三种中草药注射剂与输液配伍的不溶性微粒考察

目的：对三种中草药注射剂与输液配伍后的不溶性微粒数量变化进行观察。方法：采用ZWF-4微粒分析仪检测中草药注射剂与输液配伍后溶液中的不溶性微粒。结果：配伍溶液中不溶性微粒数量明显增多。结论：中草药注射剂中的微粒必须加以控制．与输液配伍后的不溶性微粒显著增加应引起重视。     

注射剂配伍后不同粒径不溶性微粒的倍增现象

目的：考察注射剂配伍后不溶性微粒倍增的现象。方法：用电阻法检测配伍前后不同粒径微粒的数目。结果：证实了输液配伍后澄明度合格但微粒超标的可能,并观察到不同粒径微粒倍增的程度不同。结论：应重视药物配伍后特定粒径微粒的倍增及与输液不良反应间的关系。     

药物与输液配伍后引起不溶性微粒变化的探讨

目的：检查输液与药物配伍后不溶性微粒变化。方法：按照注射液中不溶性微粒检查法检查微粒。结果：输液与药物配伍后，微粒数增加，不同剂型增加差异较大，药物配伍品种愈多，微粒增加也愈多。结论：微粒愈多对人体危害愈大，临床医师、临床药师应引起高度重视，并采取有效措施。     

常用中药注射剂与输液配伍前后不溶性微粒变化及其相关安全性研究（摘要）

目的：研究常用中药注射剂与不同厂家输液配伍前后不溶性微粒变化,从微粒污染方面考察中药注射剂临床应用的安全性。方法：调研临床上常用的中药注射剂,采用《中国药典》（2005年版）附录光阻法测定配伍前输液中及中药注射剂与输液配伍后不溶性微粒的数量。结果：配伍后,混合溶液中不溶性微粒的数量与配伍前输液中的数量相比（尤指粒径≥2um和≥5um的微粒）均显著增加,     

考察配伍前后输液中的不溶性微粒

目的考察配伍前、后输液中不溶性微粒的变化。方法采用自动微粒分析仪测定输液配伍药物前、后的不溶性微粒数。结果与结论输液配伍药物后微粒显著增加,配伍药品数越多,微粒污染越严重。     

注射用穿琥宁冻干粉针在4种输液中的稳定性考察

目的：考察注射用穿琥宁冻干粉针在4种常用输液中的稳定性。方法：应用紫外分光光度计、酸度计、注射用微粒分析仪分别考察注射用穿琥宁冻干粉针与4种输液配伍后的外观、pH、微粒、含量、紫外吸收光谱的变化。结果：注射用穿琥宁冻干粉针与4种输液配伍后外观、pH、含量、紫外吸收光谱均无显著变化。2、5和10μm微粒配伍后数量有所增加。结论：注射用穿琥宁冻干粉针可与4种输液配伍应用。     

穿琥宁注射液在6种输液中的稳定性考察

研究穿琥宁注射液在６种常用输液中的稳定性。方法：应用紫外分光光度计、酸度计、注射液微粒分析仪分别考察穿琥宁注射液与６种输液配伍后在不同温度下的外观、含量、ｐＨ、微粒及紫外吸收光谱的变化。结果：穿琥宁注射液与６种输液配伍后外观、ｐＨ、微粒、含量、紫外吸收光谱均无显著变化。结论：穿琥宁注射液可与６种输液配伍应用。     

6种中药注射液在2种输液中的微粒观察

目的：观察6种中药注射液与不同输液配伍后的微粒情况。方法：利用注射液微粒分析仪测定6种中药注射液分别与5％葡萄糖、0．9％氯化钠注射液配伍后的微粒。结果：混合液中≥2μm、≥5μm、≥10μm的不溶性微粒均有显著性啬。结论：中药注射液与输液配伍后的微料数不容忽视。     

