我院2013年9-12月心血管外科手术患者预防使用质子泵抑制剂点评

目的:为干预措施制订提供数据支持,促进临床合理用药。方法:选择2013年9-12月福建省立医院心血管外科出院的手术患者,设计心血管外科手术患者预防使用质子泵抑制剂(PPIs)点评表,收集患者基本信息、住院天数、临床诊断、手术信息及PPIs使用情况,参照《应激性溃疡防治建议》及药品说明书对PPIs使用情况进行专项点评。结果:总共点评229份病历,其中187份使用了PPIs,使用率为81.7%,泮托拉唑的使用频次最高;专项点评结果显示,疗程过长是最常见的不合理用药表现,另外还存在用药频次错误、无指征更换药物、明显药物相互作用、重复用药、无适应证用药及溶剂选择错误等不合理现象。结论:此次专项点评发现PPIs在临床使用过程中存在诸多不足,将根据点评结果制订行政及技术干预措施,并持续改进,促进PPIs的合理使用。     

2013年我某骨科清洁手术围手术期预防使用抗菌药物的合理性评价

目的：了解该院骨科清洁手术预防性使用抗菌药物的情况,评价其用药合理性。方法对该院骨科2013年597例骨科清洁手术病例进行回顾性分析,从预防用药适应证、药物选择、给药时机、给药频次、给药疗程等方面进行统计。结果597例抗菌药物预防性使用率为82．24％,适应证、药物选择、给药时机、给药频次、给药疗程合理性分别为83．91％、45．82％、71．08％、99．59％、44．20％。结论该院骨科清洁手术预防性使用抗菌药物在用药适应证、给药时机、给药频次控制较好,在药物选择、给药疗程方面需要加强管理。     

胸外科围手术期预防性使用质子泵抑制剂的药学干预效果分析

目的:探究药学干预对胸外科围手术期合理化应用质子泵抑制剂(proton pump inhibitors, PPIs)预防应激性黏膜病变(stress related mucosal disease, SRMD)的效果评价。方法:以临床药师为主体,处方点评为手段,对安徽省胸科医院胸外科全部围手术期预防SRMD使用PPIs的病例实行监控和干预,对干预前(2020年11月)、干预后(2021年3月)预防使用PPIs的使用率、使用强度以及药物使用合理性等指标进行对比分析。结果:药学干预后胸外科围手术期预防SRMD应用PPIs的使用率由50.00%降至26.86%,使用强度由每百人天21.30 DDDs降至12.46 DDDs;有指征预防PPIs使用率由22.70%升至51.81%;干预后奥美拉唑注射液使用构成比提高15.98个百分点;干预后用法用量、用药疗程的不合理现象均明显改善。结论:药学干预模式可以促进胸外科围手术期预防SRMD合理化应用PPIs,提高医院医疗质量水平,减轻患者和国家医保的经济负担,保障用药安全,值得在其他相关科室和其他重点管理药物方面推广。     

静脉用质子泵抑制剂使用合理性分析及院内管控

目的 ：探讨我院静脉用质子泵抑制剂（PPIs）使用的合理性。方法 ：收集2022年度我院使用PPI的病例,共226份病历资料符合要求。结果 ：进入季度使用金额排名前五名次数最多的PPIs依次是注射用艾司奥美拉唑、注射用艾普拉唑、注射用雷贝拉唑、注射用奥美拉唑;病历不合理率为64.16%,无适应证用药53例（36.55%）,用法用量不适宜46例（31.72%）,疗程不适宜21例（14.48%）,遴选药品不适宜17例（11.72%）,联合用药不适宜5例（3.45%）,溶媒不适宜3例（2.07%）。结论 ：对PPI使用不合理的现象需要加强重点品种管控,提升医师的合理用药水平,促进合理用药。     

质子泵抑制剂预防胆胰外科围术期应激性黏膜病变的合理性评价

目的 调查胆胰外科围术期使用质子泵抑制剂（PPIs）预防应激性溃疡（SU）的情况,评价其合理性,为PPIs的合理应用提供参考。方法 采用回顾性调查研究的方法,收集某院2020年6月1日至8月31日胆胰外科围术期使用了PPIs的患者信息,统计PPIs的使用率、用药指征,随后评价有用药指征病例的药物遴选、用药时机、用法用量等情况。结果 623例次手术,有530例次478名患者预防使用了PPIs(85.07%)。其中无PPIs用药指征的为268例次（50.57%）,262例次有用药指征病例产生不合理用药情况642例次（98.32%）,主要为遴选药物不适宜、用药时机不适宜、用药频次不适宜、疗程过长等,仅11例次（1.68%）相对合理。结论 该院胆胰外科围术期使用PPIs预防SU不合理现象显著,医师应从严把控用药指征,药师应加强前置性处方审核,共同促进药物合理使用。     

