门诊抗菌药处方调查及合理性分析

采用回顾性分析法,分层随机抽取2014年1月1日~12月31日使用抗菌药物的处方3600张,统计抗菌药应用品种、用药频度、联合用药、使用方法,并对抗菌药处方进行合理性分析。口服给药的处方占87.72%,注射给药处方占12.28%;单品种用药占83.67%,联合用药占16.33%;抗菌药处方合格率为95.08%

临床药师及用药软件对门诊处方审核结果分析

目的了解处方合理用药软件及临床药师对门诊处方审核情况,为优化处方合理用药软件提供参考。方法收集我院2017年7—12月门诊处方合理用药软件及临床药师对门诊处方人工审核的监测数据,并对有关数据进行统计分析。结果我院2017年7—12月处方总量为1 127 455份,其中用药提示474 618份,占42.1%。其中,由临床药师人工审核通过共30 133份,返回修改的1 072份;系统自动拦截共1 734份。结论处方合理用药软件同临床药师人工审方相结合能大幅提高调剂药师工作效率,进一步提升为患者服务的质量

Efficacy and safety of buprenorphine transdermal patches in relieving moderate to severe chronic pain

目的观察丁丙诺啡透皮贴剂治疗中重度慢性疼痛的疗效和安全性。方法收集2015年10月至2016年3月在我院骨科门诊确诊为中重度慢性疼痛患者68例,给予丁丙诺啡透皮贴剂进行止痛治疗,初始剂量5 mg,qw,根据疼痛情况调整剂量至无痛或基本无痛状态。对每位患者随访1个月,分别评估患者治疗前后疼痛强度、镇痛效果、生活质量、用药依从性,同时监测药物不良反应。结果治疗前、后患者疼痛数字评分分别为（5.90±1.05）分和（1.35±0.75）分,P〈0.05;疼痛总缓解率为91.18%;治疗后SF-36生活质量量表（中文版）8个方面维度分数和用药依从性均较治疗前显著提高（P〈0.05）;药物不良反应发生率为8.82%。结论丁丙诺啡透皮贴剂具有镇痛稳定、作用持久、不良反应轻、用药依从性高等特点,可倡导应用于中重度慢性疼痛的治疗。AIM To observe the efficacy and safety of buprenorphine transdermal patches in relieving moderate to severe chronic pain. METHODS From October 2015 to March 2016,a total of 68 patients with moderate to severe chronic pain in orthopaedics clinic in our hospital were treated with buprenorphine transdermal patches,used with an initial dose of 5 mg qw and adjusted dose until pain disappeared. After one-month follow-up,the patients with moderate to severe chronic pain were respectively evaluated and pain relief,quality of life,medication compliance and adverse drug reactions were compared. RESULTS At pre-therapy and post-treatment,the scores of NRS（ numerical rating scale） of the patients were（ 5. 90 ± 1. 05） and（ 1. 35 ± 0. 75） respectively,P 〈0. 05.There was significant difference befor and after treatment in pain relief,life quality and medication compliance（ P 〈0. 05）. The total remission rate in pain was 91. 18%. It was 8. 82% in incidence rate of adverse drug reactions. CONCLUSION Buprenorphine transdermal patches have the characteristics of stable analgesia,long duration of effect,less adverse drug reactions and higher compliance,and can be advocated for in the treatment of moderate to severe chronic pain

The comparative study of amoxicillin and amoxicillin dicloxacillin sodium for the eradication of H.pylori

目的评价阿莫西林与阿莫西林双氯西林钠对幽门螺杆菌(H.PylOrI)的疗效。方法 155例确诊为消化性溃疡(Pu)(A期)且H.PylOrI阳性的患者随机分为3组,A组52例,给予兰索拉唑30 Mg+阿莫西林1.0 g+替硝唑0.5 g;b组51例,给予兰索拉唑30 Mg+阿莫西林双氯西林钠0.75 g+替硝唑0.5 g;C组52例,给予兰索拉唑30 Mg+阿莫西林双氯西林钠1.5 g+替硝唑0.5 g;均每日2次,疗程7 d。停用抗生素至少4周、停用PPI至少2周,复查13C-呼气试验和胃镜尿素酶检查、观察3组H.PylOrI根除率和溃疡愈合情况,记录药物不良反应(Adr)。结果 3组H.PylOrI根除率差异有统计学意义(P0.0167)。3组溃疡愈合率差异均无统计学意义(P>0.05)。3组溃疡有效率差异有统计学意义(P0.05)。结论阿莫西林对H.PylOrI根除率高,溃疡有效率较高,Adr发生率低。Objective To evaluate effecacy of amoxicillin and amoxicillin dicloxacillin sodium for the eradication of H.pylori.Methods Totally 155 helicobaeter pylori-infected patients with peptic ulcer diagnosed by endoscopy were enrolled.The patients were randomly divided into three groups,and drugs were given as follows: each of the 52 patients of group A was given lansoprazole 30 mg+amoxicillm 1.0 g+tinidazole 0.5 g;each of the 51 patients of group B was given lansoprazole 30 mg+amoxicillin dicloxacillin sodium 0.75 g+tinidazole 0.5 g;each of the 52 patients of group C was given lansoprazole 30 mg+amoxicillin dicloxacillin sodium 1.5 g+ tinidazole 0.5 g.All drugs were given twice a day for seven days.After finishing of H.pylori therapy at least four weeks,and after withdrawing of PPI at least two weeks,we compared the H.pylori status,ulcer healing,and side-effects among three groups by inquisition,endosecopy and 13C breathing test.Results There was significant difference of the H.pylori eradication rate among the three groups(P0.05) among the three groups.There was significant difference among the three groups(P<0.05).The results between group A and group B were significantly different(P<0.0167).The results between group A and group C were not significantly different,either were the results between group B and group C.The rate of ADR showed no significant difference among the three groups.Conclusion Comparison of three groups,amoxicillin,which has highest H.pylori eradication rate,highest ulcerative healing,lowest incidence of ADR,is better than amoxicillin dicloxacillin sodium as an antibiotics for H.pylori eradication

