感染控制在静脉用药调配中心的重要性

静脉用药调配中心（ PIVAS）是指由医院药剂科提供静脉输注混合药物的配制服务。定义及要求是：符合国际标准,在依据药物特性设计的操作环境下,由专门受过培训的药剂人员严格按照程序进行,包括全静脉营养液、细胞毒性药物和抗菌药物的配置,为临床提供合理用药、质量保证的输液成品,使护士赢得优质服务时间,是集临床合理用药与药学科研为一体的机构。PIVAS是静脉用药集中调配的场所,也是院内感染控制的重点部门,调配人员在万级、局部百级的环境下,严格按照无菌操作的原则进行调配。静脉用药集中调配可以把广泛分布在各病区的污染源及危险源集中起来,有利于实施科学的管理来预防控制调配环境、调配过程等污染,并在一定的程度上减少临床护士因调配输液发生锐器伤害而导致的血源性感染,以及交叉感染和职业病的发生。但与此同时,如果忽视或不注重PIVAS的感染控制,有可能引发大批量调配输液的污染,引起临床输液的不良反应及严重的后果。我院自2011年6月帅先在云南省地、州、县级中医医院,开展静脉用药集中调配技术工作,并在2012年7月通过云南省卫生厅组织专家验收通过。经过1年多的静脉用药集中调配使用以来,临床静脉输液因液体调配质量引起的输液不良反应未发生过。笔者体会到静脉用药集中调配在保证临床输液安全,预防医院感染等方面起着至关重要的作用。现将在PIVAS工作中感染控制重要性的体会报道如下。     

分散式静脉用药调配中心的实践与创新简

目的保障临床用药安全、有效。方法比较分散式静脉用药调配中心（PIVAS）与传统集中模式PIVAS的异同及优缺点,总结分散式PIVAS的优势。结果与结论建立以科室为单位的分散式PIVAS,解决了集中模式的PIVAS工作时间安排、人员配备、运输通道的矛盾,降低了用药风险,保证了临床用药及时与安全。     

静脉用药调配中心24小时全医嘱下临时医嘱的运行模式

目的：探讨24 h工作模式下我院静脉用药调配中心（PIVAS）临时医嘱的运行模式,为临床安全合理用药提供参考。方法：分析PIVAS临时医嘱的审核、提取、批次安排、摆药、贴签、配置及扫描交接的运行模式。结果：临时医嘱PIVAS集中调配后,日均调配人数减少66.67%,调配时间减少77.78%,调配耗材减少13.64%。结论：我院PIVAS 24 h接收并配制临时医嘱,提高了工作效率,满足了临床配置临时医嘱的需求,保证了静脉用药的安全性及合理性。     

静脉用药调配中心配置间管理制度优化实践与体会

目的 优化静脉用药调配中心（PIVAS）配置间管理制度,提高医院感染控制水平。方法 注重PIVAS人员的素质培养,加强各个环节的操作制度,完善各项监测措施。结果 制度优化保证了成品输液的质量,同时可确保临床患者静脉用药的安全,有效防止了医院感染的发生。结论 通过优化配置间管理制度,使PIVAS配置间达到科学化、规范化、标准化,对于降低医院感染的发生率起到了重要作用。     

静脉药物调配中心细胞毒药物不合理用药分析

细胞毒药物是一类具有致癌、致畸、生殖毒性、低剂量时可致系列器官毒性的药物。随着对细胞毒药物危害的认识加深,自20世纪90年代我国逐步建立以配置细胞毒药物为主的静脉用药调配中心（ PIVAS）。由于细胞毒药物的特殊性,其在临床的正确使用至关重要。这就要求PIVAS药师对药物有深入的了解,如配置药品的溶媒、推荐剂量、给药途径、给药时间、静脉滴注速度、药物之间相互作用等。本文对PIVAS药师在审核医嘱中发现的不合理用药进行分析,有效提高了调配医嘱的准确性,有助于减少不合理医嘱,保证患者用药安全、有效。     

