目的:建立HPLC法同时测定参甘冠心合剂中丹参素钠、原儿茶醛、甘草苷、丹酚酸B和甘草酸铵含量的分析方法.方法:色谱柱为CAPCELL PAK C18(4.6 mm×250 mm,5μm),以乙腈-0.1％甲酸水溶液为流动相梯度洗脱;流速为1.0 mL/min,检测波长为270 nm.结果:丹参素钠、原儿茶醛、甘草苷、丹酚酸B和甘草酸铵质量浓度分别在8.880 ～44.40 μg/mL(r1 =0.9999)、0.7056 ～3.528 μg/mL(r2=0.9993)、17.04～85.20 μg/mL(r3=0.9999)、4.816 ～24.08 μg/mL(r4=0.9995)和7.856 ～39.28 μg/mL(r5 =0.9994)范围内与峰面积积分值呈良好的线性关系;平均回收率分别为100.59％、100.72％、99.42％、100.06％和101.56％,RSD分别为1.4％、2.2％、1.6％、0.77％和1.2％.结论:所建立的分析方法准确、专属性强、重复性好,可用于参甘冠心合剂的质量控制.

OBJECTIVE: To analyze the status quo of clinical application of traditional Chinese medicine injections and discuss the rational use of Traditional Chinese medicine injections so as to provide references for clinical rational use of Traditional Chinese medicine injections. METHODS: The utilization of Traditional Chinese medicine injections in our hospital from 2009 to 2011 was analyzed statistically with regard to consumption sum,DDDs and defined daily cost( DDC). RESULTS: From 2009 to 2011,the Traditional Chinese medicine injections for removing blood stasis and the anti-tumor Traditional Chinese medicine injections have been ranked among the top in both consumption sum and DDDs,which was in line with the characteristics of high incidence of cardiovascular disease in elderly patients and high proportion of breast cancer encountered in Special Department for Mammary Gland in our hospital. CONCLUSION: The clinical application of Traditional Chinese medicine injections in our hospital was rational on the whole,however,some drugs showed poor synchronization between consumption sum and DDDs. Great importance should be attached to the administration dosage of Traditional Chinese medicine injections so as to achieve rational use of Traditional Chinese medicine injections.

目的 ＂99Tc-MDP＂结合＂骨康灵＂联合治疗骨质疏松模型的分析。方法制作兔骨质疏松动物模型并进行实验分析。购置实验兔49只,分为7组：A组（正常对照组）、B组（骨质疏松对照组）、C组（＂99 Tc-MDP＂治疗组）、D组（＂阿仑膦酸钠＂治疗组）、E组（＂骨康灵＂治疗组）、F组（＂99 Tc-MDP＂联合＂骨康灵＂治疗组）、G组（＂阿仑膦酸钠＂联合＂骨康灵＂治疗组）。采用肌肉注射＂地塞米松磷酸钠注射液＂（DX）制作兔骨质疏松模型,2次/每周,连续6周,以后骨质疏松模型继续维持＂DX＂肌肉注射,但剂量改为一次/周,直至试验结束。分别在骨质疏松的基础上进行治疗,疗程为16周。疗效评判指标：病理细胞学、骨形态计量分析、骨密度检测、生物力学试验、X线摄片、CT摄片、核素骨骼显像ROI的比值、血清BALP、BGP检测。各治疗组试验数据统计结果与B组相比较,依次评判疗效为显效、有效和无效。统计方法：SPSS13.0软件分析数据,所得数据采用x珋±s表示,采用方差分析和组间比较t检验。结果治疗16周后的下一周对各组受试动物进行相关指标检测,结果显示：A组与B组的骨形态计量（121.595±33.445和65.280±21.907）、骨密度（股骨头、L4分别为0.309±0.015、0.298±0.017和0.238±0.011、0.233±0.015）、骨生物力学（股骨头、L4分别为404.433±43.655、698.380±77.520和269.437±40.595、349.350±57.288）、核素骨骼显像（4.126±0.643和6.734±0.458）、BALP（9.000±2.828和42.833±12.714）、BGP（0.105±0.0147和0.176±0.0263）,检测结果差异明显（P值均〈0.01）,病理细胞学显示B组实验兔骨小梁排列稀疏,存在较明显的骨小梁断裂现象,而A组骨小梁排列规则、正常。但X线摄片和CT摄片比较差异不显著。证明本次实验制作兔骨质疏松动物模型成立。各治疗组与B组比较也存在不同程度的差异,方差分析示：形态计

Objective To compare the cost-efficacy of domestic and import toremifene in the treatment of breast cancer. Methods Eighty patients with breast cancer were randomly divided into two groups,30 subjects in import toremifene group and 50 subjects in domestic toremifene group.Both groups were given 60 mg once a day for 12 months.The cost- efficacy was evaluated retrospectively.Results There was no significant difference in clinical effective rate and incidences of adverse event between two groups.The total costs of two groups were 3 238.08 and 4 512.00 yuan respectively,which showed statistical difference between two groups(P0.01).Conclusion From cost-efficacy analysis,domestic toremifene is safe,effective and more economic in the treatment of breast cancer.

