社区人群非甾体抗炎药、糖皮质激素相关胃肠损伤认知调查及PPI干预效果观察

目的 (1)对长期服用非甾体抗炎药物或糖皮质激素人群进行问卷调查,掌握对胃肠损伤的认知率;(2)评价质子泵抑制剂对非甾体抗炎药物、糖皮质激素胃肠道损伤干预效果。方法 (1)对东莞市麻涌镇社区中心登记长期服用非甾体类抗炎药物及糖皮质激素的人群进行问卷调查。(2)2018年6月1日～2019年5月31日,选取我院及社区门诊长期服用糖皮质激素或非甾体抗炎药物患者各120例,采用随机、单盲方法分别分为安慰剂组、雷尼替丁组与奥美拉唑组。比较各组患者的治疗效果。结果 (1)社区长期服用非甾体抗炎药物或糖皮质激素者对相关胃肠损伤认知率低。(2)奥美拉唑组患者在胃肠黏膜损伤等不良反应发生率方面均少于安慰剂组、雷尼替丁组患者(P 0.05)。结论 (1)提高社区长期服用非甾体抗炎药物或糖皮质激素者对相关胃肠损伤认知率具有重大的社会效益;(2)质子泵抑制剂能减少长期服用非甾体抗炎药、糖皮质激素药胃肠不良反应及预防胃肠出血。     

血必净注射液不良反应影响因素的Logistic回归分析

目的：了解血必净注射液不良事件和不良反应的类型,探讨临床使用发生不良反应的可疑影响因素,为临床安全用药提供科学依据。方法：通过检索收集血必净注射液所致不良反应病例40例,对患者使用血必净注射液的临床特点及影响因素进行统计分析。结果：血必净注射液发生不良反应的可疑影响因素有患者的年龄、既往过敏史、单次给药剂量、溶剂的选择及联合用药。结论：应充分了解血必净注射液不良反应的影响因素,注重临床合理用药,减少不良反应发生率,保障用药安全。     

血必净注射液联合乌司他丁注射液治疗大面积烧伤的疗效观察

目的 通过观察大面积烧伤患者血清前白蛋白(PA)的变化,评价联合应用血必净注射液与乌司他丁注射液的疗效。方法 120例重度以上烧伤患者完全随机分为血必净+乌司他丁组、血必净组、乌司他丁组和对照组各30例。各组均给予早期液体复苏、抗感染、营养支持、器官保护等治疗。血必净+乌司他丁组给予乌司他丁注射液20万U静脉滴注,2次/d,同时加用血必净注射液50 ml静脉滴注,2次/d,连续使用7d。血必净组给予血必净注射液50 ml静脉滴注,2次/d,连续使用7d。乌司他丁组给予乌司他丁注射液20万U静脉滴注,2次/d,连续使用7d。对照组给予等体积等渗盐水,连用7d。分别于To（入院后即刻）、T2（伤后48～72 h）、T4（伤后96～120 h）、T7（伤后168～192 h）抽取外周静脉血测定PA。结果 烧伤后患者PA水平均下降,在T4、T7 4组间两两比较差异均有统计学意义[T4：血必净+乌司他丁组(96.9±15.7) mg/L,血必净组(86.2±18.2)mg/L,乌司他丁组(75.6± 17.4) mg/L,对照组(64.9±18.2) mg/L;T7：血必净+乌司他丁组(70.3±25.0)mg/L,血必净组(58.2±27.1 )mg/L,乌司他丁组(47.3±14.7) mg/L,对照组(32.6±9.0) mg/L,P＜0.05或P＜0.01]。血必净+乌司他丁组较治疗前下降幅度小于血必净组、乌司他丁组和对照组（P＜0.05或0.01）。结论 血必净注射液联合乌司他丁注射液能明显改善重度烧伤患者的病情。     