不同基础输液与4种临床常用注射剂配伍前后不溶性微粒的测定分析

目的：考察不同基础输液和4种临床常用注射剂配伍前后不溶性微粒的差异。方法：选取临床常用的3个厂家（内封式聚丙烯输液袋BFS、双层无菌软袋、直立式聚丙烯输液袋，编号厂家1、2、3）的0.9%氯化钠注射液（NS）和5%葡萄糖注射液（5% GS），测定不同基础输液与临床常用注射剂配伍前后2 μm 以上不溶性微粒数量。NS与注射用盐酸氨溴索配伍，5% GS与注射用地塞米松磷酸钠配伍。另外将多索茶碱注射液和奥拉西坦注射液分别与上述2种基础输液配伍）。结果：空白输液中厂家1输液中不溶性微粒最少，厂家3最多。与注射剂配伍后，无论NS还是5%GS，厂家1输液中不溶性微粒最少，厂家3显著高于其他两家，尤其是2~5 μm，5~10 μm小粒径不溶性微粒。多索茶碱和奥拉西坦与同一厂家的5%GS和NS配伍后不溶性微粒数量相近，说明临床使用中与二者配伍皆宜。结论：不同基础输液与临床常用药配伍后不溶性微粒数量具有显著差异，提示生产企业应提高输液产品的质量控制标准，医院临床治疗需重视输液产品的遴选，为输液临床使用安全性提供保障。     

小容量注射剂与输液配伍不溶性微粒变化

目的：考察小容量注射剂配伍输液后对输液微粒的影响。方法：收集了近5年来，5种药学杂志，关于小容量注射剂(包括：中药注射液、注射用粉针剂、注射液)与输液配伍后，不溶性微粒变化的考察报告。结果：中药注射剂引起不溶性微粒增多且超标最严重，注射用粉针剂次之，而注射液基本合格。结论：提示药品标准应增加对静脉用小容量注射剂的不溶性微粒的限量检查，与输液配伍的操作环境及注射器具等应按要求执行。     

静脉输液配制后的微粒数变化及其影响因素探讨

目的：研究静脉输液中添加药物后其不溶性微粒数量的变化情况及其影响因素,为临床合理配制输液提供依据。方法：将添加药物按不同方式组合,加至输液中,按《中华人民共和国药典2010版》中不溶性微粒检查法进行测定。结果：在直立式聚丙烯输液袋中添加4种水针剂进行混合配制后测得的粒径大于或等于10斗m的微粒数平均值超过25个;在聚氯乙烯输液袋和直立式聚丙烯输液袋中添加5种水针剂进行混合配制后测得的粒径大于或等于10μm的微粒数平均值均超过25个,且在直立式聚丙烯输液袋测得的粒径大于或等于25μm的微粒数平均值超过3个;3种粉针剂中,注射用青霉素钠和注射用氨苄西林钠在上述2种输液袋中进行混合配制后测得的粒径大于或等于10μm的微粒数平均值均超过25个,其中注射用青霉素钠在直立式聚丙烯输液袋中所测得的粒径大于或等于25μm微粒数平均值超过3个。结论：输液中添加的药品种类越多,微粒污染越严重;直立式聚丙烯输液袋比聚氯乙烯输液袋更易产生微粒。     

葡萄糖氯化钠钾注射液与7种儿童常用药物的配伍稳定性研究

目的:考察葡萄糖氯化钠钾注射液(GNK)与7种儿童常用药物配伍的稳定性。方法:将 GNK 与7种药物模拟临床用药浓度分别配伍,采用高效液相色谱法分别洲定0,1,2,4,6,8 h 的药物含量,同时观察其外观变化,并测定 pH 及不溶性微粒数日。结果:GNK 与7种药物配伍的供试品溶液在8 h 内性状稳定,不溶性微粒数目符合药典规定,pH 和药物含量均无明显变化。结论:GNK 与7种药物配伍的供试品溶液在8 h 内稳定。     

临床药师在静脉输液治疗中的药学监护

目的为临床合理、安全应用静脉药物提供参考。方法对临床药师查房中收集的输液问题进行整理,从药物的配伍浓度、溶媒选择、药物配伍、静脉给药速度、光敏药物处置及液体的微粒控制等方面进行分析。结果与结论临床静脉给药存在着一定的问题,应进一步加强药学监护,将失误和相关的药品不良反应降至最低。     