101例门诊中晚期癌痛患者疼痛治疗效果分析

目的从疼痛治疗角度,探讨影响门诊中晚期癌痛患者疼痛治疗的可能因素,以期为临床合理用药提供参考。方法采用随访调查法,对本院2016年12月~2017年5月间,持有门诊麻醉药品取用特殊病历的中晚期癌痛患者101例,进行2周以上的阿片类药物止痛治疗随访,收集疼痛治疗指标,比较不同年龄、性别、肿瘤部位使用阿片类药物的疗效、剂量及不良反应。结果本研究,不同年龄段间,50~59岁患病人数所占的比例最高,60~69岁吗啡日均剂量达到最大值;不同年龄段,癌痛治疗的效果及剂量比较,差异无统计学意义;男性组NRS评分值,疼痛缓解程度值和吗啡日均剂量均略高于女性组;不同肿瘤部位间癌痛治疗的效果及剂量比较差异无统计学意义;≥60岁组恶心、呕吐和便秘发生率均高于<60岁组,差异有统计学意义(P <0. 05),男性组ADR发生率高于女性组,差别均无统计学意义。结论在癌痛治疗中,性别、年龄、肿瘤部位是临床使用阿片类药物时需要考虑的因素

Effect Analysis of Helicobacter Pylori Eradication

目的从幽门螺杆菌(HElICObACTEr PylOrI,H.PylOrI)根治的疗效角度,探讨影响H.PylOrI治疗的可能因素,以期为临床合理用药提供依据。方法对本院2010年1月—2011年9月经胃镜尿素酶检查和(或)13C-呼气试验检测H.PylOrI阳性患者的治疗情况进行随访,收集H.PylOrI治疗结果并进行统计、分析。结果患者资料完整者共502例,H.PylOrI总体根除率为60.76%,其中男性根除率为66.67%(164/246),女性根除率为55.08%(141/256),不同性别H.PylOrI根除率比较,差异有统计学意义(χ2=7.066,P0.05)。本研究筛选出9种不同的H.PylOrI根治方案,其中以质子泵抑制剂(PPI)+铋剂(b)+克拉霉素(C)+左氧氟沙星(l)方案H.PylOrI根除率最高(为80.49%),PPI+b+l+替硝唑(TIn)的H.PylOrI根除率最低(为50.00%),两种方案H.PylOrI根除率比较,差异有统计学意义(χ2=7.570,P0.05)。7 d疗程方案者占63.75%,H.PylOrI根除率为63.44%,较其他疗程高,各疗程间H.PylOrI根除率比较,差异无统计学意义(χ2=3.294,P>0.05)。埃索美拉唑(ESO)与奥美拉唑(OME)方案H.PylOrI根除率比较,差异有统计学意义(χ2=7.839,P=0.005,检验水准调整值为0.008)。结论 H.PylOrI根除率与性别、治疗方案、PPI有关,与年龄、疗程无关。Objective To explore factors that affect the outcomes of Helicobacter pylori(H.pylori) eradication.Methods A total of 502 patients who were confirmed to be with H.pylori infection by Gastroscope urease and/or 13C-UBT in our hospital between January 2010 and September 2011 were enrolled in this study.The relevant data were collected and analyzed.Results The total eradication rate was 60.76%,in which the eradication rate was 66.67%(164/246)in males and 55.08%(141/256)in females(χ2=7.066,P0.05).Among the 9 therapeutic regimens,PPI+B+C+L achieved the highest eradication rate(80.49%),whereas PPI+B+L+Tin had the lowest one(50.00%)(χ2=7.570,P0.05).About 63.75% of the patients applied the 7-day regimen,and the the eradication rate was 63.44%,which was higher than other regimens.The eradication rates showed no statistical difference among different treatment cycles(χ2=3.294,P>0.05).The esomeprazole group and omeprazole group had significantly different H.pylori eradication rates(χ2=7.839,P=0.005).Conclusion The H.pylori eradication rate is related to gender,treatment scheme,and proton-pump inhibitors,but not to age and treatment cycle

Preparation and Characterization of Folic Acid and PEG Conjugated Chitosan Nanoparticles