开展静脉药物集中调配需要注意的问题浅析

目的:为开展静脉药物集中调配提供参考。方法:结合我院实际情况,阐明静脉药物配置中心(PIVAS)在其管理部门、工作人员配备、信息系统流程、医嘱合理性审核及调配费收取等方面需要注意的问题,以保证PIVAS的顺利运行。结果与结论:PIV-AS应由医疗机构药学部门统一管理;应根据实际开展的床位数配备工作人员;应建立用药医嘱电子系统及优化信息系统流程;未通过合理用药监测系统的医嘱,药师应对其进行审核,以确保用药合理性;PIVAS运行成本高,建议物价部门尽快出台合理的收费标准。PIVAS既可充分发挥药师的药学审核作用,又保证了临床使用药品的安全有效,有助于临床药学的发展。     

差错分析在静脉用药调配中心的重要性

目的通过PIVAS在配置过程中出现的各类差错进行分析讨论,发现工作中出现的问题,总结相关的经验教训,整理改进措施。促进临床合理用药、减少和避免配置差错提供参考,提高医疗质量,保证临床用药安全。方法根据《中国药典》、《临床用药须知》、《临床静脉用药调配与使用指南》及JCI要求等相关规定,对我院静脉用药调配中心输液配置环节出现的各类差错进行回顾性原因分析总结,并提出相对应的防范措施。结果本文结合本院静脉药物配置中心工作中具体的差错例子对相应的情况进行了总结分析。其差错率主要集中在:电脑系统不够完善,医师医嘱不合理,审核人员差错,输液调配差错这四个方面。结论通过对调配过程中存在的差错分析,我们总结出:优化系统,增强审方药师业务技能,加强高危药品管理,建立差错制度等改进措施,来优化完善PIVAS的工作,使工作更加高质高效,有效杜绝差错事故的发生。     

静脉用药调配中心洁净区的感染及其控制管理

目的:考察静脉用药调配中心(PIVAS)洁净区域的感染及其控制管理方法和要求,保障静脉输液的调配安全。方法:从环境、人员管理、规范操作及物流四个方面进行感控管理。结果:自2003年建立PIVAS以来,PIVAS未发生因调配质量导致的输液反应。结论:加强PIVAS洁净区域各环节感控管理,可保证成品输液的质量,确保临床患者静脉用药的安全。     

品管圈在静脉用药调配中心的实践与结果分析

目的:通过在静脉用药调配中心(PIVAS)推行品管圈活动,减少药物调配差错,保障患者用药安全,提高医院药事管理水平。方法:引入品质管理概念,运用多种统计方法,按照品管七大手法来解决实际工作中的问题。结果:PIVAS药物调配过程的差错由改善前的平均每月34.00例降低至改善后的平均每月17.17例。结论:将品管圈的改善方法运用于PIVAS的药物调配质量管理中,可以极大发挥整个科室团队协作能力,减少药物调配差错,提高药物调配质量,降低工作过程中的风险。     

静脉药物配置中心的质量控制与管理

目的建立静脉药物配置中心(PIVAS)质量管理有效方法及控制体系。方法全面分析静脉药物配置中心质量管理各环节和要素,研究各项控制措施,并纳入质量管理与控制体系。结果质量管理与控制体系基本建立,进一步保证药品配置质量,提高静脉用药安全性,降低了输液反应率,加强了抗菌药物使用控制与管理,有效发挥了药学工作作用。结论 PIVAS的建立,实现了医院药学由单纯药物保障型向技术服务型的转变,有效遏制了获得性医院感染的发生率,保障了医患安全。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Deoxynivalenol in cereals in Russia

A survey of the occurrence of deoxynivalenol (DON) and zearalenone (ZEN) in wheat, rye, barley and maize harvested in 1989-2001 in several regions of Russia has been conducted. A total of 5652 samples of cereals were analysed for DON and ZEN by using TLC and normal-phase HPLC with UV-detector. DON was detected in 69% of 2166 samples from Krasnodar region which is considered to be the major Fusarium endemic region of Russia. The contamination levels ranged from 0.1 till 8.6 ppm, MTEL was exceeded in 37% of these samples. The positive correlation between DON concentration and a percentage of Fusaria-damaged wheat kernels has been shown. DON occurrence and contamination levels were much lower that for wheat. Based on the results of monitoring and the data of average actual consumption of wheat products in Russia, the estimated daily intake of DON per 1 kg of body weight (EDI)was calculated. EDI varied from 0.07 ug in 1990-1991 till 1.40 ug in 1992. Although average EDI were lower than adopted tolerable daily intake (TDI, 3 ug/kg body weight) EDIs for the North-Caucasian region in some cases exceeded TDI.