医院2022年质子泵抑制剂处方点评及不合理处方分析

目的 回顾性点评医院2022年1—12月质子泵抑制剂(PPIs)处方,分析不合理处方。方法 本研究采用回顾性分析方法,随机抽取2022年1—12月珠海市妇幼保健院信息管理系统(HIS)中使用PPIs治疗患者的处方500张,依据《质子泵抑制剂临床应用指导原则》与《质子泵抑制剂预防性应用专家共识》等相关指南共识,以及PPIs相关药品说明书为参考,分析医院2022年1—12月PPIs类药物使用情况,并分析PPIs类药物使用不合理情况及不同科室PPIs类药物使用不合理情况。结果 500张PPIs处方中,口服用剂型占比87.20%,注射用剂型占比12.80%;艾普拉唑肠溶片(壹丽安)使用率最高,为40.80%,艾司奥美拉唑镁肠溶片(帮卡欣)使用率第二,为25.60%,奥美拉唑肠溶胶囊(罗欣)使用率为第三,为20.80%。500张PPIs处方中,PPIs用药不合理占比18.00%(90/500),其中适应证不适宜占比最高,为54.44%,遴选药品不适宜占比第二,为20.00%,无适应证用药占比第三,为11.11%,临床诊断书写不全、用法用量不适宜以及药品剂型或给药途径不适宜占比分别为7.78%、4...     

注射用白眉蛇毒血凝酶的临床应用调查分析

目的:调查白眉蛇毒血凝酶的临床用药情况,为临床合理用药提供参考。方法:回顾性调查230份病例,统计白眉蛇毒血凝酶的科室用量分布和人均用量,并对治疗目的、用药疗程、给药途径、给药时机和联合用药情况进行分析。结果:临床用药存在适应证不适宜、给药途径不适宜、给药时机不适宜和用药疗程过长的问题。结论:白眉蛇毒血凝酶的使用应严格把握适应证,短期应用常规剂量。     

基于《质子泵抑制剂临床应用指导原则（2020年版）》评价质子泵抑制剂的合理使用情况

目的 评价某三级医疗机构质子泵抑制剂（PPIs）的临床应用现状,以便促进临床规范使用PPIs。方法 基于《质子泵抑制剂临床应用指导原则（2020年版）》（《指导原则》）,从适应证、用法用量、相互作用及特殊人群用药等4个方面评价该院2021年度20个住院病区随机抽样的PPIs临床应用数据。结果 共收集2131份病历,患者PPIs的应用情况与《指导原则》中推荐意见比较,在适应证方面,948例治疗用药患者中,有51例（5.38%）急性胰腺炎患者不能明确判断;1183例预防用药患者中,有432例（36.52%）明确不符合,645例（54.52%）符合,106例（8.96%）不能明确判断。在用法用量方面,1639例患者中,1058例（64.55%）符合,581例（35.45%）不符合,165例患者给药疗程不符合。在相互作用方面,87例患者氯吡格雷与艾司奥美拉唑或奥美拉唑同时使用。在特殊人群用药方面,33例肝肾功能不全患者使用PPIs超过限定日剂量。结论 该院PPIs临床应用情况与《指导原则》中推荐意见有一定差距,应采取措施进一步规范PPIs的临床合理用药。     

医院骨科围术期预防性使用质子泵抑制剂的合理性评价

目的 分析医院骨科围术期使用质子泵抑制剂(PPIs)预防应激性溃疡(SU)的使用情况及合理性评价,为临床合理使用PPIs提供参考。方法 调取东南大学附属中大医院2020年1月份骨科出院手术病例,统计基本信息、手术情况、PPIs的使用、SU应激源及风险因素,综合分析用药合理性。结果 376例手术病人中有289例预防性使用PPIs,多选用注射剂(261例,90.31%),用药时机主要为术后用药(233例,80.62%),用药疗程中位数为3.0 d。不合理使用问题普遍存在,其中44例(15.23%)无适应证用药、26例(9.00%)用药频次错误、139例(48.10%)用药疗程过长、242例(83.74%)剂型选择不适宜。结论骨科围术期PPIs预防性使用不合理的现象较为严重,医院应加强对围术期预防性使用PPIs的管理。     

880例妇科手术患者应用质子泵抑制剂合理性分析

摘 要 目的：调查某院妇科手术患者质子泵抑制药（PPIs）使用情况,分析PPIs预防应激性溃疡（SU）合理性,为临床正确使用PPIs提供参考。方法: 抽取2016年首次入住妇科病区的出院患者病历1000份,回顾性分析PPIs使用情况,评价其使用合理性。结果:PPIs预防使用率为90.72%（880/970）;28.18%（248/880）的患者不具备预防用药指征,95.68%（842/880）的患者给药时机错误,91.46%（578/632）的患者用法用量错误。结论:妇科手术患者使用PPIs预防SU时,存在适应证、品种选择、用法用量等方面的不合理现象,应加强技术和行政干预,制定符合本院实际情况的PPIs使用标准,改善PPIs不合理使用现状。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.