随着健康中国和区域精神医疗卫生中心的建立和实施,社会对药学和药师的工作提出了更高的要求.为更好地服务于我国精神卫生事业和本区域精神医疗中心建设,本文通过总结精神专科医院临床药学发展中的不足以及影响临床药师综合能力提升的因素,在结合本专业实际工作的基础上,综合其他专业临床药学发展方向和临床药师成长规划,提出了提升精神专科医院临床药师综合能力的教学方法和培训措施以及适合自身发展的平台建设.另外,本文还对具体教学内容、培训和学习方法、平台建设要求和药师使命等进行了系统阐述,目的是在提升精神专科医院临床药师综合能力的前提下,为今后制定科学合理且利于自身发展的考核制度提供依据.

结合本医疗机构药学服务队伍、部门结构设置和学科定位等方面的经验和不足,尝试探讨本专业的发展方向和学科定位,以实现在优化建设特色精神专科药学服务队伍的同时,提升本区域精神药学服务质量和医疗服务水平.另外在查找和分析精神专科医院临床药学发展环节的问题,提出较为合理的药学人才培养方式和信息化平台建设,以服务于学科发展,并为精神科临床药师培养方案的制定和实施提供理论支撑.

目的:基于荟萃分析(Meta分析)方法,系统评价阿戈美拉汀对抑郁症伴睡眠障碍患者的睡眠改善效果及其安全性,为临床治疗提供循证参考.方法:检索PubMed、the Cochrane Library、EMBase、中国知网、万方数据库和维普数据库,纳入从建库至2020年4月公开发表的关于阿戈美拉汀治疗抑郁症伴睡眠障碍患者的中英文文献[研究组患者单独使用阿戈美拉汀口服治疗,对照组患者单独使用5-羟色胺再摄取抑制类抗抑郁药(米氮平、帕罗西汀或艾司西酞普兰等)治疗或阿戈美拉汀联合其他药物治疗],提取汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)相关数据,采用RevMan 5.3软件进行文献质量评价和Meta分析.结果:共纳入8项研究,合计332例患者.Meta分析结果显示,抑郁症伴睡眠障碍患者单独使用阿戈美拉汀治疗后,其HAMD评分(SMD=-5.31,95％CI=-6.28～-4.33,P<0.00001)、PSQI总分(SMD=-3.66,95％CI=-4.16～-3.17,P<0.00001)均较治疗前明显降低,差异均有统计学意义.结论:阿戈美拉汀对抑郁症伴睡眠障碍患者的抑郁症状和失眠症状均有较好的改善作用,但受纳入研究的质量和样本量限制,该结论需大样本、多中心、长时间的随访结果进行验证.

目的 了解不同年龄段住院精神分裂症患者临床用药状况,为临床合理用药提供依据.方法 将3940例住院精神分裂症患者按年龄分为儿童青年组293例,成年组3493例,老年组154例.分析3组入院及出院时抗精神病药物及联合其他精神药物应用状况.结果 入院时3组以单用抗精神病药物为主(儿童青少年组为74.4％,成年组为69.8％,老年组为65.6％);出院时3组以单用或2种抗精神病药物联用为主,但儿童青少年组2种联用率略高(58.7％).入院及出院时3组90％以上的患者应用非典型抗精神病药物治疗.入院及出院时3组联合心境稳定剂应用率比较差异有统计学意义(P<0.01),儿童青年组高于成年组及老年组.入院及出院时老年组联合苯二氮艹卓类药物居多;入院时儿童青年组及成年组联合苯二氮艹卓类药物居多,而出院时联合心境稳定剂居多,苯二氮艹卓类药物次之.结论 不同年龄段住院精神分裂症患者以单一应用非典型抗精神病药物治疗为主,临床用药状况基本合理.