输液加药后微料污染情况调查

本文采用肉眼观察的方法对输液加药后微粒污染的情况进行了调查。共调查３０９瓶加药输液，有肉眼可见微粒者２２４瓶，占７２．５％。其中加安瓿装药物者微粒检出率为５２．０％，加小瓶装药物者微粒检出率为９２．４％。微粒主要是橡胶屑、玻璃屑等。微粒的产生与加药的多少和穿刺瓶塞次数有关     

Particulate and microbial contamination in in-use admixed intravenous infusions

We compared particulate and microbial contamination in residual solutions of peripheral intravenous admixtures after the termination of drip infusion between intravenous fluids admixed with glass ampoule drugs and those admixed with pre-filled syringe drugs. The mean number of particles>or=1.3 microm in diameter per 1 ml of residual solution was 758.4 for fluids (n=60) admixed with potassium chloride in a glass ampoule (20 ml volume), 158.6 for fluids (n=63) admixed with potassium chloride in a pre-filled syringe (20 ml volume), 736.5 for fluids (n=66) admixed with sodium chloride in a glass ampoule (20 ml volume), 179.2 for fluids (n=15) admixed with sodium chloride in a pre-filled syringe (20 ml volume), 1884.5 in fluids (n=30) admixed with dobutamine hydrochloride in 3 glass ampoules (5 ml volume), and 178.9 (n=10) in diluted dobutamine hydrochloride in pre-filled syringes (50 ml volume: For these samples alone, particulate and microbial contamination were evaluated in sealed products.) Thus, for potassium chloride or sodium chloride for injection, the number of particles>or=1.3 microm in diameter in the residual intravenous solution was significantly higher for fluids admixed with glass ampoule drugs than for those admixed with pre-filled syringe drugs (p<0.0001). For dobutamine hydrochloride for injection, the number of particles>or=1.3 microm in diameter in the residual intravenous solution was estimated to be higher for fluids admixed with its glass ampoule drug than for those admixed with its pre-filled syringe drug. Observation of the residual solutions of fluids admixed with potassium chloride, sodium chloride, or dobutamine hydrochloride in glass ampoules using an electron microscope with an X-ray analyzer showed glass fragments in each residual solution. Therefore, for the prevention of glass particle contamination in peripheral intravenous admixtures, the use of pre-filled syringe drugs may a useful method. No microbial contamination was observed in any of the residual solutions of 5 types of admixture.     

Compatibility screening of linezolid injection during simulated Y-site administration with other drugs and infusion solutions

OBJECTIVE: To evaluate the physical compatibility of linezolid injection (Zyvox-Pharmacia) during simulated Y-site administration with 8 infusion solutions and 110 selected other drugs. DESIGN: Controlled experimental trial. SETTING: Laboratory. INTERVENTIONS: Five-milliliter samples of linezolid injection 2 mg/mL were mixed with 5 mL samples of the selected infusion solutions and the selected other drugs diluted in 5% dextrose injection, or, if necessary to avoid incompatibility with the diluent, 0.9% sodium chloride injection. MAIN OUTCOME MEASURES: Visual examinations of the samples were performed in normal fluorescent light with the unaided eye and using a Tyndall beam (high-intensity monodirectional light source) to enhance visualization of small particles and low-level haze. The turbidity of each sample was measured, and for samples that did not exhibit visible precipitation, the particle content was measured, as well. All of the samples were assessed initially and at 1 and 4 hours. RESULTS: All of the infusion solutions and most of the test drugs were physically compatible with linezolid injection during the 4-hour observation period. Physical incompatibilities resulted when linezolid injection was combined with five of the drugs: amphotericin B, chlorpromazine hydrochloride, diazepam, pentamidine isethionate, and phenytoin sodium. Precipitation, turbidity formation, and/or unacceptable changes in measured haze levels were observed. CONCLUSION: Linezolid 2 mg/mL was physically compatible for 4 hours at room temperature with all 8 infusion solutions tested and 105 of the drugs tested. Simultaneous Y-site administration of linezolid injection with the five drugs resulting in physical incompatibilities should be avoided.     

