以克服药品不良反应为目的开发新复方制剂的思路与策略

增强疗效,减少不良反应是新药研发工作的重中之重。复方制剂不但具有降低不良反应发生率,提高药效的作用,还具有研发成本低和研发周期短的特点,因此已经成为新药研发的热点。本文综述了以克服药品不良反应为目的而设计的复方制剂,阐述了通过新的药物组合减少由于药理作用带来的个性不良反应,以及通过新的制剂技术减少血药浓度波动带来的共性不良反应2种复方制剂设计策略出发,以期为复方制剂的研发提供有益的思路。     

居家静脉输液安全评估表的设计和应用

目的：探讨使用居家静脉输液安全评估表对患者输液安全的影响,以确保居家患者的输液安全。方法：自行设计居家静脉输液安全评估表,内容主要围绕居家输液患者的病情、居家环境和照顾者的照护能力,确定存在的问题,并采取针对性的指导措施。结果：通过全面评估125例共327例次居家静脉输液,显示照顾者的照护能力得到提升,社区护士重复上门率由6.21%降至1.83%,患者及照顾者对社区护理服务的满意度由91.27%提升至98.40%,差异有统计学意义（P＆lt;0.05）。结论：通过使用居家静脉输液安全评估表的方式,能有效提高居家患者输液安全性。     

Quality of life four years after acute myocardial infarction: short form 36 scores compared with a normal population

OBJECTIVES: To assess the impact of myocardial infarction on quality of life in four year survivors compared to data from "community norms", and to determine factors associated with a poor quality of life. DESIGN: Cohort study based on the Nottingham heart attack register. SETTING: Two district general hospitals serving a defined urban/rural population. SUBJECTS: All patients admitted with acute myocardial infarction during 1992 and alive at a median of four years. MAIN OUTCOME MEASURES: Short form 36 (SF 36) domain and overall scores. RESULTS: Of 900 patients with an acute myocardial infarction in 1992, there were 476 patients alive and capable of responding to a questionnaire in 1997. The response rate was 424 (89. 1%). Compared to age and sex adjusted normative data, patients aged under 65 years exhibited impairment in all eight domains, the largest differences being in physical functioning (mean difference 20 points), role physical (mean difference 23 points), and general health (mean difference 19 points). In patients over 65 years mean domain scores were similar to community norms. Multiple regression analysis revealed that impaired quality of life was closely associated with inability to return to work through ill health, a need for coronary revascularisation, the use of anxiolytics, hypnotics or inhalers, the need for two or more angina drugs, a frequency of chest pain one or more times per week, and a Rose dyspnoea score of >/= 2. CONCLUSIONS: The SF 36 provides valuable additional information for the practising clinician. Compared to community norms the greatest impact on quality of life is seen in patients of working age. Impaired quality of life was reported by patients unfit for work, those with angina and dyspnoea, patients with coexistent lung disease, and those with anxiety and sleep disturbances. Improving quality of life after myocardial infarction remains a challenge for physicians.     

Sildenafil improves health-related quality of life in patients with pulmonary arterial hypertension

BACKGROUND: Sildenafil inhibits phosphodiesterase-5, enhancing cyclic guanosine monophosphate- mediated relaxation of pulmonary vasculature and is effective in treating patients with pulmonary arterial hypertension (PAH). METHODS: Patients with PAH (n = 278) received oral sildenafil (20, 40, or 80 mg three times daily) in a 12-week, double-blind, placebo-controlled study and an open-label extension. Health-related quality of life (HRQoL) was recorded by patients using the Medical Outcomes Study 36-item short form (SF-36) and EuroQol 5D (EQ-5D) questionnaires at baseline and after 12 and 24 weeks of therapy. Data are presented for patients who received sildenafil for up to 24 weeks. RESULTS: Sildenafil-treated patients, compared with placebo-treated patients, exhibited significant improvement in exercise capacity at week 12 (p < 0.001). Increases from baseline to week 12 were observed in all SF-36 domains for sildenafil-treated patients, with statistically significant improvements, compared with placebo-treated control subjects, in physical functioning (p < 0.001), general health (p < 0.001), and vitality (p < 0.05). Statistically significant improvements were also observed for the EQ-5D current health status (p < 0.01) and utility index (p < 0.01). These benefits were maintained for 24 weeks. Treatment groups were pooled for analyses as the results for the 6-min walk distance, SF-36, and EQ-5D were not dose dependent. CONCLUSIONS: Sildenafil improves HRQoL of PAH patients. These improvements appear to be maintained for at least 24 weeks. The effects are strongest in domains addressing the physical impact of health on daily activities and patients' overall perception of health.     

