兴安盟医院住院患者用药医嘱的监测与分析

目的 分析不合理用药现状,了解合理用药监测系统（PASS）及其对临床用药的监测情况.方法 利用PASS系对兴安盟人民医院医院2011年1月1日-2011年3月31日期间所有住院患者的用药医嘱进行回顾性监测,并对结果进行分析统计总结.结果 共监测医嘱127034条,其中不合理用药共发生25658次,占监测总医嘱的20.20％.问题医嘱主要发生在使用剂量、药物与药物相互作用等方面.结论 不合理用药情况占有很高比例,PASS系统可以有效地监测医嘱中的不合理用药,从而预防和减少药物不良反应的发生,提高了合理用药水平.但是PASS系统存在一定局限性,有待进一步完善.     

利用PASS软件对我院住院患者用药医嘱的合理性分析

目的：研究合理用药监测系统时我院住院部各科室合理用药情况进行监测,促进和推动现代药学信息服务工作,为进一步提高我院合理用药保障水平提供参考。方法：收集我院2013年12月住院部8个科室1380条用药医嘱进行审核,对审查中发现的的黑色、红色、橙色警示级别进行分析,比较汇总结果。结果：监测结果发现问题223个,其中儿童用药4例,重复成分14例、重复治疗21例、国内注射剂配伍15例、药物一药物相互作用169例。结论：PASS系统可有效地监测医嘱中的不合理用药情况,其有较高的应用价值。但PASS系统尚存在一定局限性,有待进一步升级完善。     

药物使用不当浅析对处方中不合理用药的分析

处方分析是了解临床用药情况和促进临床合理用药的重要手段。随着医疗水平的提高及新药品种的增多，临床上多种药物联合用药已经相当普遍。因而，对药物间的相互作用及联合用药的合理性进行分析就显得额外重要。我就在一千张处方中发现的几点不合理用药情况浅谈几点。     

1000例老年患者用药合理性分析

目的了解老年患者的用药情况,评判药物使用的合理性。方法应用回顾性病历调查方法对1000例老年住院患者用药进行了分析,共查阅5600余条医嘱。结果1000名患者住院期间使用药物平均为4~15种,最多可达26种;35·2%患者存在不合理用药现象;有8种常见的不合理用药表现,药物相互作用及药物不良反应随用药品种增多而增加。结论老年住院患者存在不合理用药,应加强临床用药的监测,尽量减少用药品种,避免不合理的联合用药,进一步提高老年住院患者的用药水平。     

1000例老年患者用药合理性分析

目的了解老年患者的用药情况,评判药物使用的合理性.方法应用回顾性病历调查方法对1 000例老年住院患者用药进行了分析,共查阅5 600余条医嘱.结果 1 000名患者住院期间使用药物平均为4～15种,最多可达26种;35.2%患者存在不合理用药现象;有8种常见的不合理用药表现,药物相互作用及药物不良反应随用药品种增多而增加.结论老年住院患者存在不合理用药,应加强临床用药的监测,尽量减少用药品种,避免不合理的联合用药,进一步提高老年住院患者的用药水平.     

消化系统药物不合理应用分析

目的分析临床常见的消化系统药物的不合理应用,用于纠正和防范临床不合理用药。方法通过进行处方分析,通过消化系统不合理用药的处方及医嘱和搜索相关文献,总结分析不合理用药情况。结果消化系统不合理用药的情况非常普遍,尤其是联合用药过程中,存在不合理的联用和用药间隔,重复和过量用药,药物相互作用和禁忌症认识不足等问题。结论消化系统药物的不合理用药情况仍需要医生、药师、护士共同协助合作,逐渐改善不合理用药情况,同时临床药学部分应积极开展医院药学信息化工作,为医生和护士提高用药信息,指导临床用药,提高临床用药水平。     

