医院内部分科室抗菌药物应用分析

目的为增进抗菌药物的合理应用,抽查部分科室病例,并对其抗菌药物使用情况进行了分析。方法对抽取病历的用药种类及用药时间、药物联用情况等进行统计、分析。结果围手术期抗菌药物预防性应用率达100%,用药合理占70.04%,基本合理为23.34%;不合理占6.62%;治疗性应用抗菌药物的病例均达到《抗菌药物临床应用指导原则》的基本要求。结论我院围手术期患者抗菌药物应用情况还未能完全达到《抗菌药物临床应用指导原则》中的要求,应进一步加强监管。     

头孢菌素类衍生物的中间体合成研究

本文简述了从青霉素（Ｇ或Ｖ）经化学转化制取头孢菌素类衍生物的中间体。     

淋球菌对头孢曲松和头孢克肟耐药现状及耐药机制研究进展

世界各地不断分离出对头孢曲松和头孢克肟敏感性下降的淋球菌菌珠.penA、mtrR、DorB1b和ponA基因是与淋球菌对头孢菌素敏感性下降的主要相关基因.研究表明,镶嵌状penA基因导致淋球菌对头孢克肟敏感性降低,并可能导致淋球菌对头孢曲松敏感性下降.mtrR、porB1b和ponA基因突变与淋球菌对头孢克肟和头孢曲松敏感性下降有明确关系,镶嵌状penA、mtrR、porB1b和ponA基因多态性可能共同导致淋球菌对头孢曲松和头孢克肟的敏感性明显降低.     

Updates in bacteriological epidemiology of community-acquired severe acute cholangitis and the effectiveness of metronidazole added routinely to the first-line antimicrobial regimen

Prompt antimicrobial therapy, together with subsequent biliary drainage, is crucial to prevent the rapidly deteriorating course of severe acute cholangitis. Therefore, updates in bacteriological epidemiology and resistance profile are important for management of this critical disease. Also, because the routine addition of metronidazole to the first-line regimen is controversial, we intended this prospective study with historical controls. Patients with severe acute cholangitis who fulfilled the definition of severity by the Tokyo Guidelines and underwent biliary drainage within 24 h from presentation were enrolled prospectively from January 2010 to December 2011. During that period, metronidazole was not added to third-generation cephalosporins, which were used as the initial antimicrobials except for patients who were allergic to penicillin and received ciprofloxacin instead (no metronidazole group). Outcomes were compared with a historical cohort from March 2007 to December 2009 when metronidazole was added routinely (metronidazole group). A unified strategy was maintained throughout the whole period excepting the use of metronidazole. Outcomes between the metronidazole group (n = 338) and the no metronidazole group (n = 338) did not differ in terms of the rate of successful biliary drainage by interventional procedures (93.2 % vs. 94.7 %, p = 0.88), time elapsed for cholangitis to be controlled (10.4 ± 0.6 vs. 8.9 ± 1.2 days, p = 0.38), and mortality (1.2 % vs. 0.6 % with p = 0.34 for all causes and 0.9 % vs. 0 % with p = 0.15 for cholangitis-related, respectively). As the routine addition of metronidazole did not improve outcomes, it can be excluded from the first-line regimen if emergent biliary drainage can be performed efficiently.     

盐酸头孢吡肟的合成

以7-ACA为起始原料,在环己烷中用六甲基二硅氨烷(HMDS)和三甲基碘硅烷(TMSI)将7-ACA中的氨基和羧基硅烷化,然后与N-甲基吡咯(NMP)和TMSI的反应产物混合,生成(6R,7R)-7-氨基-3-[(1-甲基-1-吡咯烷鎓盐)甲基]头孢-3-烯-4-羧酸氢碘酸盐(中间体Ⅱ),再与活性酯反应得到盐酸头孢吡肟。     