血必净联合甲强龙治疗百草枯中毒患者肺损伤的研究

目的评价血必净联合甲强龙治疗百草枯中毒患者肺损伤的临床疗效。方法选择我院急诊2004年1月-2008年9月收治的急性百草枯中毒患者51例,随机分为对照组(24例)与治疗组(27例)。对照组给予常规治疗。治疗组在对照组的基础上应用血必净注射液50mL,2次/d,连用7d;甲强龙500mg,1次/d,连用5d。结果治疗组发生低氧血症、Ⅰ型呼吸衰竭、ALI、ARDS、机械通气例数少于对照组,P<0.05;治疗组肺纹理增强、点片状影、磨玻璃影、胸腔积液、纤维条索、网状影、结节影表现明显少于对照组,P<0.05;治疗组入院后发生MODS、死亡数少于对照组,P<0.05。结论血必净联合大剂量甲强龙治疗可减轻肺组织损伤程度,降低患者死亡率。     

基于自发报告数据库的血必净注射液不良反应回顾性分析

目的:探讨血必净注射液不良反应(ADR)发生的特点和相关因素,为临床安全用药提供参考。方法:采用回顾性分析方法,对2007～2021年湖北省药品不良反应监测数据库中598例涉及血必净注射液ADR报告的性别、年龄、诱导时间、不良反应类型、累及系统/器官及临床表现等进行统计分析。结果:598例血必净注射液ADR病例中,男女比例为1∶1.12,年龄1～94岁;新的ADR为243例(40.64%),ADR表现涉及全身多个系统/器管,最多的是皮肤及其附件损害。598例ADR中血必净注射液用量10～500 ml不等,用量50 ml的最多,占55.02%;478例(79.93%)ADR在用药30 min内出现。47例ADR存在联合用药情况,其中联用抗菌药物的20例。266例ADR存在超说明书用药,主要表现为用法用量未按说明书规定,单次剂量偏小占35.28%。结论:临床应用血必净注射液时应关注特殊人群用药,尽可能按说明书推荐的用法用量,用药早期要密切监护。药品生产企业应进一步完善说明书相关内容,保障临床用药安全。     

对1例肺隐球菌感染患者的药学监护

1例42岁女性患者,因咳嗽、咳痰伴胸闷1月余,咯血3d入院。结合肺隐球菌的病理结果,先后给予抗真菌药物氟康唑和伊曲康唑治疗。住院期间药师及时评估治疗方案,并对患者的肝肾功能监测、抗真菌药物潜在药物相互作用以及药物配制注意事项等提供药学监护。患者首次静脉滴注伊曲康唑结束后,出现一过性视物模糊,11d后再次静脉滴注自觉症状加重,第13天停药后未再出现视物模糊,考虑为伊曲康唑的不良反应。接受抗真菌药物治疗32d后,因症状较前改善,患者出院继续接受抗真菌治疗。鉴于肺隐球菌病长期正规治疗的重要性,提示患者关注氟康唑的药物相互作用,谨慎合用其他药物。     

2017-2018年东南大学附属中大医院血必净注射液的使用合理性分析

目的了解东南大学附属中大医院血必净注射液的应用情况,为提高合理应用提供参考。方法调取东南大学附属中大医院2017年1月—2018年12月应用血必净注射液的病历共1 344份,对其临床应用情况进行统计和分析。结果 929份含血必净注射液的病历主要集中在骨科,占69.12%,普外科占24.26%。适应症方面:骨科有适应症使用比例仅为39.3%。用法用量方面,血必净的使用量(50～100 mL)及溶剂体积(100 mL)的合格率分别为98.66%、96.95%,给药频次的合格率仅为17.26%,主要以1次/d给药为主。疗程方面,3～14d给药时间占79.01%。联合用药方面,抗菌药物与血必净注射液联合应用率高达78.94%,其中27.60%抗菌药物使用为预防用药,51.34%抗菌药物使用为抗感染治疗。此外,血必净注射液与丹参川芎嗪、痹祺胶囊、盘龙七片及接骨七里片等联合使用的频次较高,属于重复用药。结论需加强血必净注射液在用法用量及联合用药方面的的处方审核,尤其在使用频次及重复给药方面,需严格把控。此外,血必净注射液在骨科的使用比较多,符合适应症的比例较低,临床药师应加大干预力度、多与临床医生沟通,为医生提供合理用药指导,以促进血必净注射液在临床更加安全、合理及有效的应用。     

