中药注射剂临床合理用药调查

目的通过了解某院中药注射剂临床用药实际情况,采取相应的改进措施,提高临床合理用药质量。方法选取采用中药注射剂的病历共450份,按照《中药注射剂临床使用基本原则》、药物使用说明书等对溶媒应用、联合用药及用法用量进行调查分析。结果 450份病历中,中药注射剂使用合理215例（47.78%）,用药不合理235例（52.22%）,存在溶媒选择不当、超剂量用药、联合用药不当、超适应证用药、超疗程用药、稀释比例不当等现象。结论中药注射剂临床合理用药不理想,要重视合理用药管理,提高中药注射剂用药质量,更好的为患者服务。     

使用瓜蒌皮注射液288例的合理性评价

目的：分析瓜蒌皮注射液临床使用情况,指导临床合理应用中药注射剂。方法：抽取某医院2016年7月288例使用瓜蒌皮注射液患者,按年龄、适应证、溶媒等进行统计,根据药品说明书和相关指南对使用的合理性进行评价。结果：不合理用药主要表现为超适应证用药占33.3%,疗程不当占46.5%,溶媒不适宜占90.6%。结论：医院应加强对中药注射剂使用的管理,保障用药安全。     

对住院患者使用中药注射剂的情况调查

目的：调查我院住院患者中药注射剂应用情况,为临床合理用药提供参考。方法：抽取我院归档病历400份,对中药注射剂的使用情况进行调查、统计、分析。结果：中药注射剂在临床上存在联合用药不当、溶媒选择和用量不当、超剂量、超疗程、超适应症、未辨证施治等现象。结论：我院中药注射剂存在不合理使用现象,应引起足够的重视,要进一步加强中药注射剂规范化使用的管理,避免或减少不良反应的发生,确保用药安全有效。     

某医院中药注射剂处方分析

目的对北京市垂杨柳医院中药注射荆处方进行分析,了解门、急诊患者用药基本情况,保证患者用药安全有效。方法抽取2012年10月1日-10月31日门、急诊含有中药注射剂的处方,对其不合理用药情况进行分类和统计,分析原因并提出处理建议。结果合中药注射剂的处方2412张,其中不合理处方854张,占中药注射剂处方总量的35．4％。情况分类如下：用法用量不合理共98例,占不合理处方数的11．5％;诊断与用药不符共42例,占不合理处方数的4．9％;中西药配伍不合理共13例,占不合理处方数的1．5％;溶媒不合理共701例,占不合理处方数的82．1％。结论该院中药注射剂的使用存在一些问题且呈多样性,需要药师与医师及时沟通,及时解决处方中不合理用药问题,保障患者用药安全、经济、有效。     

中药注射剂在脑梗死患者中的应用分析

目的通过分析我院中药注射剂在脑梗死患者中的使用现状,为临床合理使用中药注射剂提供参考。方法随机抽查我院2011-2012年使用中药注射剂的脑梗死患者150例,采集和统计相关数据,并进行用药合理性评价与分析。结果治疗脑梗死的中药注射剂有15个品种,使用频数最高的是活血化瘀类的药物,使用例次最高的为注射用血栓通,占37.33%,适应证符合率为93.37%,用法用量正确率为62.7%,溶媒选用正确率为78.7%,中药注射剂单瓶滴注率为84%,疗程正确率为73.33%。结论我院中药注射剂使用基本合理,但存在一定问题,临床使用应遵循中医用药规律,详细阅读中药注射剂说明书,以充分发挥中药注射剂的优势。     

141例中药注射剂不合理使用分析

目的：了解我市某院中药注射剂使用的现状,为合理使用中药注射剂提供参考。方法：随机抽查该院41个临床科室的住院病历395例,对中药注射剂的使用情况进行统计分析。结果：395份病历中有205例使用中药注射剂,使用率为51.90%。其中,不合理用药141例,不合格率为68.78%,对是否使用中药注射剂、用药指征、剂量及疗程、溶媒选择、配伍禁忌、给药途径等项目进行调查分析。结论：该院临床科室中药注射剂的合理使用还存在较多问题,中药注射剂合理使用水平有待进一步提高。     

中药注射剂临床不合理用药分析

目的:通过对临床所见中药注射剂不合理使用情况分析,为临床合理用药提供参考。方法:随机抽查使用中药注射剂的病历285份,对其中发现的中药注射剂不合理应用情况进行统计分析。结果:共有不合理用药39份(占总量的13.7%),主要表现在超适用症,溶媒选择不当,给药剂量过大,改变给药途径,联用不合理等方面。结论:中药注射剂临床用药存在安全隐患,需要进一步加强中药注射剂临床应用的监管。     

心内科住院患者中药注射剂应用调查分析

目的：调查分析我院心内科住院患者中药注射剂的应用情况,为中药注射剂的规范应用和管理提供参考依据。方法：随机抽取我院心内科2010年9月出院患者病历149份进行回顾性调查分析。结果：149例患者中,使用中药注射剂121例,使用率为81.21%;联合用药54例,占使用中药注射剂患者的44.63%;我院心内科中药注射剂使用存在超限量使用、溶媒配伍不当、联合用药率高等不合理情况。结论：我院心内科中药注射剂的应用存在一些不当之处,医院须采取切实可行的干预措施,加大监管力度,才能使用药逐步趋向合理。     

我院中药注射剂溶媒应用的合理性分析

目的研究分析我院中药注射剂溶媒应用的合理性。方法选取2016年5月至2017年3月期间在我院应用中药注射剂进行治疗的1360例患者,对全部入选患者的临床相关资料进行回顾性分析,观察了解患者治疗中中药注射剂的溶媒应用情况,并对溶媒应用不合理情况进行观察分析。结果通过对所有入选患者的临床相关资料分析显示,在患者的治疗中,艾迪注射剂的溶媒应用不合理性最高(46.15%),其次分别为灯盏花素注射剂(30.72%)与参芪扶正注射剂(28.89%)。结论在我院的中药注射剂治疗中存有溶媒应用不合理情况,医院应加强对中药注射剂的应用监管,以对临床患者的用药治疗有效性及安全性进行保障。     

临床药师在中药注射剂使用过程中的药学监护

目的：中药注射剂在临床使用中存在的诸多问题,提出药学监护中需要关注的药学信息要点,开展药学监护。方法：对静脉给药过程中,中药注射剂的溶媒选择、对症用药、药物配伍、药物剂量、静脉给药速度、给药间隔和疗程等环节中存在的不合理用药情况进行分析。结果：药学监护中应加强对中药注射剂使用的各个环节相关药学信息的关注和监控,以减少中药注射剂在静脉给药过程中的不合理现象。结论：促进中药注射剂的安全、合理应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.