危重症伴胃潴留患者肠内营养支持的药学监护

目的探讨临床药师在危重症患者营养支持中的作用。方法临床药师参与1例在实施肠内营养支持过程中出现胃潴留的危重症患者的治疗,建议医师根据病情变化及时调整营养支持方案。结果临床药师为患者提供个体化药学服务,提高了临床治疗效果,改善胃潴留的情况。结论临床药师在为患者提供个体化营养支持方面具有自身的优势,能在临床治疗中发挥重要作用。中华医学会课题(2016B-YX025);;重庆市高等教育教学改革研究项目(163198);;院所教育科学研究项目(50212-2434、2636

多西环素联用阿托伐他汀钙致严重肝功能异常1例

1病例资料患者，男，73岁，因突发言语含糊、右侧肢体乏力4h，于2016年2月713就诊于我院神经内科。患者既往有冠心病史数年，未治疗。否认肝炎、结核、疟疾等传染病史，否认肾炎、高血压、糖尿病等病史，否认手术史、外伤史、输血史，否认药物、食物过敏史

Analysis of Clinical Pharmacists Participating in the Warfarin Anticoagulation Treatment for 1 Double Valve Replacement Patient with Thrombocytopenia

目的探讨双瓣置换术后并发血小板减少的患者的抗凝治疗策略,为临床药师参与抗凝治疗提供参考。方法临床药师回顾性分析1例双瓣置换术后患者血小板减少的原因,结合药代动力学知识和相关文献资料,确定华法林初始剂量和目标国际标准化比值(INR),优化抗凝方案。结果患者血小板计数逐渐恢复正常;华法林抗凝治疗以5 mg为初始剂量,目标INR为1.8~2.5。经过五次剂量调整后以3.125 mg的维持剂量带药出院,出院时INR为1.5。结论临床药师参与可为患者提供更加安全、有效的治疗方案。Objective To explore the anticoagulation strategies for 1 double value replacement patient with thrombocytopenia, and to nsummarize the experience of clinical pharmacists participating in the anticoagulant therapy. Methods The clinical pharmacist retrospec-tively analyzed 1 patient with thrombocytopenia after double valve replacement. According to pharmacokinetic knowledge and related lit-eratures, the initial dose of warfarin and the target international normalize( INR) were determined and the anticoagulation regimen was optimized. Results The platelet counts gradually returned to normal; the warfarin anticoagulation was started with an initial dose of 5 mg,the target INR was 1. 8- 2. 5. After adjusting the dosage five times, the patient discharged with a maintenance dose of 3. 125 mg and an INR of 1. 5. Conclusion The participation of clinical pharmacists can provide more safe and effective treatment regimen for patients

Utilization of Immune-Enhancing Drugs in the Hospital from 2011 to 2013

目的分析医院免疫增强药物的使用情况,为合理用药提供依据。方法应用金额排序法和用药频度(DDDs)分析法,统计分析医院2011年至2013年临床使用的免疫增强药物。结果 2011年至2013年免疫增强药物的销售金额和限定日剂量逐年上升。核糖核酸Ⅱ的销售金额始终居首位,乌苯美司排在最后,脾氨肽的销售金额增长幅度最大,甘露聚糖肽则出现了下滑;DDDs稳居首位的是胸腺五肽,静注人免疫球蛋白排在最后;各药限定日费用均有所变化,胸腺五肽逐年下降,胸腺肽α1逐年上升,其余各药变化较小,总体稳定;药品销售金额排序/DDDs排序(B/A)最高的为胸腺五肽,最低的为核糖核酸Ⅱ,2012年至2013年甘露聚糖肽与胸腺肽α1均为1.00。结论医院免疫增强药物的使用基本合理,但用量逐年增加,存在不合理用药情况,需进一步加强管理。Objective To analyze the utilization of immune- enhancing drugs in the hospital and provide evidence for the rational use of these drugs. Methods The amount of sorting method and DDDs method were used to statistically analyze the clinical use of immune-enhancing drugs in our hospital from 2011 to 2013. Results The amount of sales and DDDs of immune- enhancing drugs in the hospital had increased year by year. For the latest 3 years,the sales amount of RNA Ⅱ was always in the first place,ubenimex came in last, the sales amount of spleen aminopeptidaset increased mostly, while mannatides were running down; Thymopentin ranked first in DDDs, and intravenous human immunoglobulin came in last; all drugs had changes with DDC, among which thymopentin had declined year by year,while thymosin α1 had increased year by year,small changes were found in the other drugs,and with overall stability; thymopentin had the highest B / A value,and RNA Ⅱ had the lowest B / A value,mannatide and thymosin α1 had a B / A value closer to 1. 00. Conclusion The utilization of immune- enhancing drug in the hospital is reasonable,but the amount is increasing every year,accompanied by irrational drug use,which needs a better management

