妇产科术中腰-硬联合麻醉布比卡因用量的临床分析

目的：探讨妇产科手术使用腰-硬联合麻醉中布比卡因的用量。方法：收集2008年10月～2010年10月在我院行腰-硬联合麻醉的妇产科手术患者240例,其中,剖宫产手术患者、附件包块切除患者和子宫全切术患者各80例,再将这3组不同类型的妇产科手术患者分别按照身高分成4个亚组,即150～155 cm组、156～160 cm组、161～165 cm组和166～170 cm组,每个亚组20例。比较不同类型手术不同身高亚组患者在术中使用布比卡因的用量、药物起效时间、生命体征变化情况等,观察是否存在差异。结果：不同类型手术组和不同身高亚组之间布比卡因药物用量存在差异,用量随着身高的增加而增加,差异具有统计学意义（P〈0.05）。各组患者在平均动脉压力（MAP）、起效时间、牵拉反应率方面比较,差异无统计学意义（P〉0.05）。结论：麻醉师应根据不同手术类型和患者的身高采用不同的麻醉药用量,改善麻醉效果,减轻麻醉风险。     

不同剂型利福平投药后血药浓度的监测结果分析

目的 分析两种不同剂型利福平投药后血药浓度的监测结果,以指导临床合理用药。方法 选择2016年5月至2017年6月昆明市第三人民医院结核二科收治的活动性肺结核患者130例,按照数字表法随机分为注射组(65例;利褔平采用静脉滴注的方式,0.6g/次,1次/d,用500ml 5%葡萄糖注射液配制)和口服组(65例;利褔平采用口服的方式,0.6g/次,1次/d);利福平最低抑菌浓度(MIC)为0.39~1.56μg/ml,本研究统计达到MIC为0.39μg/ml的患者例数。口服组最终有2例患者因不同时间点血药浓度监测数据存在遗漏,故剔除,本研究最终纳入128例患者,其中注射组65例,口服组63例。两组患者用药第7天后,采集不同时间点的血浆标本,通过超高效液相色谱-串联质谱法(UPLC-MS/MS)检测两组利福平的血药浓度值。结果 注射组利福平最高血药浓度出现在输注后1.5h,中位数(四分位数)[M(Q₁,Q₃)]为0.954(0.210,3.420)μg/ml;口服组最高血药浓度出现在服药后2h,M(Q₁,Q₃)为1.253(0.249,2.501)μg/ml。注射组峰值血药浓度为1.786(0.704,3.591)μg/ml,均值血药浓度为0.688(0.269,1.087)μg/ml,均高于口服组[分别为1.468(0.423,3.748)μg/ml和0.571(0.149,1.894)μg/ml],但差异均无统计学意义(Z值分别为-0.90和-0.02,P值分别为0.366和0.980);注射组谷值血药浓度为0.004(0.001,0.038)μg/ml,低于口服组[0.007(0.001,0.070)μg/ml],差异有统计学意义(Z=-8.74,P=0.000)。注射组总体达到MIC的比率为47.7%(248/520),口服组为49.4%(218/441),差异无统计学意义(χ²=0.29,P=0.591)。结论 患者采用注射和口服利福平的治疗方案,血药浓度值均较低,有超过50%的患者总体时间内并未达到MIC,无法满足利福平推荐的参考范围,可能存在剂量上的不足;应继续加强对利福平血药浓度的监测,规范使用利福平注射液。     

The effects of a hospital staff training program on the treatment practices of postoperative pain in children under 8 years.