浅谈医院静脉药物配置中心的工作

目的：探讨静脉药物配置中心和药师在医院临床药学中的作用。方法：介绍上海交通大学附属第一人民医院静脉药物配置中心的工作概况，分析不合理的处方和工作中遇到的问题。结果：通过将静脉输注药物集中配置，加强了对约品的管理，保证了输液的质量。结论：通过药师对临床合理用药的监控，确保用药安全有效，充分发挥了药师在医院药学中的作用。     

抗肿瘤药静脉给药中的监护

目的：探讨抗肿瘤药静脉注射渗漏原因、所致组织损伤机制,提出有效的防治措施,提高用药安全性。方法：结合临床实际,回顾分析相关文献。结果：抗肿瘤药静脉注射渗漏,同药物本身、护理穿刺技术、患者个体因素相关联;发生机制为直接毒性和间接损伤。结论：抗肿瘤药静脉注射渗漏可采用局部封闭、外敷、解毒剂、物理照射等方法进行有效治疗。提高护理操作技术,加强健康教育和追踪观察,可起到积极预防作用。     

Preparation and Preclinical Evaluation of Inhalable Particles Containing Rapamycin and Anti-Tuberculosis Agents for Induction of Autophagy

Purpose

Mycobacterium tuberculosis (Mtb) inhibits host defense mechanisms, including autophagy. We investigated particles containing rapamycin (RAP) alone or in combination with isoniazid (INH) and rifabutin (RFB) for: targeting lung macrophages on inhalation; inducing autophagy; and killing macrophage-resident Mtb and/or augmenting anti-tuberculosis (TB) drugs.

Methods

PLGA and drugs were spray-dried. Pharmacokinetics, partial biodistribution (LC-MS/MS) and efficacy (colony forming units, qPCR, acid fast staining, histopathology) in mice following dry powder inhalation were evaluated.

Results

Aerodynamic diameters of formulations were 0.7–4.7 μm. Inhaled particles reached deep lungs and were phagocytosed by alveolar macrophages, yielding AUC0-48 of 102 compared to 0.1 μg/ml?×?h obtained with equivalent intravenous dose. RAP particles induced more autophagy in Mtb-infected macrophages than solutions. Inhaled particles containing RAP alone in daily, alternate-day and weekly dosing regimens reduced bacterial burden in lungs and spleens, inducing autophagy and phagosome-lysosome fusion. Inhalation of particles containing RAP with INH and RFB cleared the lungs and spleens of culturable bacteria.

Conclusions

Targeting a potent autophagy-inducing agent to airway and lung macrophages alone is feasible, but not sufficient to eliminate Mtb. Combination of macrophage-targeted inhaled RAP with classical anti-TB drugs contributes to restoring tissue architecture and killing Mtb.

     

1 039例儿童上呼吸道感染处方用药构成分析与评价

目的:探讨我院儿童上呼吸道感染用药处方的合理性。方法:选取佛山市顺德区第一人民医院附属陈村医院2016年8-10月儿科门诊明确诊断为上呼吸道感染的1 039例患儿,对其用药类别、给药途径、药品费用、炎症指标及复诊情况等进行回顾性分析。结果:1 039例患儿处方中,中成药处方使用最多为780例次,抗病毒药物处方672例次,解热镇痛药物处方633例,抗菌药物处方129 例次;抗病毒药物使用金额比例最高,占35.70%,中成药占27.69%;口服给药处方929例,静脉给药处方110例,静脉给药与口服给药患儿抗菌药物使用比例相近,但静脉给药患儿复诊比例高。结论:我院儿科门诊上呼吸道感染处方用药基本合理,但存在部分中成药重复用药使用和抗菌药物用药起点高、糖皮质激素静脉用药指征不明确等情况。