血必净治疗恶性血液病化疗后肺部感染的疗效观察

目的观察血必净注射液治疗恶性血液病患者化疗后并发肺部感染的临床疗效及其副作用。方法将96例患者随机分为治疗组48例与对照组48例,治疗组给予血必净注射液和头孢毗肟治疗,对照组单用头孢吡肟治疗。比较两组治疗后有效率、发热停止时间及药物副作用。结果治疗组总有效率96％,对照组总有效率83％;发热停止时间治疗组为（2±1）d,对照组为（6±3）d;治疗组无明显副作用。结论血必净注射液治疗恶性血液病化疗后肺部感染具有提高有效率及迅速退热等优势,并且副作用少。     

血必净注射液对窒息模型大鼠复苏后心功能、心肌细胞钙离子变化的影响

目的:研究血必净注射液对窒息模型大鼠复苏后心功能、心肌细胞钙离子变化的影响。方法:复制缺氧致心搏骤停-心肺复苏(CA-CPR)大鼠模型,实验分为4组,即假手术、模型及血必净注射液高、低剂量(4、2mL.kg-1)组;观察复苏前、复苏成功后6h平均动脉压(MAP)、左室内压最大上升和下降速率(±LVdp/dt max)、心肌细胞钙离子荧光强度平均值及病理的变化。结果:复苏成功后6h与模型组比较,血必净注射液高剂量组MAP显著升高(P<0.01);血必净注射液高、低剂量组大鼠±LVdp/dt max均显著降低(P<0.01),大鼠心肌细胞钙离子荧光强度平均值显著升高(P<0.01);光镜下血必净注射液高剂量组大鼠心肌损害减轻。结论:血必净注射液可以改善心肺复苏后心功能不全,抑制心肌细胞钙超载,减轻心肌损伤。     

血必净注射液不良反应7例分析

目的 探讨血必净注射液发生药品不良反应（ADR）的特点及对策。方法 调查2013年1月—12月在天津市武清区中医院使用血必净注射液的70例患者,对7例ADR报告进行回顾性分析。结果 ADR以男性患者居多,发生时间主要在用药20 min内,ADR病例受累器官系统主要以皮肤及其他多个器官系统综合为主。结论 临床上应用血必净注射液应引起足够的重视,做好ADR的预防措施和采取有效的对策,对减少患者发生ADR有一定帮助。关键词：血必净注射液;不良反应;用药安全。     

用血必净注射液治疗血流感染30例患者的疗效观察

目的：评价用血必净注射液治疗血流感染的临床疗效。方法：将 60 例血流感染患者分成治疗组和对照组;治疗组采用血必净注射液 50 毫升（5 支）加入 0.9% 氯化钠注射液 100 mL 中,静滴,qd;对照组不加用血必净;两组均给予常规抗感染治疗,疗程为 2 周;评价两组治疗前后的感染控制情况。结果：治疗组与对照组比较,白细胞总数和中性粒细胞值均明显下降（P＜0.05）,C-反应蛋白较对照组亦明显下降（P＜0.05）;治疗组患者体温恢复正常所需时间较对照组明显缩短（P＜0.05）。结论：用血必净注射液联合抗感染药物治疗血流感染的效果比常规抗感染治疗效果好,且安全、可靠。     

The effect of portal hypertension on indomethacin-induced small intestinal ulceration in the rat

The purpose of this study was to determine whether portal hypertension potentiates intestinal ulceration induced by indomethacin. Portal hypertension was produced in male Sprague-Dawley rats by two-staged ligation of the portal vein. Sham-operated rats were used as controls. The rats were given 20 mg/kg of indomethacin intragastrically, 7 and 14 days, respectively, after complete portal vein ligation. Forty-eight and 72 h after indomethacin, portal pressures were measured and the whole small intestine removed for quantitative measurement of the percent of the mucosa ulcerated by computerized image analysis. There were no differences in the area of ulceration between the portal hypertensive and sham-operated rats at either 7 or 14 days, despite the presence of significant portal hypertension. Portal hypertension does not appear to potentiate small intestinal ulceration induced by indomethacin in rats.     