无缝隙对接在空勤科医疗保障中的应用

目的：通过无缝隙对接在空勤科医疗保障中的应用提高飞行人员满意度。方法宣传、执行无缝隙对接,深入细节,分工明确,抓好质量,落实回访。结果根据科室层面综合评价指标,门诊、住院人数增加,飞行人员满意度上升。讨论无缝隙对接适应空勤科医疗保障的新特点。     

慢性肾功能衰竭合并急性左心衰竭患者心肌酶和肌钙蛋白的意义分析

目的 探讨慢性肾功能衰竭合并急性左心衰竭患者心肌酶和肌钙蛋白升高的临床意义.方法 选择慢性肾功能衰竭合并急性左心衰竭患者38例（试验组）,另选取同期未发生急性左心衰竭的慢性肾功能衰竭患者42例作为对照组,检测两组肌酸激酶同工酶（CK-MB）、天冬氨酸氨基转移酶（AST）、心肌肌钙蛋白Ⅰ（cTnI）、肌酐的变化,并记录患者院内预后.结果 试验组CK-MB、cTnI均较对照组明显升高[（36.23±14.27） U/L比（14.71士8.27）U/L、（11.26±5.04）μg/L比（5.24±2.31）μg/L],差异有统计学意义（P＜0.05）;两组AST、肌酐水平均较正常值明显升高,但两组间比较差异无统计学意义（P＞0.05）;试验组院内病死率明显高于对照组[47.37％（18/38）比16.67％（7/42）],差异有统计学意义（P＜0.01）;多因素分析结果显示,CK-MB、cTnI均是影响慢性肾功能衰竭合并急性左心衰竭患者预后的独立危险因素（r=5.03,3.27,P＜0.05）.结论 慢性肾功能衰竭合并急性左心衰竭患者心肌酶和肌钙蛋白的升高对预后有评估作用.     

某院紫杉醇注射剂用药情况与不良反应相关因素分析

摘 要 目的：分析紫杉醇注射剂用药情况及其不良反应相关因素,为临床合理用药提供参考。方法：回顾性分析某院2017年3月~ 2017年11月255例使用紫杉醇注射剂患者的用药情况如给药剂量、溶媒、紫杉醇剂型、化疗前是否进行预防用药和化疗方案等及其用药期间发生药品不良反应（ADR）的特点,并分析ADR的相关因素。结果：255例患者中男112例,女143例,平均年龄56.6岁,原发肿瘤主要为非小细胞肺癌、卵巢恶性肿瘤和头颈部癌,肿瘤TNM分期主要为Ⅳ期。紫杉醇单药化疗44例（17.25%）,联合化疗211例（82.75%）。紫杉醇适应证、给药剂量和溶媒等方面超说明书用药比例分别为53.72%、20.54%和10.10%。ADR发生率为81.96%,严重ADR占20.70%（94/454）。主要ADR类型为血液和淋巴系统疾病及骨骼肌和结缔组织,最常见WBC降低（25.11%）。对紫杉醇ADR发生率有显著性影响的因素包括患者所在科室、生产厂家及是否进行预防用药。结论：某院紫杉醇注射剂存在超说明书用药情况,但超说明书用药与ADR发生无相关性。几种联合化疗方案的ADR发生率差异无统计学意义,使用紫杉醇脂质体可能会减少ADR的发生。     

不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度的影响

目的：研究不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度的影响。方法：回顾性分析某院270例丙戊酸血药浓度监测报告,记录患者姓名、年龄、体质量、丙戊酸的用法与用量、联合用药情况（合用药品及其用法与用量）和血药浓度监测结果。分析不同丙戊酸盐和丙戊酸剂型对丙戊酸标准血药浓度的影响。结果：二元Logistic回归分析结果表明丙戊酸盐类型和剂型对标准血药浓度有显著影响（P<0.05）;丙戊酸镁的标准血药浓度[（9.18±3.54）μg·kg·mL^-1·mg^-1]大于丙戊酸钠盐的标准血药浓度[（6.76±2.54）μg·kg·mL^-1·mg^-1];丙戊酸缓释片的标准血药浓度[（8.38±3.49）μg·kg·mL^-1·mg^-1]大于丙戊酸普通片的标准血药浓度[（6.88±2.54）μg·kg·mL^-1·mg^-1],差异均具有显著性（P<0.05）。结论：不同丙戊酸盐和丙戊酸剂型对丙戊酸血药浓度存在明显影响,如何选择丙戊酸盐和丙戊酸剂型对丙戊酸的合理运用具有重要意义。