Objective To investigate the value of 99Tc-MDP combined with GUKANGLING for the treatment of osteoporosis model.Methods Rabbit osteoporosis model was established and analyzed.Forty-nine rabbits were bought and divided into 7 groups,including Group A(normal control),Group B(osteoporosis control),Group C(99Tc-MDP treatment group),Group D(lendronate sodium treatment group),Group E(GUKANGLING treatment group),Group F(99Tc-MDP combined with GUKANGLING treatment),and Group G(alendronate sodium combined with GUKANGLING treatment).Rabbit osteoporosis model was made by intramuscular injection of dexamethasone sodium phosphate,twice a week for 6 weeks continuously.Dexamethasone was then injected once a week until the experiment ended.The treatment was conducted for 16 weeks.Pathocytology,BMD,biomechanics,bone morphology,X-ray,CT,radionuclide bone scintigraphy,and serum BALP and BGP were used to compare the treatment results.SPSS 13.0 was used to analyze the data.A variance analysis and t-test were chosen as the statistics method.Results Relative indexes were examined on the next week after the 16-week treatment.Results showed that bone morphology(121.595±33.445 and 65.280±21.907),BMD(femoral head,L4 0.309±0.015,0.298±0.017 and 0.238±0.011,0.233±0.015),bone biomechanics(femoral head,L4 404.433±43.655,698.380±77.520 and 269.437±40.595,349.350±57.288),radionuclide bone scintighraphy(4.126±0.643 and 6.734±0.458),and serum BALP(9.000±2.828 and 42.833±12.714),BGP(0.105±0.015 and 0.176±0.026) were significantly different between Group A and Group B(P<0.01).The pathocytology of Group B showed diffused trabecula lining and more apparent trabecular broken.But in Group A,the trabecular was formulated in a normal state.This result proved the success in the osteoporosis animal model establishing.The treatment groups showed difference compared to Group B.The variance analysis showed bone morphology F=12.371,BMD F=8.832 in the femoral head and F=7.174 in L4,bone biomechanics F=10.548 in the femoral head and F=22.737 in L4,radionuclide bone scintighraphy F=24.830,BALP F=37.356,and BGP F=12.031,with statistical differences(P<0.01).Group F improved most apparently,and then Group C,G,and D,according to efficacy data.Group E did not showed apparent improvement in BMD and biomechanics,but a little improvement showed in bone morphology,radionuclide bone scintigraphy,and serum BALP and BGP.Conclusion The combining treatment of 99Tc-MDP and GUKANGLING show a better result.Combing with Chinese traditional medicine,99Tc-MDP may have activity of protecting SOD,suppressing the differentiation of mononuclear osteoclast precursor,decreasing the calcium lose.It may relate to the effect of benefiting qi for activating blood circulation and reinforcing liver and kidney to strengthen bones of KUKANGLING.A combining treatment of Chinese medicine and western medicine may enhance the clinical effect.

OBJECTIVE:To evaluate the pharmacoeconomic value of tamoxifen versus toremifene as endocrine therapy for breast cancer.METHODS: 130 patients with breast cancer were assigned to receive either tamoxifen(group TAM,n=80 cases) or toremifene(group TOR,n=50 cases).The curative efficacy and safety of two therapies were recorded and evaluated using cost-effectiveness analysis in pharmacoeconomics.RESULTS: In TAM group versus TOR group,the drug cost stood at 90.30 yuan vs.809.52 yuan,with effective rate of 88.75% vs.94%.CONCLUSION: TAM is superior to TOR in terms of pharmacoeconomics.