老年人不合理用药问题的干预研究

目的了解多药合用的老年患者治疗药物的合理使用情况,和药师在治疗团队中的作用。方法符合纳入标准的老年患者182人,男性58人,女性124人;平均年龄71.1岁。由药师、医师和护士组成的治疗团队对患者的用药情况进行审核,每位患者面对面的用药指导和教育时间不少于30min,6周后随访了解干预效果。结果共发现药物相关问题643条（平均每位患者3.5条）,涉及的药物数为608个,主要问题是无适应证用药177条（25.73%）;有用药适应证但没有用药43条（6.69%）和诊断不明确的95条（14.77%）共计315条（43.19%）。干预后,接受建议的共计339条（停药160条,更改152条,新增药物27条）,患者的平均用药数从6.54条减为5.81条,干预前后差异有非常显著性（P〈0.01）。结论老年患者用药存在较多不合理使用问题,药师在治疗团队中发挥重要作用。     

某高校社区门诊处方抗高血压药物分析

目的对中央财经大学校医院2010年4月和5月门诊高血压病人降压药物的应用现状和联合用药情况进行处方数据统计,探讨高血压治疗用药的合理性,为临床治疗提供合理用药参考。方法抽查我院2010年4月和5月门诊抗高血压药物处方,对年龄、用药种类、用药频率、联合用药情况进行统计分析。结果高血压以中老年患病居多;降压药使用频率居前的依次是钙离子拮抗剂（CCB）、β-受体阻滞剂（β-RB）、血管紧张素转换酶抑制剂（ACEI）。结论本医院降压药物的临床使用情况基本合理,但有待进一步改善。     

抗生素的药物相互作用

在临床用药中，抗生素通常联合用药，有时也与其他药物合用，而这些药物之间的相互作用可能会使治疗失败甚至产生严重的毒副作用。从药代动力学、药效学及药学等方面对抗生素的药物相互作用以及对临床用药的指导意义进行了介绍。     

比阿培南临床合理使用评价标准的建立与应用

目的 建立新碳青霉烯类抗菌药物比阿培南药物利用评价(DUE)标准,并进行回顾性应用调查分析,为临床合理使用比阿培南提供参考依据.方法 参考世界卫生组织及美国、加拿大等发达国家DUE操作指南,构建DUE标准基本框架,结合《抗菌药物临床应用指导原则》及比阿培南药品说明书等,组织专家讨论建立比阿培南DUE标准；设计患者使用比阿培南调查表,评价某三甲医院比阿培南使用情况.结果 建立的比阿培南DUE标准包括用药指征、用药过程、用药结果3个部分；通过回顾性分析DUE标准应用,发现某三甲医院比阿培南在临床应用过程中在患者治疗前后体温监测、血常规检查、药物使用剂量和给药途径、溶媒选用和滴注时间、药物相互作用等方面符合标准率均为100.0％；在用药指征和禁忌证把握、病原学检查、用药疗程、抗菌药物联合应用等方面存在不合理现象,其中用药指征符合标准率为70.0％,8.3％有用药禁忌证、第1次使用前＜72 h进行细菌培养和药敏试验的占60.0％、用药疗程符合标准率为58.3％、抗菌药物联合应用符合标准为40.0％.结论 建立的比阿培南DUE标准具有较好的实用性,在临床实践应用中可发现临床用药过程中存在的问题或不足,对促进临床合理用药具有重要指导意义.     

Risk factors to be considered at the beginning of antihypertensive therapy in diabetes mellitus

The treatment of hypertension in diabetic patients due to its high prevalence rate belongs to the everyday clinical practice of internists, diabetologists and general practitioners. The main points of the initiation on of antihypertensive treatment in diabetic patients are reviewed. In order to decrease the target organ damages the treatment of early recognized cardiovascular risk factors are of great importance. The target value of antihypertensive treatment in diabetic patients is < 130/80 mmHg (in case of proteinuria > 1 g daily: < 125/75 mmHg). The global cardiovascular risk is high or very high in diabetic patients both with grade I-III hypertension and with high normal blood pressure, therefore, treatment with antihypertensive drug (besides life style optimalisation) should be initiated promptly in these cases. In case of micro- or macroalbuminuria antihypertensive drug (mainly with characteristics of blocking the renin-angiotensin-system) should be given to each diabetic subject irrespective of actual blood pressure values. Success of antihypertensive treatment in diabetic patients could be achieved mainly with combination therapy only. It is reasonable to initiate antihypertensive therapy primarily with a low dose combination of two agents in diabetic patients with hypertension.     