ROLES OF ENTEROBACTERIA, NITRIC OXIDE AND NEUTROPHIL IN PATHOGENESIS OF INDOMETHACIN-INDUCED SMALL INTESTINAL LESIONS IN RATS

Roles of enterobacteria, nitric oxide (NO) and neutrophil in indomethacin-induced small intestinal lesions were examined in rats. Indomethacin (10 mg kg-1), administered s.c. as a single injection, caused haemorrhagic lesions in the small intestine, mostly in the jejunum and ileum. The lesions were first observed 6 h after administration of indomethacin, the severity increasing progressively with time up to 24 h later. Following indomethacin, the enterobacterial numbers, inducible NO synthase (iNOS) activity and NO production in the intestinal mucosa were also increased with time, and changes in the former preceded those in the latter two as well as the occurrence of intestinal damage. Treatment of the animals with both NG-nitro-L-arginine methyl ester (L-NAME) and aminoguanidine prevented intestinal lesions induced by indomethacin, with suppression of NO production. Both dexamethasone and FR167653 (an inhibitor of interleukin-1 beta/tumour necrosis factor-alpha production) also reduced the severity of intestinal lesions as well as the increase in iNOS activity following administration of indomethacin. Likewise, the occurrence of intestinal lesions was attenuated by pretreatment of the animals with anti-neutrophil serum (ANS). None of these treatments, however, affect the translocation of enterobacteria in the mucosa. By contrast, ampicillin (an anti-bacterial agent) suppressed the increase in mucosal iNOS activity as well as the enterobacterial numbers invaded in the mucosa and inhibited the occurrence of intestinal lesions after administration of indomethacin. These results strongly suggest that enterobacterial translocation in the mucosa is the first step required for activation of various factors such as iNOS/NO and neutrophils, all involved in the pathogenesis of indomethacin-induced intestinal lesions.     

血必净注射液对严重脓毒症患者免疫功能的影响

目的 探讨血必净注射液对严重脓毒症患者免疫功能的影响.方法 选择我院EICU严重脓毒症患者60例,随机分为常规治疗组和血必净组,每组30例,常规治疗组给予常规治疗,血必净治疗组在常规冶疗的基础上给予血必净注射液.观察两组患者治疗前和冶疗后第7天T淋巴细胞亚群包括CD3＋、CD4＋、CD4/CD8比值和免疫球蛋白的变化.结果 治疗7 d后,两组患者免疫指标均有不同程度的恢复（P〈0.05）,与常规治疗组相比,血必净组CD3＋、CD4＋、CD4/CD8比值和IgG、IgA、IgM显著增加（P〈0.05或P〈0.01）.结论 血必净能有效恢复严重脓毒症患者免疫稳态,阻止病情恶化,从而改善预后.     

1例深静脉导管相关感染患者的药学监护

1例75岁女性患者,因脑膜瘤诱发意识不清入院,入院后行手术治疗,术后发生深静脉导管相关感染。临床医生结合疾病特点经验性给予万古霉素抗感染治疗,效果欠佳,血培养及导管尖端培养回报为弗氏柠檬酸杆菌,根据药敏试验结果及患者病情变化,临床药师建议先后给予注射用头孢曲松钠、注射用亚胺培南西司他丁钠、注射用头孢曲松钠升级、降阶梯、序贯治疗,同时对深静脉导管相关感染的经验治疗、目标治疗进行药学监护,对应用注射用亚胺培南西司他丁钠可能存在的潜在风险提出建议。经有效的抗感染治疗15 d后,患者痊愈出院。     

Prophylactic effect of rebamipide against the irritative and healing impairment actions of alendronate in rat stomachs

