2022年2月底以来,上海发生的新型冠状病毒肺炎疫情点多面广、频发持续,"静态管理"下医疗资源挤兑严重,针对感染人群的慢性疾病服务相对缺位.方舱医院一定程度上满足了特殊时期慢病患者就医需求,监测慢病患者疾病变化、防止慢病急性发作或急危重症发生.该文结合实践经验,对新型冠状病毒肺炎疫情期间方舱医院高血压病、糖尿病患者的慢病管理要点进行探讨,为我国在应对突发公共卫生事件期间方舱医院的运行、管理提供参考.

病例1,男,25岁,因"口腔脓肿7个月、体检发现双肺多发结节3个月"于2020年9月2日收入我院.患者7个月前自行用工具拔除龋齿,未成功,后该龋齿旁牙龈形成一包块,伴红肿、疼痛,患者自行用工具挑破,后该处反复红肿,但未至医院处理.3个月前至我院口腔科检查,行新型冠状病毒筛查过程中,2020年5月15日胸部CT检查提示:双肺多发小结节,部分空洞形成(图1A).患者无咳嗽、咳痰、发热等不适,未予处理.于1周前再次来我院口腔科复诊,2020年8月22日复查胸部CT提示:双肺多发小结节,部分空洞形成,较前部分病灶缩小,部分病灶增大,部分病灶新增空洞(图1B).患者仍无发热、咳嗽,咳痰,胸闷、胸痛等症状,门诊以"双肺多发结节待查"收入我科.起病以来,患者精神、食欲可,大小便正常,体力、体重无明显变化.既往史、家族史无特殊.体格检查:右侧磨牙内侧上颚可见一红肿包块,大小约2 cm × 2 cm;颈部淋巴结无肿大;双肺呼吸音清,未闻及明显干湿啰音;心脏及腹部体格检查未及异常;四肢关节无畸形、红肿,双下肢无红肿.实验室检查:血常规、尿常规、红细胞沉降率、血管紧张素转化酶、肺癌标志物均正常,血结核杆菌感染T细胞斑点试验( T-SPOT)结果阴性.抗中性粒细胞胞浆抗体(ANCA)、(1,3)-β-D葡聚糖试验( G试验)、半乳甘露聚糖试验( GM试验)、HIV抗体、血培养结果均为阴性.心脏超声检查未见明显异常.支气管镜检查示:双侧支气管可见范围(段及亚段)未见明显异常.支气管肺泡灌洗液结核GeneXpert、细菌培养、GM试验结果均为阴性.支气管肺泡灌洗液送检宏基因组新一代测序( mNGS)结果示:惠普尔养障体(TW).初步诊断为惠普尔病患者(WD).予磺胺甲噁唑治疗后,分别于2020 年10 月12 日(图1C)和2020 年11月11日(图1D)复查胸部CT显示病灶明显好转.

Team of Department of Pediatric Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology successfully performed the first case of robotic thoracoscopic surgery on type Ⅲ esophageal atresia in August 2020, the key procedures and postoperative effect were reported as follows.

Objective:To explore the safety, efficacy and cosmetic outcomes of transumbilical enterostomy (TUE) and two-stage laparoscopic-assisted pull-through for Hirschsprung's disease (HSCR).Methods:From February 2014 to February 2019, 58 HSCR children (41 boys, 17 girls) undergoing enterostomy were reviewed, including rectosigmoid HSCR of severe enterocolitis or dilated colon (n=13), long-segment HSCR (n=27) and with total colonic aganglionosis (TCA, n=18). Enterostomy was performed at a mean age of (5.7±2.4) months. TUE (n=27) and conventional abdominal enterostomy (CAE, n=31) were performed. Short segment HSCR underwent laparoscopic Soave procedure while long segment HSCR or TCA laparoscopic Duhamel procedure. Demographics, complications and cosmetic outcomes were evaluated.Results:No significant inter-group differences existed in operation time of TUE, blood loss, length of stay or hospital costs ( P>0.05). Two cases in TUE group and 2 in CAE group developed stomal mucosal prolapse (7.41% vs. 6.45%, P>0.05). There was wound infection at stoma in 1 case in TUE group and 2 cases in CAE group (3.70% vs. 6.45%, P>0.05). Dermatitis around stoma occurred in 4 patients in TUE group and 8 in CAE group (14.81% vs. 25.81%, P>0.05). There was one case of obstruction in CAE group and none in TUE group. Enterocolitis occurred in 3 and 4 children in TUE and CAE groups respectively (11.11% vs. 12.90%, P>0.05) and both responded well to conservative measures. Operative duration for two-stage laparoscopic procedure was significantly shorter in TUE group than that in CAE group (143.0±27.1 vs. 158.9±29.4 min, P<0.05). The cosmetic outcomes using scar score was significantly better in TUE group than that in CAE group (6.51±0.86 vs. 14.12±1.29, P<0.05). Conclusions:Transumbilical enterostomy is both safe and effective for HSCR. And staged laparoscopy-assisted pull-through achieves cosmetic outcomes similar to primary laparoscopic pull-through.