他汀类药物防治冠状动脉粥样硬化心脏病112例分析

目的：探讨他汀类药物在冠心病二级防治中的作用。方法：回顾性分析112例冠心病患者经他汀类药物治疗前后的指标及效果。结果：他汀类药物治疗前后指标比较,差异有显著性意义（P〈0.05或P〈0.01）。结论：他汀类药物对冠心病患者有积极的防治作用。     

Lifestyle intervention for the prevention of cardiovascular disease

The high cardiovascular disease prevalence in western countries is largely attributable to the contemporary lifestyle. Interventions in the area of nutrition and physical activity have been shown to be effective in the prevention of cardiovascular disease. Successful implementation of lifestyle intervention programmes may be just as effective as drug treatment. In combination with drug treatment, intervention in the area of nutrition and physical activity is the recommended treatment for patients at a high risk of cardiovascular disease. Addition of new drugs to those presently available is associated with low absolute risk reductions and high costs, particularly in the presence of successful lifestyle interventions.     

The Performance Gap between Clinical Trials and Patient Treatment for Dyslipidemia

Cardiovascular disease is the primary cause of death in the US. Controlling dyslipidemia, particularly elevated low-density lipoprotein-cholesterol (LDL-C), is considered a primary strategy to reduce cardiovascular risk. HMG-CoA reductase inhibitors (statins) are the most effective agents available to lower LDL-C. Moreover, evidence from numerous prospective clinical trials has shown that statins reduce both cardiovascular disease morbidity and mortality in patients with dyslipidemia. Newer evidence has resulted in updated consensus guidelines that list reducing LDL-C values to a greater degree than has previously been recommended as therapeutic options for certain at-risk populations. Despite these conclusive benefits, most patients at risk for cardiovascular disease have LDL-C values that are above recommended goal values. Observational studies have identified several problems in managing dyslipidemia. These include infrequent screening for dyslipidemia by measuring fasting lipid panels, not prescribing statin therapy in high-risk individuals, incomplete monitoring in patients receiving statin therapy, and a general inability to attain recommended LDL-C goal values in patients receiving statin therapy. This gap between efficacy from clinical trials and treatment in clinical practice is particularly important to managed care organizations because statin therapy can reduce cardiovascular risk and may result in reduced overall healthcare costs. Many drug-based and system-based strategies can be implemented by managed care organizations to reduce this gap. Using high-potency statins, selecting appropriate initial statin doses based on the degree of LDL-C reduction that is required, and combination therapy (e.g. a statin with ezetimibe, bile acid sequestrants, niacin, or fibric acid derivatives) can result in greater LDL-C lowering than by simply using the lowest starting dose of any given statin. System-based models that utilize specific disease state management clinics, therapeutic intervention programs that target population-based improvements in LDL-C goal attainment, and judicious formulary management that includes therapeutic conversion initiatives have all been successfully implemented in managed care environments.     

Sexual function in hypertensive patients receiving treatment

In many forms of erectile dysfunction (ED), cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and phosphodiesterase 5 are usually well tolerated, provided there is a baseline blood pressure of at least 90/60 mmHg. However, there are two exceptions: nitric oxide donors and alpha-adrenoceptor blockers. Any drug serving as a nitric oxide donor (nitrates) is absolutely contraindicated in combination with phosphodiesterase 5 inhibitors, due to significant, potentially life threatening hypotension. Also, a-adrenoceptor blockers, such as doxazosin, terazosin and tamsulosin, should only be combined with phosphodiesterase 5 inhibitors with special caution and close monitoring of blood pressure.     