73例头孢菌素类药物严重不良反应分析

目的：了解头孢菌素类药物引起的严重不良反应（SADR）的发生规律,发掘药物警戒信号,为临床安全合理用药提供参考。方法：收集武汉市不良反应监测系统数据库中2009～2011年头孢菌素类严重的（包括新的严重的）不良反应报告,从中筛选出符合标准的73例进行分析。结果：73例SADR涉及头孢菌素19个品种,其中以头孢曲松的比例最高;临床表现以过敏性休克和过敏样反应为主的全身性损害最为突出;41例SADR发生时间在30min内;50岁以上的老年人及10岁以下儿童ADR构成比较高。从ADR病例报告中反映存在相当数量的不合理用药现象。结论：临床应高度重视头孢菌素类药物引起的过敏性休克等SADR,增强合理用药意识,以减少和避免SADR的发生。     

A Rapid,Validated RP-HPLC Method for the Simultaneous Determination of Cleaning Validation and Cross-Contamination of 12 Beta-Lactam Compounds

The present work reports a rapid reversed-phase high-performance liquid chromatography (RP-HPLC) method for the simultaneous determination of 12 beta-lactam components for cleaning validation and cross-contamination. A strategic experimental approach was implemented for the method development. The desired chromatographic separation was achieved on a Symmetry C18 (4.6 X 75 mm, 3.5 μm) column using gradient elution. The optimized mobile phase consisted of the buffer tetrabutylammonium hydroxide pH-6.8 and acetonitrile. The eluted compounds were monitored at 215 nm and 254 nm wavelength using a photodiode array detector. The developed method separated 12-beta-lactam compounds from each other within a run time of 50 min. The method is effective for the determination of cross-contamination of penicillin and cephalosporin production blocks. The present method is specific and a lower limit of quantification was determined on the basis of the signal-to-noise ratio method; it is 1 μg/mL for all components. The developed RP-HPLC method was validated according to the International Conference on Harmonization (ICH) guidelines.     

17例双硫伦样反应临床分析

目的探讨双硫伦样反应的发生特点,引起临床医护人员的重视,避免误诊。方法对本院2005年5月～2007年6月发生的17例双硫伦样反应的病例资料进行回顾性分析,总结其发生的原因、诱因、临床表现、治疗转归,误诊等。结果①双硫伦样反应见于各种原发病患者;②导致双硫伦样反应的患者以使用头孢菌素类抗生素为主;占94.12%;③双硫伦样反应的患者以接触酒类和乙醇制剂为主要诱因;④临床表现有颜面潮红、头痛、胸闷、心悸、恶心呕吐、烦躁、气促、低血压、呼吸困难;⑤双硫伦样反应一般出现在饮酒后20～60min;⑥对症治疗后临床症状在30～120min内缓解。结论对使用头孢菌素药物患者应重视双硫伦样反应的发生,治疗过程前后应特别医嘱避免饮酒和使用乙醇制剂。     

头孢类抗菌药物联合其他药物致不良反应的临床评价分析

目的：探讨头孢类抗菌药物合并用药的不良反应发生情况,为临床合理用药提供参考。方法：对2006年1月～2015年1月我院收集的头孢类抗菌药物合并用药不良反应241例病例资料进行回顾性分析,调查合并用药的药品种类及合并用药前后不良反应发生情况差异。结果：头孢类抗菌药物联合用药出现不良反应的药物种类主要有水电解质和酸碱平衡调节剂、抗病毒类药物、中药注射剂、激素类药物、其他抗菌药物等;头孢类抗生素的主要不良反应以过敏反应、消化系统不良反应、神经系统不良反应较为常见,各类不良反应的发生率较用药前均显著升高（P＜0.05）。结论：头孢类抗菌药物联合其他药物使用过程中也会引发一些不良反应,临床使用过程中必须加以重视。     

注射用头孢菌素类处方临床配伍研究

目的：分析注射用头孢菌素类抗菌药物输液配伍现状,为药物合理配伍提供有价值的参考。方法：随机抽取2015年1～3月我院儿科门诊处方2810张作为研究对象,分类统计使用注射用头孢菌素类抗菌药物处方,并对处方药物配伍进行分析。结果：经过统计分析,注射用头孢菌素类处方652张,在儿科门诊处方中占23.20%;输液处方927张,占32.99%;注射用头孢菌素类处方占70.33%;注射用头孢菌素类药物与其他药物配伍使用处方,占85.91%,不合理配伍处方44张,占6.75%。结论：在临床应用的注射用头孢菌素类药物处方配伍中,存在一定的不合理配伍问题,应采取切实有效措施,提高处方配伍的合理性,保证合理用药。