患者,女,47岁.因"双下肢乏力2年余,发现肺部阴影2周余"于2020年6月5日入院.患者2余年前无明显诱因出现双下肢乏力,长时间行走后双下肢乏力加重,无感觉麻木,无肌肉及关节疼痛,无发热,无言语含糊、吞咽困难、饮水呛咳,未予处理.患者2周前于当地医院体检,胸部CT检查结果示右肺中叶感染.患者无咳嗽、咳痰、发热、胸闷、胸痛等不适,于当地医院门诊行抗感染治疗1周(头孢哌酮钠舒巴坦钠+左氧氟沙星)后复查胸部CT示右中叶节段性不张,左肺下叶结节.遂于9天前至当地医院住院,查肌酸激酶(CK) 248 U/L(≤170 U/L,括号内为正常参考值范围,以下相同),红细胞沉降率3 mm/h (0～20 mm/h),超敏C反应蛋白(hs-CRP)2.5 mg/L(＜1.0 mg/L),降钙素原(PCT) ＜0.04 ng/ml(0.02～ 0.05 ng/ml).

本文报道2020年9月采用da Vinci Si机器人手术系统治疗出生52天囊肿型胆道闭锁1例,普通腹腔镜并稍扩大脐部切口牵出肠管,完成离断空肠和侧侧吻合,对接机器人完成Kasai手术.总手术时间210 min,无术中并发症发生,术后第2天排墨绿色胆汁样便,术后12天出院.口服利胆、抗炎及护肝药物治疗,随访6个月,黄疸指标逐渐下降至正常水平,未发生胆管炎.

Objective:To compare effects of different foods in correcting nocturnal hypoglycemia in elderly patients with diabetes.Methods:A total of 115 elderly patients with diabetes mellitus who had nocturnal hypoglycemia during hospitalization in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to October 2019 were selected as research objects. According to the treatment method adopted when hypoglycemia occurred, they were divided into 27 cases in the biscuit group, 30 cases in the sugared beverage group, 32 cases in the candy bar group and 26 cases in the glucose group. They respectively ate 4 pieces of Taiping soda biscuits or Jiashili breakfast cakes, about 138 g of fresh orange or 150 ml of 100% orange juice of Nongfu Orchard, 2 pieces of Dove milk chocolate and 30 ml of oral 50% glucose solution. Fingertip blood glucose test was used to detect the immediate blood glucose level when hypoglycemia occurred, the blood glucose level of 15 min after correction and the fasting blood glucose level in the next morning in the 4 groups. After the fasting blood glucose test was completed the next morning, the patients' satisfaction with food choices was investigated using a low-glycemic food satisfaction questionnaire.Results:The time of hypoglycemia correction was shorter in the glucose group, the candy bar group and the sugared beverage group than in the biscuit group. The glycemic values of the glucose group and the candy bar group at 15 min after correction were higher than those of the biscuit group and the sugared beverage group.The differences were statistically significant ( P<0.05) . The differences of taste, satiety, convenience of carrying, effect of correcting hypoglycemia, influence on blood glucose in the next morning, convenience of purchasing and need to eat other food score were statistically significant ( P<0.05) . The scores of satiety, influence on blood glucose in the next morning in the biscuit group were higher than those in the other 3 groups, and the scores of effect of correcting hypoglycemia and needing to eat other foods were lower than those in the other 3 groups, and the differences statistically significant ( P< 0.05) . The taste score of sugared beverage group was higher than that of the other 3 groups, and the difference was statistically significant ( P < 0.05) . The convenience of carrying score of the biscuit group and the candy bar group was higher than the other two groups, and the difference was statistically significant ( P<0.05) . The convenience of purchasing score of the glucose group was lower than the other 3 groups, and the difference was statistically significant ( P<0.05) . Conclusions:Biscuits, sugared beverages, candy bars and glucose solutions can all correct nocturnal hypoglycemia and have no effect on blood sugar in the next morning. However, sugared beverages, candy bars and glucose solutions have a better effect on raising blood sugar, while biscuits are more satisfying for patients in terms of satiety, portability and the effect on blood sugar in the next morning. Therefore, patients can choose emergency food in case of hypoglycemia according to personal preference.

