and medical specialists tended to report less often than GPs. CONCLUSIONS: There is a considerable degree of underreporting, which might partly be explained by lack of knowledge and misconceptions about spontaneous reporting of adverse drug reactions.     

临床药师参与1例尿毒症患者并发抗生素脑病的药学监护

目的 临床药师通过对1例尿毒症并发抗生素脑病患者进行药学监护,发挥其在治疗团队中的作用.方法 通过对患者进行全程药学监护,监测相关指标和不良反应,及时给出调整建议,评价治疗效果.结果 临床药师通过对该患者实施药学监护,提高了药物治疗的安全性和有效性,提高了患者的依从性.结论 通过参与临床实践,临床药师为合理用药提供了帮助,使患者获得优良的药学服务.     

临床药师对监护室高脂血症胰腺炎患者的药学监护

目的探讨对高脂血症胰腺炎患者的药学监护方法。方法为1例高脂血症胰腺炎患者提供具体化的药学服务,制订个体化的监护计划,同时根据药物的临床疗效及时调整药学监护方案。结果临床药师以抗感染治疗、降脂治疗和营养支持作为切入点,开展药学监护,避免了临床治疗中的潜在不良反应。结论临床药师参与临床治疗过程提高了患者用药的安全性及有效性,同时改善患者用药依从性及整体治疗水平。     

儿童急性淋巴细胞白血病治疗中甲氨蝶呤血药浓度与不良反应的相关性研究

目的：研究急性淋巴细胞白血病（ALL）患儿应用大剂量甲氨蝶呤（MTX）化疗期间，MTX血药浓度与不良反应的关系，从而设定合理的MTX解救方案。方法：133例ALL标危患儿连续静脉滴注MTX 24h后，监测48h时MTX血药浓度（C48h），并观察毒副作用。结果和结论：MTX C48h≤0．1μmol／L是一个比较安全的浓度范围，在充分水化、碱化的同时，在MTX C48h为0．3μmol／L左右时停止解救，在临床上仍然是安全的。     

发达国家药物不良反应监测概况

药物不良反应(ADRs)是世界医疗界的难题,本文对欧美等发达国家药物不良反应发生现状、监管现状及避免ADRs增进药物安全性的方法等几方面进行综合评述,以助于吸取有效经验。