We examined the effect of rebamipide, an antiulcer drug, on the mucosal irritative and the healing impairment action of alendronate in rat stomachs. Male SD rats were used to examine the effect of rebamipide in the following 3 experiments. 1) Alendronate applied topically to the chambered stomach under urethane anaesthesia produced a decrease in the transmucosal potential difference and an increase of gastric mucosal blood flow and luminal acid loss, resulting in slight damage to the mucosa. Pretreatment with rebamipide for 3 days had no effect on the changes induced by alendronate. 2) Oral administration of alendronate caused non-haemorrhagic lesions in the stomach within 4 hr. Rebamipide, given either as a single p. o. injection or repeatedly for 7 days, did not significantly affect the lesions induced by alendronate. 3) Alendronate, given p. o. once daily for 1 week, markedly delayed the healing of acetic acid-induced gastric ulcers with the suppression of basic fibroblast growth factor (bFGF) expression. Rebamipide, given twice daily for 7 days, significantly promoted the delayed ulcer healing caused by alendronate, with the concomitant recovery of bFGF expression. These results suggest that rebamipide does not affect the direct irritating action of alendronate in the gastric mucosa, but this agent antagonizes the healing impairment action of alendronate by counteracting the downregulation of bFGF expression in the ulcerated mucosa. Received 26 July 2006; revised 11 January 2007; accepted 11 January 2007     

不同NSAIDs肠病模型中肠黏膜通透性的比较研究

目的探讨不同NSAIDs肠病模型中肠黏膜通透性改变的研究。方法选用不同NSAIDs(阿司匹林、吲哚美辛、双氯芬酸钠)制备小鼠NSAIDs肠病模型。其中阿司匹林组(500 mg.kg-1)、吲哚美辛组(5 mg.kg-1)、双氯芬酸钠(10 mg.kg-1)灌胃给药3 d。在此基础上,进行不同剂量双氯芬酸钠不同时间灌胃给药。实验结束后取小鼠小肠进行Evans-blue通透性检测,并计算小肠溃疡数目。结果在不同NSAIDs肠病模型中,阿司匹林组小鼠小肠黏膜未见明显溃疡,小肠黏膜通透性轻度升高(621.1±114.2 vs 460.6±89.7μg.g-1),吲哚美辛组小鼠小肠黏膜损害明显,小肠溃疡明显增多(8.2±1.9 vs 0),小肠通透性显著升高(2132.0±315.7 vs 460.6±89.7μg.g-1),双氯芬酸钠组小肠黏膜损伤和小肠黏膜通透性升高均较吲哚美辛组减轻。随着双氯芬酸钠给药剂量增加和给药时间延长,小鼠小肠黏膜损害和肠黏膜通透性增高越明显。结论在不同NSAIDs肠病模型中,阿司匹林组小鼠小肠损害轻,吲哚美辛组小肠损伤严重,双氯芬酸钠2.5 mg.kg-1灌胃3 d可引起小肠黏膜通透性和肠黏膜损害,适用于NSAIDs肠病模型的研究。     

The influence of dopamine agonists and antagonists on indomethacin lesions in stomach and small intestine in rats

Dopamine agents (saline in control groups) were coadministered with indomethacin by either single or repeated application. The ulcerogenic effect (erosions and/or ulcers) of repeated given indomethacin on gastric mucosa differed clearly from that on intestinal mucosa. The effect on intestinal mucosa was markedly greater than after a single dose. The effects of dopamine agents appeared to be more consistent. Domperidone and haloperidol, given as single or repeated doses, strongly aggravated both the gastric and intestinal lesions. Bromocriptine and amantadine had a protective effect. The adverse effects of both dopamine antagonists (increased after repeated administration) were strongly inhibited by the simultaneous administration of either bromocriptine or amantadine. The involvement of the dopamine system (central or peripheral) in the mechanisms that maintain gastric (probably related to cytoprotection also) and intestinal mucosa integrity is therefore suggested.