本文报道2020年5月采用da Vinci Si机器人手术系统治疗出生15天Ⅰ型食管闭锁1例,采用非对称布局trocar,序贯扩张法置入trocar,镜头臂12 mm位于右侧腋中线第5肋间,2个机械臂8 mm trocar位于右侧腋中线第3肋间和腋后线第7肋间,距离镜头trocar分别为3 cm和5 cm,腋前线第6肋间放置3 mm trocar和辅助器械.总手术时间120 min,无并发症发生,术后2周碘水造影提示吻合口通畅,无吻合口漏及吻合口狭窄,术后15天出院.随访1个月,经口喂养80～100 ml/次,无呕吐及呛咳.

目的 比较不同临床分型的新型冠状病毒肺炎患者实验室检查结果与病情严重程度的相关性.方法 以2020年2月1日至2020年2月21日在华中科技大学同济医学院附属同济医院发热病房住院的50例确诊新型冠状病毒肺炎患者为研究对象,根据国家卫生健康委员会的诊断标准,该50例患者被分为危重型(8例)、重型(32例)、普通型(10例),比较不同型别患者的血常规、血生化、凝血常规结果和炎症因子的表达水平,分析上述指标的变化规律及其与临床分型的关系.结果 危重型患者白细胞和中性粒细胞计数明显高于重型和普通型患者(P<0.05);危重型和重型患者淋巴细胞计数下降较普通型患者更明显(P<0.05);危重型患者较重型和普通型患者乳酸脱氢酶水平升高,肾功能损害、凝血功能异常更明显(均P<0.05);危重型患者的降钙素原、超敏C反应蛋白、IL-6和TNF-α水平升高较重型和普通型患者更明显(均P<0.05);超敏C反应蛋白水平在重型和普通型患者之间的差异也具有统计学意义(P<0.05).结论 危重型新型冠状病毒肺炎患者更易合并细菌感染和多器官功能损害;超敏C反应蛋白、IL-6、TNF-α表达水平可灵敏反映患者全身炎症反应程度,有助于疾病临床分型.

新型冠状病毒肺炎(COVID-19)来势汹汹,而合并其他基础疾病的COVID-19患者更属于高危人群.血糖控制水平直接影响身体免疫应答和状态,其导致的免疫力低下状态极易增加患病几率,已感染的患者则更易加重感染,进一步继发细胞因子风暴.因此COVID-19合并2型糖尿病患者在疫情期间需要在治疗新型冠状病毒感染的同时做好血糖控制和管理.结合糖尿病合理用药相关研究,对COVID-19现有临床数据特征进行分析,探讨COVID-19合并糖尿病患者的药学实践模式和用药监护策略,以期对这类患者提供更为优化合理的用药方案,改善临床用药水平.

目的:调查新型冠状病毒肺炎(COVID-19)患者抑郁、焦虑及失眠的情况,评估新型冠状病毒(SARS-CoV-2)感染对患者心理方面的影响以及发生心理疾病的风险因素.方法:对收治的560例COVID-19患者进行横截面研究.分别采用9项患者健康问卷(PHQ-9)、7项广泛性焦虑障碍量表(GAD-7)和失眠严重指数(ISI)问卷,自拟一般状况调查表调查患者抑郁、焦虑、失眠情况以及人口学基本特征,采用单因素和多因素Logistic回归法分析抑郁、焦虑、失眠的影响因素.结果:在490例受访者中,182例(37.1％)表现为抑郁,154例(31.4％)出现焦虑,148例(30.2％)出现失眠.多因素Logistic回归法分析显示离异或丧偶、受访时仍在医院治疗、家人感染SARS-CoV-2是发生抑郁的独立危险因素[OR 95％ CI分别为3.653(1.238,11.327),1.818 (1.040,3.182),1.620 (1.087,2.434),P＜0.05].多因素Logistic回归分析显示,重症患者出现抑郁症状的风险较入院时轻症患者低[OR 95％ CI 0.420(0.251,0.686),P＜0.05].女性、受访时仍在医院治疗、家人存在SARS-CoV-2感染是焦虑的独立危险因素[OR95％ CI分别是1.664 (1.115,2.492),2.643 (1.520,4.610),1.708 (1.125,2.621),均P＜0.05].受访时处于隔离期或仍在住院治疗中的患者发生失眠的风险明显升高[OR 95％ CI分别是2.107 (1.344,3.327),2.215 (1.262,3.879),均P＜0.05].结论:抑郁、焦虑和失眠为COVID-19患者常见的心理疾病.我们应给与COVID-19患者更多的心理关怀和心理疏导.

