ADE触发工具在药品不良事件监测中的应用

目的：探索ADE触发工具在医院药品不良事件（ADE）监测中的应用。方法：根据医疗保健研究所（IHI）推出的ADE触发工具及医院具体用药情况,选择19项触发器。自医院电子病历系统随机抽取2015年第三季度出院病历共967份（肿瘤患者和18岁以下患者除外）,回顾性研究患者的用药情况、检验检查指标及病程记录,对触发器显示阳性的患者进行ADE判定和分析,并进行数据统计和分析,评估各触发器信号与ADE发生的相关性。结果：967位患者中触发器阳性者达到417例次,涉及319位患者,确定33位患者发生ADE,ADE检出率为10.34%（33/319）。33例ADE中E级ADE为31例,F级为2例。同时间段医院ADE自愿上报率为0.67%（147/21897）,与经触发器检出的ADE发生率相比,有统计学差异;且在医院ADE自愿上报系统中未检查到此33例ADE患者信息。结论：ADE触发工具对发现ADE具有较强的敏感性,与自愿上报系统相比,可发现更多的ADE,但触发器需要进一步修正。     

Sleep‐disordered breathing in heart failure patients with different etiologies

BackgroundThe prevalence of sleep‐disordered breathing (SDB) is closely related to the severity of heart failure (HF), and the severity of HF is different in patients with HF of different etiologies. Hypothesis: This study aimed to explore the prevalence of SDB in patients with HFof different etiologies.MethodsHospitalized HF patients were consecutively enrolled. All patients underwent portable overnight cardiorespiratory polygraphy. Patients were divided into five groups according to the etiology of HF: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB and clinical data was compared among the five groups.ResultsIn total, 248 patients were enrolled in this study. The prevalence of SDB in HF was 70.6%, with the prevalence of obstructive sleep apnea (OSA) at 47.6% and central sleep apnea (CSA) at 23.0%. Patients were divided into five groups: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB among the five groups was 75.3%, 81.4%, 77.8%, 51.9%, and 58.5% (p = .014), respectively. The prevalence of OSA among the five groups was 42.7%, 72.1%, 36.1%, 37.0%, and 49.1% (p = .009), whereas the CSA was 32.6%, 9.3%, 41.7%, 14.8%, and 9.4% (p < .001), respectively.ConclusionsSDB is common in HF patients. The prevalence and types of SDB varied in HF with different etiologies, which may be related to the different severities of HF. SDB was highly prevalent in patients with ischemic, hypertensive, and myocardial HF. Hypertensive HF patients were mainly complicated with OSA, while myocardial HF patients were mainly complicated with CSA. Both conditions were highly prevalent in ischemic HF patients. The prevalence of SDB was relatively low in valvular and arrhythmic HF patients, and OSA was the main type.     

EGFR突变阳性肺腺癌患者多学科诊疗一例

本文介绍1例55岁女性肺腺癌患者从初诊、根治性手术、术后辅助治疗到远处转移后的多学科诊治过程.患者因右肺结节就诊,经多学科讨论后接受肺叶切除术,术后病理为腺癌,基因检测提示表皮生长因子受体(epidermal growth factor receptor,EGFR)基因敏感突变,患者接受多学科讨论的建议进行含铂双药辅助...     

对促宫颈成熟与引产孕产妇的全程分娩管理模式

目的 探讨在全程分娩管理模式下,为孕产妇提供促宫颈成熟与引产服务的可行性。方法 选择2018年1月1日至2020年12月31日,在南京大学医学院附属鼓楼医院接受待产、分娩到产后康复(LDRP)一体化全程分娩管理模式(以下简称为LDRP管理)的848例孕产妇为研究对象。根据孕产妇进入产房时是否进入自然产程,将其分为自然临产组(n=441)和引产组(n=407)。采用回顾性分析法,对2组孕产妇的一般临床资料,如分娩年龄、孕次、孕龄、妊娠并发症,以及母儿结局进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,并经过南京大学医学院附属鼓楼医院伦理委员会审核批准(审批文号：201702001)。结果 (1)2组孕产妇分娩年龄、孕次和高龄孕产妇所占比例比较,差异无统计学意义(P>0.05)。2组孕产妇分娩孕龄、经产妇占比、早产率、缩宫素使用率、分娩时长比较,差异有统计学意义(P<0.05)。(2)引产组孕产妇均使用前列腺素类药物促宫颈成熟或缩宫素进行引产,其中使用地诺前列酮栓、米索前列醇、缩宫素、地诺前列酮栓+米索前列醇分别为26.5%(108/407)、...     

新型冠状病毒肺炎疫情期间临床试验工作现状的调查与研究

新型冠状病毒肺炎疫情蔓延下,临床试验工作的节奏遭受巨大挑战,南京大学医学院附属鼓楼医院基于疫情期间临床试验工作指引和相关法规,通过设计调查问卷,调研临床试验工作开展现状并进行分析,对在研项目的研究者、临床监查员(clinical research associate,CRA)、研究协调员(clinical resear...     