The widespread use of day case surgery for minor operations in children places increased emphasis on home care, parental responsibility and attention to suitable analgesia. This study evaluated a training program for doctors and nurses on postoperative analgesia in children by following up parental perceptions of pain relief after discharge. The main objective of our study was to determine the effects of a training program on treatment practices in the hospital and on the home care instructions provided. The study was carried out in two phases. A questionnaire was sent to parents of children aged under 8 years who had undergone a minor otorhinolaryngological operation (tonsillectomy, adenoidectomy, irrigation of maxillary sinus, insertion of grommets, or paracentesis) at the Day Case Unit in Kuopio University Hospital. The parents of 115 children returned the questionnaire in the preintervention study and those of 112 children in the postintervention study (response rates: 79% and 86% respectively). The training program for personnel (intervention) was organized between the two studies. It started with a onehour lecture on postoperative pain and pain treatment in children, and the lecture was followed by two weeks of bedside teaching. The overall standard of pain treatment in the hospital was good. Most of the children had no pain or only mild pain on discharge (93% before the intervention and 90% after the intervention). The intervention had no effect on the likelihood of children receiving pain medication. Noticeable changes occurred in the selection of pain medicines and dosage forms, and in the increased number of home care instructions provided for parents. We conclude that the training program for both professional groups (doctors and nurses) can be beneficial in changing the treatment practice (especially the use of medicines and dosage forms). Such training programs also make it possible to emphasize the importance of proper instructions for home care and thus to improve the quality of information provided for parents.     

苓桂术甘汤剂量变化的临床应用体会

《伤寒杂病论》开创了中医理、法、方、药紧密结合的先河,其立法创方之严谨,临床疗效之卓著,堪称经典。历代医家均精研其辨证思想与方证精髓,从中汲取了诸多宝贵的临床经验。然而,时至今日,关于《伤寒杂病论》中药物剂量的临床应用方面仍有较多争议。古有传药不传火之秘,中医治病在辨证、立法、选方、遣药之外,取效与否的关键很大程度上在于药物的剂量是否恰当。笔者认为,用药以偏纠偏,病轻药宜轻,病重药宜重,兼之因时、因地、因人制宜,方能取得满意的临床疗效。现以经方苓桂术甘汤为例,结合笔者临床案例体会,对该方药物剂量与疗效的临床应用关系做一分析研究。     

Stability of chronic medicines in dosage administration aids. How much have been done?

Background

The prevalence of chronic diseases is increasing in Asia, therefore compliance to the medications is of utmost importance to slow disease progression and improve outcomes. Dosage administration aids (DAAs) serve as important tool to improve the compliance of patients. However, there is a dearth of data on the stability of chronic medications in DAAs. Furthermore, data presented by our Western counterparts may not be applicable to us because of our extreme humidity and temperature. In this study, we aim to summarize the data available in the literature on the stability of chronic medications in DAA.

Methods

We performed a literature search using electronic databases and related keywords.

Results

In total, 24,336 articles were retrieved and 21 articles were found to be relevant to our topic. This commentary stratified drugs according to their treatment categories and key stability conclusions, DAA and conditions used and recommendations were presented.

Conclusion

Due to the lack of specific data, pharmacists have to exercise their professional judgment with the help from professional guidelines when using DAA in repackaging medication. Manufacturers and regulators can play a greater role in filling the gap needed to provide pharmacists with necessary information to fulfill their function.     

羟甲基烟酰胺分散片的研制

目的：研制羟甲基烟酰胺分散片。方法：以崩解时间为指标。比较几种崩解剂的作用，以正交试验设计确立最佳处方，并与普通片进行体外溶出度比较。结果：崩解剂以低取代羟丙纤维素(L-HPC)效果最优，最佳处方崩解时间为78．9S，溶出速度远大于普通片。结论：所研制的羟甲基烟酰胺分散片溶出迅速。     

97种皮肤科用医院制剂文献调查分析

目的:考察皮肤科用医院制剂现状及发展趋势,为医院制剂发展提供参考。方法:对2001～2005年发表在《中国医院药学杂志》、《中国药房》杂志“医院制剂”栏目中有关皮肤科用医院制剂的97篇文献进行统计分析。结果:97种制剂涉及剂型种类达23种,其中西药制剂56种,中药制剂20种,中西药复方制剂21种。结论:局部外用制剂在皮肤科用医院制剂中占有非常重要的地位。