目的 探讨腹腔镜辅助Malone手术治疗儿童完全性大便失禁的效果.方法 回顾性分析2017年5月～2018年11月腹腔镜辅助Malone手术治疗直肠肛门疾病矫治术后保守治疗无效的完全性大便失禁8例资料.平均年龄9.2岁(6～14岁).术后6个月以Schell评分评价手术效果,以大便失禁快速评价量表(Rapid Assessment Fecal Incontinence Score,RAFIS)评估排便功能.结果 8例均顺利完成手术.平均手术时间84 min(65～110 min).术后24 h开始流质饮食.随访时间6～24个月,平均16个月.1例术后2个月造瘘口狭窄,经间断扩张及放置支撑管后缓解,无造瘘口感染、出血、插管困难等并发症.术后1个月腹壁无明显瘢痕.每天灌肠1～2次,灌肠液200～500 ml,灌肠后30～45 min内可完成排便,两次排便期间无污粪.术后6个月Schell评分22～25分,(24.0±1.8)分;RAFIS量表从术前(19.0±1.0)分降至(4.3±0.7)分.结论 腹腔镜辅助Malone手术治疗儿童顽固性完全大便失禁近期效果确切,远期效果及并发症需要进一步观察评价.

目的 针对冠心病(CHD)患者生存质量与出院自我护理能力相关性进行分析,为改善患者的生存质量提供依据.方法 198例冠心病患者,采用调研问卷形式,依据出院自我护理能力(SCHFI)量表、生活质量(SF)量表进行调研,分析冠心病患者生存质量与出院自我护理能力的相关性.结果 患者自我护理能力为(134.61±17.49)分,自我护理维持为(36.52±7.93)分,自我护理管理为(58.93±7.49)分,自我护理信心为(39.31±5.73)分,生存质量为(84.76±12.93)分.出院自我护理能力各维度与疾病感知各维度、生存质量均呈正相关.结论 冠心病患者的出院自我护理能力各维度与疾病感知各维度、生存质量均呈正相关.

Objective To evaluate the feasibility and short-term outcome of robotic-assisted anorectal pull-through for anorectal malformations in infants. Methods From October 2016 to October 2017, 9 male infants with anorectal malformations, including 2 cases of recto-bladder neck fistula, 2 cases of recto-prostate fistula, and 5 cases of recto-bulbar fistula, were treated by robotic-assisted anorectal pull-through. Their mean age was 4. 7 months (range, 3-9 months). Three trocars were used. The patient was placed in supine position followed by insertion of trocars. The da Vinci Si robotic system was utilized. With the help of robotic hook, the rectum was mobilized by dividing the peritoneal folds on either side at the level of peritoneal reflection. Distal dissection was carried out under proper fascia of rectum until the end of fistula was identified. It was divided and repaired robotically. Guided by robotic visualization, an accurate pull-through canal was created with pelvic floor muscles surrounding it symmetrically. Then rectum was exteriorized to the perineum through this canal. Anorectal anastomosis was performed with interrupted suture. Results Nine patients underwent robotic-assisted anorectal pull-through successfully without intraoperative complications. The mean operative time was 116 min (range, 105-130 min). The mean docking time was 42 min (range, 35-50 min). The mean time at console was 31. 4 min (range, 26-38 min). Anatomical layers and details of tissue were clearly identified during the surgery, with little blood loss. No intraoperative complications occurred. The mean time of postoperative hospitalization was 10. 2 days (range, 7 -14 d). During the follow-ups for a mean of 10 months (range, 6 -15 months), there were 6 cases of good anus function scores and 3 cases of fair ( soiling). Two patients experienced stricture of anus, and their defecation functions showed favourable evolution during 6-month follow-ups after conservative treatment. Conclusions The da Vinci robotic system allows better dissection and easier closure of fistula. It minimizes side injury of pelvic nerves and external sphincter by dissection under the proper fascia of rectum and accurate creation of pull-through canal. Early outcomes are encouraging, though further evidences of larger trails and long-term follow-ups are needed.