Objective To study the bone biomechanics of the rabbit osteoporosis models induced by dexamethasone sodium phosphate injection (DX) using a combined treatment modality of 99Tc-MDP and GuKangLing.Methods Rabbits were intramuscularly injected with DX (2 mg/kg) twice a week for 6 weeks.The animal osteoporosis model group (Group C) and normal group (Group A) were compared to confirm the model was available.Another control group (Group B),the osteoporosis control group (Group D) were set for the comparison at the end of the experiment.The 99Tc-MDP therapy group (Group E),GuKangLing therapy group (Group F) and 99Tc-MDP plus GuKangLing therapy group (Group G) were included in the study.The treatment lasted for 16 weeks.The bone biomechanics,cytopathology bone histomorphology,bone mineral density (BMD),X-ray,CT,bone scintigraphy and serum bone alkaline phosphatase (BALP)and P (bone gla protein) were chosen as the markers or methods to evaluate the treatment results (excellent,effective and invalid).The analysis of variance (ANOVA) and t-test were used for group comparison analysis.Results Cytopathology result indicated that there was no bone trabecula destruction in Group A.However,there was distinct bone destruction in Group C.The bone biomechanics (left femur head (265.914 ±52.773) N,L4(369.671 ±94.919) N),BMD(left femur (0.238 ±0.016) g/cm2,L4(0.236 ±0.016) g/cm2)and bone histomorphology ( (66.230 ± 10.848) ％ ) in Group C reduced clearly as compared with Group A ((405.343±55.410) N,(750.870±53.718) N,(0.294±0.017) g/cm2,(0.302±0.023) g/cm2,( 131.500 ± 21.846) ％ ) ( t ≥4.550,all P ＜ 0.01 ).Radionuclide bone scan also showed that the uptake of tracers was higher by the main arthrosis in Group C than that in Group A.Vertebra was not clearly visualized on bone scan image.There were significant differences between Group A and Group C in serum BALP and P ((45.000±7.303) vs (12.485 ±1.512) U/L,(0.168±0.018) vs (0.115 ±0.017) μg/L,t =4.126,5.476,both P ＜ 0.01 ),which indicated that the animal osteoporosis model was available.The pathological results showed an improved recovery of bone structure and trabecular in Groups E and G,but a worse recovery in Group F.Biomechanics result in Groups E and G (left femur head (386.457 ±77.077) N and (432.771 ± 17.525) N,L4(649.550 ± 126.859) N and (655.443 ±76.555) N) improved apparently,which were similar to Group B.The radiotracer uptake in Group F was lower than that in group D.The bone biomechanics,bone histomorphology,BMD,serum BALP and P after the treatment showed significant differences in Groups E,F and G (F:8.556 - 31.608,all P＜0.01 ),and the bone biomechanics result in Group G was a little better than that in Group E (t =2.625,P ＜ 0.05 ).The results of Group G and E were considered as excellent,and Group F was considered as effective.Conclusions The treatment of 99Tc-MDP combined with GuKangLing could improve the bone biomechanics of rabbit osteoporosis models and may be a potential method to increase the bone strength for resisting external force.

为了贯彻执行<处方管理办法>,规范医疗服务行为,保障用药安全,减少不合理用药,维护病人利益,自2007年5月新<处方管理办法>颁布以来,上海市黄浦区中心医院将处方质量控制作为抓质量管理的重要手段之一,将原来各部门各自抽查处方方式改为由医教部(门诊办公室)、药剂科、临床各科医疗干事共同参与,每月进行1次处方抽查和点评.通过定期进行处方抽查、分析与评价,并将结果及时反馈与行政干预,进一步提高了全院合理用药水平.现将2008年本院处方抽查情况及存在问题做一统计和分析.

AIM: To establish quality standard for Compound Shengui Capsules. METHODS: Glycyrrhiza uralensis Fisch.、Panax notoginseng(Burk.) F.H.Chen、Salvia miltiorrhiza Bge.and Ligusticum chuanxiong Hort.were identified by TLC.Ammonium glycyrrhizinate and tanshinoneⅡ_A were determined by HPLC.(RESULTS): (TLC) spots developed were fairly clear and the blank test showed no interference.The linear rangers were 0.5-4μg(r=0.999 8)for ammonium glycyrrhizinate;0.04-0.32μg(r=0.999 6) for tanshinoneⅡ_A.The average recoveries of them were 98.9%,97.8%,respectively. CONCLUSION: The methods is effective for the quality control of Compound Shengui Capsules.

格列齐特缓释片作为一种新剂型的口服磺脲类降糖药,与格列美脲、格列本脲及格列齐特普通片等磺脲类药物相比,具有疗效好、安全性高、耐受性和依从性好等优点,并且有保护心血管及防治糖尿病并发症的作用,可作为强化治疗糖尿病代谢紊乱和血管并发症的一线药物。

近年来,随着药物种类、剂型的不断增加,药物引起的不良反应和药源性疾病也逐年增加,这已引起临床工作者的关注.为了提高医疗质量,减少药源性疾病,指导和促进临床合理用药,作者对2003-2005年收集的上海市黄浦区中心医院不良反应报告386例进行分析,其中由中药引起的不良反应共计87例,占22.54%.本研究对这87例中药不良反应进行回顾性分析,探讨其发生的原因、药品种类及损害类型等,为临床合理用药提供参考.