Update on the clinical utility of fenofibrate in mixed dyslipidemias: mechanisms of action and rational prescribing

Mixed dyslipidemia is a common lipid disorder characterized by the presence of an atherogenic lipoprotein phenotype due to abnormalities in various atherogenic and anti-atherogenic lipoproteins. Despite the link between the decrease of LDL-cholesterol by statin treatment and the prevention of cardiovascular disease, a high residual risk is observed in statin trials. This residual risk is partly explained by lipoprotein abnormalities other than LDL. Fenofibrate exerts a favorable effect on the atherogenic lipid profile of mixed dyslipidemia and can effectively reduce cardiovascular disease in patients with mixed dyslipidemia. Fenofibrate may offer important treatment alternatives as a second-line therapy in several circumstances: in combination with a statin for patients with mixed dyslipidemias not at goals on statin mono-therapy; in monotherapy for patients intolerant or with contraindication to statin therapy; and in combination with other drugs (ezetimibe, colesevelam) for patients with mixed dyslipidemias, known intolerance, or contraindication to statin and not at goals on fenofibrate monotherapy. However, the role of fenofibrate-statin therapy and of other therapies involving fenofibrate in cardiovascular risk reduction strategies remains to be established.     

Determining cardiovascular risk in patients with rheumatoid arthritis: waiting for trial outcomes is not recommended

Cardiovascular risk management is clearly indicated in patients with rheumatoid arthritis (RA) today because this risk is comparable to patients with diabetes. Although formal evidence of cardiovascular endpoint trials with statins and/or antihypertensives is lacking in patients with RA, there are no indications that these drugs will have limited effect. In contrast, there is accumulating evidence as to the efficacy of the use of these drugs in RA that is at least comparable to their effects in the general population. All patients with RA should therefore receive cardiovascular risk-management therapy aimed at powerful suppression of the chronic inflammatory process as well as treatment with statins and/or antihypertensives, if indicated. Obviously, monitoring in the clinical setting is necessary to document if such therapy does indeed reduce cardiovascular disease in patients with RA.     

Determining cardiovascular risk in patients with rheumatoid arthritis: waiting for trial outcomes is not recommended

Cardiovascular risk management is clearly indicated in patients with rheumatoid arthritis (RA) today because this risk is comparable to patients with diabetes. Although formal evidence of cardiovascular endpoint trials with statins and/or antihypertensives is lacking in patients with RA, there are no indications that these drugs will have limited effect. In contrast, there is accumulating evidence as to the efficacy of the use of these drugs in RA that is at least comparable to their effects in the general population. All patients with RA should therefore receive cardiovascular risk-management therapy aimed at powerful suppression of the chronic inflammatory process as well as treatment with statins and/or antihypertensives, if indicated. Obviously, monitoring in the clinical setting is necessary to document if such therapy does indeed reduce cardiovascular disease in patients with RA.     

血小板功能检测指导急性冠脉综合征抗血小板治疗的研究

目的探索血小板功能检测在未行血运重建术治疗的急性冠脉综合征(ACS)患者中抗血小板治疗的临床应用价值。方法 60例ACS患者根据血小板功能分为四组予相应的个体化抗血小板治疗,并随访1年,比较四组患者血栓/出血事件发生率。结果高剂量氯吡格雷治疗组及加用西洛他唑治疗组血小板聚集率比标准治疗组明显下降(P<0.05),但四组患者主要心血管事件发生率及出血率无统计学差异(P>0.05)。结论血小板功能检测在指导急性冠脉综合征患者抗血小板治疗中未获得预期临床获益,其应用价值仍需大规模、前瞻性及更严谨的研究去验证。     

缬沙坦治疗心血管疾病的临床效果观察

目的 观察缬沙坦治疗心血管疾病的临床效果。方法 选取河南省信阳市中心医院2012年3月-2012年9月期间收治的64例心血管疾病患者作为研究对象,随机分为实验组与对照组。对照组患者给予常规治疗,实验组患者在常规治疗基础上加用缬沙坦治疗,对比2组患者临床治疗效果。结果 2组患者的血压均下降且达到理想水平,但治疗前后组间比较差异无统计学意义。心血管事件发生率对照组为31.26%,实验组为9.38%,2组比较差异有统计学意义（P〈0.05）。结论 心血管疾病患者在常规治疗的基础上加用缬沙坦治疗,降低了心血管事件的发生率,提高了对心血管的保护作用,疗效显著,值得临床推广。