Objective:To optimize the clinical dosage regimen of amoxicillin and clavulanate potassium extended release ( ER) tablets based on the PK/PD parameters. Methods:Totally 30 healthy subjects ( half male and half female) were randomly divided into three groups, and orally administered the ER tablets respectively under fasting condition, before the meal and after the meal, and the optimal administration time was determined by comparing the pharmacokinetic characteristics. The subjects in the three groups were ad-ministered the ER tablets respectively at low, medium and high dosage, and the optimal dosage and dosing interval were determined based on the PK/PD parameters. Results:Under fasting condition, the AUC of amoxicillin [(32.2 ±15.0) μg·h·ml-1] was sig-nificantly lower than that before the meal [(41.7 ±1.92) μg·h·ml-1] and that after the meal [(42.6 ±17.7) μg·h·ml-1]. In contrast, the AUC of clavulanate acid after the meal [(1.89 ±0.54) μg·h·ml-1] was significantly lower than that under fasting condition [(2.55 ±0.76) μg·h·ml-1] and that before the meal [(2.58 ±0.76) μg·h·ml-1] (P<0.05). Amoxicillin and clavulanic acid displayed linear pharmacokinetics within the range of 1000-4000 mg and 62. 5-250 mg, respectively. After a single o-ral administration of amoxicillin and clavulanate potassium ER tablets at low, medium and high dose, the duration of blood concentra-tion above the minimum inhibitory concentration (MIC, 2. 0 μg·ml-1) (T> MIC) in 12 h was 5. 5, 7 and 10 h, and the percentage was 46%, 58% and 83%, respectively, and T> MIC in 12 h was 4. 5, 6 and 8 h, and the percentage was 38%, 50% and 67%, re-spectively when MIC was 4. 0μg·ml-1 . Conclusion:It is suggested that amoxicillin and clavulanate potassium ER tablets be taken at the start of a standard meal, 2 tablets per time, twice daily, which is sufficient to achieve T> MIC of 40% -50%.

目的:建立高效液相色谱-质谱联用(HPLC-MS/MS)测定人血浆中卢非酰胺浓度的方法.方法:40名健康受试者随机分成4组,分别单剂量口服给药卢非酰胺片200,400,800,1200mg.血浆样品经乙腈沉淀蛋白提取分离,色谱柱为Ultimate(R)AQ-C18(100 mm×2.1mm,5μm,Welch Material Inc.);流动相为乙腈-5mmol·L-1乙酸胺水溶液(含0.1％甲酸)=32∶68;流速为0.30 mL·min-1;内标为埃索美拉唑.采用电喷雾离子源,以多反应监测(MRM)方式进行正离子检测.结果:卢非酰胺的血浆浓度在40～5 000ng·mL-1范围内线性良好,定量下限为40ng·mL-1,日内精密度(RSD)均≤8.20％,日间精密度(RSD)均≤6.35％,提取回收率为91.94％～96.48％.卢非酰胺呈非线性药动学特征,单剂量空腹口服给药卢非酰胺片200,400,800,1200mg后,Cmax分别为1803.50±528.06,2485.00±562.71,3710.00±965.50和4158.00±1181.91μg·L-1.AUC0-t分别为34522.13±9525.00,56138.53±18021.98,88848.53±23348.14和107058.03±34420.08 μg·h·L-1.结论:该法操作简单,灵敏,准确,重复性好,适用于卢非酰胺片临床药动学研究.从药动学研究可知,卢非酰胺在中国健康受试者中呈非线性药动学特征.

目的 观察罗氟司特片在健康比格犬体内的药动学特点,比较受试制剂和参比制剂的相对生物利用度.方法 健康雄性比格犬6只,随机、交叉、单剂量灌服罗氟司特片受试制剂或参比制剂500 μg,采用高效液相色谱-串联质谱(HPLC-MS/MS)法测定血浆罗氟司特浓度,用DAS软件计算药动学参数,比较相对生物利用度.结果 罗氟司特受试制剂和参比制剂的主要药动学参数如下:浓度-时间曲线下面积(AUC0-t)分别为(16.33±9.79),(16.21±10.43)μg·h·L-1;AUC0-∞分别为(17.11±10.39),(16.86±10.70) μg"·L-1;峰浓度(Cmax)分别为(5.07±2.74),(5.39±3.67)μg·L-1;达峰时间(tmax)分别为(1.04±0.51),(0.96±0.56)h;半衰期(t1/2)分别为(1.97±0.65),(2.21±0.72)h.受试制剂对参比制剂的相对生物利用度为(100.9±6.3)％.结论 建立的HPLC-MS/MS法适用于罗氟司特片的药动学研究,受试制剂与参比制剂的药动学特征相似.