羟基喜树碱的代谢与CYP450的相关性研究

目的：研究羟基喜树碱（HCPT）在体外小鼠肝微粒体中对 CYP450活性的影响,为临床合理联合用药提供参考。方法：在小鼠体外肝微粒体中分别加入六种亚型酶的探针药物对乙酰氨基酚、非那西丁、双氯芬酸钠、睾酮、酒石酸美托洛尔、奥美拉唑和羟基喜树碱溶液,在优化的孵育体系下温孵。用 HPLC 法测定各空白对照组和羟基喜树碱溶液中各探针药物代谢产物的浓度并比较代谢率的差异,以评价羟基喜树碱对各亚型酶活性的影响。结果：在代谢反应过程中,在50~200μmol·L-1内,羟基喜树碱的浓度与孵育体系中 CYP3A4的特异性底物睾酮、CYP2E1的特异性底物对乙酰氨基酚的剩余药量呈正比例关系,且具显著性差异（P＜0.05）,与其他四种探针药物的剩余药量无明显的浓度依存关系（P＞0.05）。结论：HCPT 在肝微粒体的代谢反应过程中受代谢酶 CYP3A4和 CYP2E1的作用,竞争性地抑制了睾酮和对乙酰氨基酚在肝微粒体中的代谢。     

复杂眼外伤晶状体玻璃体切除术后二期后房型人工晶状体植入的临床研究

目的探讨复杂眼外伤晶状体玻璃体切除术后二期后房型人工晶状体植入的手术方法及评价其疗效。方法对35眼因复杂的眼外伤行晶状体切除联合玻璃体切除,术后3个月-6 a行后房人工晶状体植入术。术后随访3-24个月,平均（9.2±6.5）个月。结果35眼均顺利植入后房人工晶状体,其中睫状沟聚丙烯缝线双襻固定15眼,单襻固定15眼,不须固定者5眼。所有患眼均达到或超过术前最佳矫正视力,无远期严重并发症。结论晶状体和玻璃体切除术后二期后房人工晶状体植入术安全可靠,是目前矫正晶状体玻璃体切作术后屈光不正较好的方法。     

Comparison of the effects of perineural or intravenous dexamethasone on thoracic paravertebral block in Ivor‐Lewis esophagectomy: A double‐blind randomized trial

Efforts to prolong thoracic paravertebral block (TPVB) analgesia include local anesthetic adjuvants, such as dexamethasone (Dex). Previous studies showed that both perineural (PN) and intravenous (i.v.) routes could prolong analgesia. As PN Dex is an off‐label use, anesthesiologists should be fully informed of the clinical differences, if any, on block duration. This study was designed to evaluate the two administration routes of Dex for duration of analgesia in TPVB. Ninety‐five patients scheduled for Ivor‐Lewis esophagectomy were randomized to receive TPVB (0.5% ropivacaine 15 ml), PN or i.v. Dex 8 mg. The primary end point was the duration of analgesia. The secondary end points included pain scores, analgesic consumption, adverse effects rate, and incidence of chronic pain at 3 months postoperatively. The PN‐Dex group showed better analgesic effects than the i.v.‐Dex group (p < 0.05). Similarly, the visual analogue scale scores in patients at 2, 4, 8, and 12 h postoperatively were lower in the PN‐Dex group than the i.v.‐Dex group (p < 0.05). The analgesic consumption in both the PN‐Dex and i.v.‐Dex groups was significantly lower than that in the control group (p < 0.05). Regarding the incidence of chronic pain, regardless of route, Dex decreased the incidence of chronic postsurgical pain and neuropathic pain at 3 months after surgery (p < 0.05), but there were no clinical differences between the i.v.‐Dex and PN‐Dex groups. Perineural dexamethasone improved the magnitude and duration of analgesia compared to that of the i.v.‐Dex group in TPVB in Ivor‐Lewis esophagectomy. However, there were no clinically significant differences between the two groups in the incidence of chronic pain.

Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC? Both perineural (PN) and intravenous (i.v.) dexamethasone (Dex) could prolong the duration of a nerve block, but the superiority of either route is still inconclusive. WHAT QUESTION DID THIS STUDY ADDRESS? The study investigated the effects of the two routes of Dex added to ropivacaine on analgesic effects of thoracic paravertebral block in patients undergoing Ivor‐Lewis esophagectomy. WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE? These results extend the knowledge of the superior analgesic effect of Dex for the management of perioperative pain in the setting of Ivor‐Lewis Esophagectomy. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE? Because PN Dex is an off‐label use, our study conformed the safety of Dex as PN adjuvants and extended its application field in clinical work.