Analysis of antibacterial use density in the inpatients in 2011

目的:分析某医院2011年住院患者抗菌药物的使用强度,为合理使用抗菌药物提供参考。方法:回顾性收集该医院2011年抗菌药物相关使用数据,采用EXCEl 2003软件对各项数据进行汇总、排序;以限定日剂量(ddd)为单位,计算抗菌药物的使用频度(dddS)和使用强度(Aud)并进行统计、分析。结果:某医院2011年住院患者抗菌药物使用强度为66.08dddS/100人天。头孢菌素类、β-内酰胺酶抑制剂及其复合制剂和喹诺酮类的Aud值依次排前三名,绝大多数都是注射剂;头孢地嗪钠的Aud在所有品种中位居第一。结论:某医院2011年抗菌药物的总Aud低于全国平均水平,但也存在个别抗菌药物选用频度过高、滥用广谱抗菌药等不合理现象。应严格限制三代头孢菌素、β-内酰胺酶抑制剂及其复合制剂的临床应用,加强抗菌药物应用的监督管理及知识培训,加强临床药师的监督用药作用,预防和纠正不合理用药现象。Objective: To analyze the application of antibacterials in inpatients of a hospital in 2011,in order to provide references for rational use of antibacterials.Methods: The data about use of antibacterials in 2011 were retrospectively collected and sorted by Excel 2003.With defined daily dose(DDD) as the unit,DDDs and antibacterial use density(AUD) were analyzed statistically.Results: The mean value of AUD was 66.08 DDDs/100 persons/day.Cephalosporins,beta-lactamase inhibitors and quinolones ranked in the first three places in terms of AUD,and the majority of antibacterials were injections.The AUD of cefodizime sodium ranked the first in antibacterials.Conclusion: On the whole,AUD of the hospital was lower than national average level in 2011.But there were still irrational drug use,such as frequent use of some antibacterials,abuse of broad-spectrum antimicrobial agents.Third-generation cephalosporins,beta-lactamase inhibitors and combinations should be strictly restricted in clinical application.It is necessary to strengthen management and education of use of antibacterials and the supervision function of clinical pharmacists for controlling irrational medication

Participation of Clinical Pharmacists in Identification of Infectious Bacteria and Colonization Bacteria and Treatment of One Patient with Pulmonary Infection after Craniocerebral Operation

目的:小结临床药师参与临床颅脑术后患者肺部感染的治疗。方法:临床药师协助医师鉴别1例颅脑术后肺部感染患者的感染菌与定植菌,并确立抗感染方案。结果:临床药师综合感染危险因素、临床与实验室表现、用药史等多方面因素进行分析,所选抗菌药物有效覆盖感染菌,及时控制感染。结论:临床药师利用自身专业知识,协助医师解读细菌培养及药敏报告,促进患者用药更安全、及时、有效。Objective: To summarize the participation of clinical pharmacists in the treatment of patients after craniocerebral operation with pulmonary infection.Methods: Clinical pharmacists assisted physicians in identifying infectious bacteria and colonization bacteria of one patient with pulmonary infection after craniocerebral operation and establishing the anti-infection treatment regimen.Results: Clinical pharmacists analyzed various factors such as infection risk factors,clinical and laboratory manifestation and medication history,and effectively selected antibacterial drugs covering the infectious bacteria to timely control the infection.Conclusion: With pharmaceutical knowledge,clinical pharmacists can assist physicians in the interpretation of bacterial culture and drug susceptibility reports to promote safer,more timely and effective medication for patients

医院322例药品不良反应报告分析

目的分析药品不良反应发生的基本情况,为临床安全、合理用药提供参考。方法回顾性分析某医院2011年1月至12月收集的322例Adr报告,并进行统计分析。结果322例Adr报告中,严重Adr为133例,占41.30%。中老年患者比例最大(57.14%),给药途径引发的以静脉给药为主(77.01%)。抗菌药物引起的Adr居首位(34.78%),其中喹诺酮类Adr发生率最高,其次为头孢菌素类。结论在Adr监测中应加强对抗菌药物、中药注射剂的监测,并关注抗肿瘤药物的严重Adr,针对性地实施Adr防治措施,降低用药风险

Correlation of ATP Binding Cassette Transporter A1 Gene Polymorphisms and Lower Extremity Atherosclerotic Disease