Objective To study the clinical effect of Yiqi Yangyin Qingfei Recipe and prednisone on treatment of cryp-togenic organizing pneumonia, for providing reference for the treatment of this type of pneumonia. Methods A total of 116 pa-tients from April 2010 to December 2010 in our hospital with hidden source sex machine pneumonia patients were studied, they were randomly divided into two groups, the control group was given prednisone, the observation group was given Yiqi Yangyin Qingfei Recipe on the basis of prednisone treatment, the inflammation levels, the disappear time of recurrence, the recurrence rate, the adverse reaction and the clinical total effective rate of was compared in the two groups. Results When compared with before, the abnormal neutrophils ratio was markedly improved, the observation group improved more obviously, which better than the control, the difference was statistically significant;The disappear time of pneumonia symptoms was obviously less than control, the recurrence time and rate was significantly longer than the control, the difference was statistically significant;the adverse reaction of patients was hyperglycemia, the digestive tract ulcer and osteoporosis, the incidence of adverse reactions in the observation group was 31.0%, which significantly lower than the control of 65.5%, the clinical total effective rate is 93.1%in the observation group, which was obviously higher than that of control group 74.1%, the difference was statistically signifi-cant. Conclusion Yiqi Yangyin Qingfei Recipe and prednisone shows obviously effective on treatment of cryptogenic organizing pneumonia, the levels of inflammation was significantly reduced, the clinical symptoms and recurrence rate was reduced, the adverse reaction was less than compared with single hormone treatment, the clinical total effective rate is higher, which more suitable for the treatment of diseases in the class.

Objective To study the pharmaeokinetics of single and multiple administration of levosulpiride in Chinese healthy volunteers.Methods An open, randomized and parallel study was conducted.Thirty subjects, half male half female, were divided into three groups and received single and multiple intramuscular injection of different doses of levosulpiride, respectively.Blood samples were collected at designed time and the concentrations of levosulpiride in plasma were determined by LC/MS/MS method.The pharmacokinetic parameters were calculated by DAS 3.0 software.Results The main pharmacokinetic parameters of single 25, 50 and 75 mg levosulpiride were as follows:cmaxwere (724.70 ±248.91), (949.60 ±234.80)and(1619.00 ±366.80)μg· L -1, t1/2 were (7.65 ±1.32 ) , ( 7.58 ±0.89 ) and ( 8.01 ±0.88 ) h, AUC0-t were ( 2874.17 ±1093.71 ) , ( 4481.75 ±913.09 ) and ( 7559.33 ± 1428.87) μg· L-1 · h, respectively.For the sequential administration, t1/2 was ( 7.41 ±0.79 ) h and AUC0-t was ( 4658.33 ±909.51 )μg· L-1 · h.Conclusion Single intramuscular injection of levo-sulpiride shows a good linear relationship between 25 and 75 mg in Chi-nese healthy volunteers.There is no accumulation tendency for the sequential administration found and there was no significant difference between male and female subjects.

目的:建立同时测定人血浆中阿莫西林和克拉维酸钾的浓度的高效液相色谱-质谱联用(HPLC-MS-MS)方法.方法:以头孢羟氨苄为内标,血浆样品经乙腈沉淀蛋白后用0.5 ml二氯甲烷萃取,采用Hypersil ODS2色谱柱(2.1 mm×150mm,5 μm),以乙腈-5 mmol·L-1醋酸铵含0.3％甲酸水溶液(9.5∶90.5)为流动相,流速为0.3 ml·min-1,以液相色谱分离、电喷雾离子化串联质谱进行检测,采用多反应检测模式(MRM)同时测定阿莫西林(m/z,363.9/222.7)和克拉维酸(m/z,197.8/135.8)的浓度.结果:阿莫西林和克拉维酸钾标准曲线的线性范围分别是20～22 000 ng·ml-1 (r=0.998 4)和15～6 000 ng·ml-1 (r=0.999 1);日内精密度与日间精密度RSD均小于15％.结论:本方法能简便、快速、准确地测定人血浆中阿莫西林和克拉维酸钾浓度,适用于阿莫西林克拉维酸钾缓释片的临床药动学研究.