目的利用离子交联和化学交联相结合的方法制备壳聚糖纳米粒子(nPS),并对nPS分别进行了叶酸(fA)和聚乙二醇(PEg)的修饰。方法通过红外光谱进行结构验证;用扫描电镜和粒度分析仪对粒子的微观形态、粒径、电位等进行了表征;通过与HElA细胞摄取实验对其靶向作用进行验证。结果离子交联和化学交联相结合的方法制备壳聚糖纳米粒子粒径在200 nM左右并且粒径分布窄,修饰后的nPS(fA-nPS、PEg-nPS及fA+PEg-nPS)粒径不受功能基团修饰的影响。激光共聚焦试验证明fA-nPS及fA+PEg-nPS能显著提高细胞对粒子的摄取,而PEg-nPS则明显降低其对粒子的摄取。结论 fA+PEg-nPS有望成为一种新型的药物载体,用于抗癌药物对癌细胞的主动靶向。OBJECTIVE An ionic gelation combined with chemical crosslinking method was developed to prepare chitosan nanoparticles,followed by conjugation with folate(FA) and polyethylene glycol(PEG).METHODS The structures were verified by infrared spectroscopy.The morphology,diameter and Zeta electric potential of the nanoparticles were assayed by environmental scanning electron microscope and scattering particle analyzer.The specificity of the FA+PEG-NPs targeting cancer cells was demonstrated by human adenocarcinoma Hela cells.RESULTS The chitosan NPs presented a narrow size distribution with an average diameter about 200 nm regardless of the type of functional group.Laser confocal scanning imaging proved that both FA+PEG-NPs and FA-NPs could greatly enhance uptake by Hela cells.However,the PEG-NPs showed contrary results.CONCLUSION FA+PEG-NPs can be applied as a new vehicle to actively deliver anticancer drugs to tumor cells.厦门市科学技术计划资助项目(3502Z20114007

药物不良反应316例报告分析

目的探讨药物不良反应(Adr)的发生因素、一般规律及特征,为临床安全、合理用药提供参考。方法对收集到的316例Adr,按年龄和性别、怀疑药的种类、给药途径、Adr所累及的系统、器官及临床表现等进行分类统计与分析。结果 涉及Adr的药物共150种(含不同剂型和规格),抗菌药物居首位,其次为解热镇痛药物、中药制剂和消化系统用药;以皮肤及其附件损害最为严重,其次为中枢及外周神经系统和消化系统反应;严重Adr 38例,新的严重Adr 3例,新的一般Adr 26例,一般Adr 249例,其中治愈160例、好转149例、有后遗症7例。结论为减少Adr的发生,医务人员在临床药物使用中应重视和加强Adr监测,结合Adr发生特点,注意Adr高发药物的使用,确保用药安全

Clinical pharmacist intervention effects on analgesic treatment of outpatients with terminal cancer

目的探讨临床药师在门诊晚期癌症患者疼痛治疗中的作用。方法采用随机对照法,收集病例为2012年12月至2013年5月,在我院门诊建立麻醉药品取用卡的晚期癌痛患者101例,分为实验组和对照组。实验组实施技术干预,对照组不予技术干预。每位患者随访1个月后,分别评估其疼痛强度、生活质量、用药依从性和回顾监测Adr,并对结果进行比较研究。结果两组患者在疼痛强度、用药依从性方面差异有统计学意义,部分生活质量指标(疼痛、认知、情绪、疲倦、恶心、呕吐、便秘及总体健康状况)和部分不良反应(恶心、呕吐、便秘)差异也有统计学意义;而阿片类药物使用剂量和部分生活质量指标(躯体功能、角色功能、社会功能、气促、失眠、食欲、腹泻、经济困难)差异无统计学意义。结论临床药师对门诊晚期癌症患者疼痛治疗的干预,能提高患者用药合理性、用药安全性和用药依从性,能有效缓解患者癌痛,改善其生活质量。AIM To explore the role of clinical pharmacists in the analgesic treatment of cancer outpatients.METHODS This was a randomized and controlled study.A total of 101 cases of terminal cancer outpatients in our hospital with a card about narcotic drugs from December 2012 to May 2013,were divided into the trial group and the control group.The trial group was given technological intervention treatment while the control group was not.After one-month follow-up,clinical pharmacists respectively evaluated terminal cancer patients' pain relief,quality of life,medication compliance,and monitoring review of adverse drug reactions,and compared the results.RESULTS There was statistic significance between 2 groups in pain relief,medication compliance,some quality of life indexes( pain,cognition,emotion,fatigue,nausea,vomiting,constipation and overall health status) and some indexes of adverse drug reactions( nausea,vomiting and constipation)( P < 0.05),whereas there was no significant difference in using doses about opioid drugs as well as some quality of life indexes( somatic function,role function,social function,polypnea,insomnia,appetite,diarrhea and economic difficulties).CONCLUSION Through the intervention treatment of outpatients with terminal cancer pain,clinical pharmacists could not only significantly improve patients' medication safety,medication compliance and the quality of life but also effectively alleviate the cancer patients' pain,and quality of life