目的：进行三磷酸腺苷结合盒转运体A1（ATP binding cassette transporter A1,ABCA1）基因单核苷酸多态性（single nucleotide polymorphisms,SNP）与下肢动脉粥样硬化（lower extremity atherosclerotic disease,LEAD）的关联分析。方法：收集福建省闽南地区630例体检者（314例LEAD者和316例正常者）的临床资料及外周血;采用Sequenom Mass Array系统对该人群的ABCA1基因9个SNP位点进行检测。结果：9个SNP位点中,rs2980083位点不符合Hardy-Weinberg平衡,分析中舍去;rs2066714与rs2066715,rs1800976与rs2246293,rs2246293与rs2980083,rs1800976与rs2980083等4组位点之间存在明显的连锁不平衡（D＇〉0.9,r2〉1/3）,对其构建的6种单倍型在两组的分布差异无统计学意义（P〉0.05）;该8个SNP位点的基因型统计在病例对照分析中的分布频率未见显著差异（P〉0.05）,基因logistic回归分析未显示有患病风险。结论：闽南汉族人群ABCA1基因rs10124755、rs2980083、rs1800976、rs4149341、rs2066714、rs2066715、rs2066716、rs2230808、rs2246293多态性可能与LEAD的遗传易感性无关。Objective： To analyze the correlation of single nucleotide polymorphisms （SNP） of ATP binding cassette transporter A1 gene （ABCA1） and lower extremity atherosclerotic disease （LEAD）. Methods： The clinical data and peripheral blood were col- lected from 630 participants （314 LEAD cases and 316 normal controls） in Han population of Minnan. The 9 SNP genotypes in the ABCA1 gene were detected by Sequenom MassArray. Results： Among the 9 SNP genotypes, rs2980083 was rejected because it wash＇ t in accordance with Hardy-Weinberg equilibrium. Obvious linkage disequilibrium was found between rs2066714 and rs2066715, rs1800976 and rs2246293, rs2246293 and rs2980083, and rs1800976 and rs2980083 （D＇ 〉 0.9 ,r2 〉 1/3）. There were no significant differenees （ P 〉 0.05 ） in 6 haplotypes of ABCA1 gene groups between the LEAD eases and the normal controls. No significant differ- ences （ P 〉 0.05 ） were found in frequency distribution between the LEAD cases and the normal controls in 8 SNP according to the re- sults of genotype statistics. There was no onset risk of LEAD according to the gene logistie regression analysis. Conelusion： The SNPs of rs10124755, rs2980083, rs1800976, rs4149341, rs2066714, rs2066715, rs2066716, rs2230808 and rs2246293 might not eorrelate with the susceptibility of LEAD in Han population of Minnan.2013年度南京军区医学科技创新课题（编号：MS098

Pharmaceutical Consultation Practice for One Case of Rapidly by Growing Mycobacteria Bloodstream Infections

目的：探讨快速生长分枝杆菌血流感染的诊治方法。方法：通过1例骨折术后快速生长分枝杆菌血流感染的两次会诊实践,对治疗过程中不同阶段需要考虑的药物治疗问题进行总结分析。结果：第一次会诊,根据患者的血药浓度和肌酐清除率,优化了万古霉素给药剂量。第二次会诊,在患者症状和检验结果明显好转情况下,建议医生积极针对快速生长分枝杆菌进行抗感染治疗。建议停用抗结核药,改为克拉霉素联用阿米卡星后,患者病情好转出院。结论：对手术部位疑似、确诊快速生长分枝杆菌感染的病例,积极的干预和正确的诊治是成功的关键。Objective： To investigate the diagnosis and treatment of rapidly growing mycobacteria bloodstream infections. Meth- ods： Based on the two pharmaceutical consultation practice for one case of rapidly growing mycobacteria bloodstream infections after fracture operation, the paper summarized and analyzed the problems in different stages of treatment. Results ： The first consultation op- timized the dosage of vancomycin according to the patient- serum concentration and creatinine clearance rate. The second consultation suggested doctors actively perform anti-infection treatment for rapidly growing mycobacteria after the patient＇ s clinical symptoms and ex- amination results were improved significantly. It is recommended to withdraw anti TB drugs, and the use of clarithromycin combined with amikacin was suitable. The patient was discharged with improved health conditions. Conclusion： Positive intervention and correct diagnosis are the keys for the successful treatment of suspected or definite mycobacteria infection in surgical sites.解放军第一七五医院2016年青年苗圃课题（编号：16Y023

Function of Apoptosis and Autophagy in Cardiovascular Diseases

细胞凋亡与自噬是普遍存在于各种细胞内的生命现象,广泛参与了机体的生理、病理过程,且二者有着多因子、多通路的相互影响,这种错综复杂的关系贯穿于各种心血管疾病的始终,对多种心血管疾病的发生发展转归起重要作用。现对细胞凋亡与自噬及其相互关系进行梳理,并综述其在心血管疾病中的作用。Apoptosis and autophagy are common life phenomenon in various cells, which widely involve in physiological and pathological processes, and interact with one another by many factors and multiple pathways. This intricate relationship runs through a variety of cardiovascular diseases, and plays an important role in the occurrence, development and prognosis of many cardiovascular diseases. The effects of apoptosis and autophagy and their interrelationship in cardiovascular diseases were reviewed and summarized in this paper.2013年度南京军区医学科技创新课题（编号：MS098