目的 探讨后腹腔镜切开取石术(retroperitoneal laparoscopic lithotomy,RPLU)、输尿管软镜碎石清石术(lithotripsy with flexible ureteroscope,FURL)及经皮肾镜碎石清石术(percutaneous nephrolithotomy,PCNL)种不同方法 治疗输尿管上段嵌顿性结石的疗效,以明确直径大于1.5 cm的输尿管上段嵌顿性结石的最佳处理方案.方法 回顾性分析159例输尿管上段嵌顿性结石,收集其术前术中资料,按术式不同分为RPLU组56例、FURL组55例、PCNL组48例.对手术时间、术后住院时间、结石清除率、术后并发症等数据进行统计学分析.结果 FURL组手术时间和术后住院时间明显短于RPLU组和PCNL组,差异均有统计学意义(P<0.05).RPLU组术后3 d和术后1个月的结石清除率(100％,100％)稍高于FURL组(90.9％,94.5％)和PCNL组(93.8％,93.8％),3组患者术后无严重并发症出现,差异均无统计学意义(P>0.05).结论 3种不同手术方法 治疗嵌顿性输尿管上段结石均安全有效,FURL组手术时间及住院时间更短,患者术后恢复更快,更具有优势.

新型冠状病毒肺炎是由新型冠状病毒(2019-nCoV)引起的肺炎,国家已将该病纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防、控制措施.本文以国家卫生健康委员会的相关法规、诊疗规范、科研进展和循证学数据为基础,结合精神专科医院实际情况,制定适合新乡医学院第二附属医院的患者就诊流程及医务人员防控措施,为疫情防控提供工作建议和指导.

目的:系统评价碳酸锂联合131 I对毒性弥漫性甲状腺肿伴白细胞减少症的疗效和安全性.方法:计算机检索the Cochrane Library、PubMed、万方数据库、中国知网及维普数据库,辅以网络检索和手工检索,收集有关碳酸锂联合131 I治疗毒性弥漫性甲状腺肿伴白细胞减少症的临床研究(观察组患者采用碳酸锂与131 I联合治疗;对照组患者单纯采用131 I治疗),对纳入的研究采用RevMan 5.3软件进行荟萃分析(Meta分析).结果:共纳入5篇文献,涉及777例患者.Meta分析结果显示,观察组患者的血清游离三碘甲状腺原氨酸(FT3)水平在联合用药后15 d(MD=-17.85,95％CI=-21.79～-13.91,P<0.00001)、30 d(MD=-16.21,95％CI=-29.62～-2.80,P=0.02)和90 d(MD=-3.14,95％CI=-5.34～-0.93,P=0.005)均明显低于对照组,差异均有统计学意义;观察组患者的血清游离甲状腺素(FT4)水平在联合用药后15 d(MD=-18.09,95％CI=-22.78～-13.41,P<0.00001)、30 d(MD=-20.67,95％CI=-32.56～-8.78,P=0.0007)和90 d(MD=-7.64,95％CI=-12.18～-3.09,P=0.001)均明显低于对照组,差异均有统计学意义;观察组患者的白细胞计数(WBC)在联合用药后15 d(MD=0.56,95％CI=0.25～0.88,P=0.0004)、30 d(MD=0.72,95％CI=0.38～1.07,P<0.0001)均明显高于对照组,差异均有统计学意义,而在联合用药后90 d时与对照组的差异无统计学意义(MD=1.12,95％CI=-0.05～2.28,P=0.06).结论:碳酸锂联合131 I可有效降低毒性弥漫性甲状腺肿伴白细胞减少症患者的FT3和FT4水平,并可升高患者的WBC水平.

目的 探讨经皮肾镜取石术治疗老年上尿路结石患者术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素.方法 回顾性分析95例老年上尿路结石经皮肾镜术后患者临床资料,评估术前术中各种因素与术后SIRS的相关性.结果 95例患者中,SIRS表现22例(23.2％),其中2例发生感染性休克,经积极抗感染和支持治疗后痊愈,无死亡病例.SIRS组糖尿病史、反复尿路感染史、术前尿培养阳性率、鹿角形结石率、结石负荷和手术时间均明显高于或多于非SIRS组,差异有统计学意义(P＜0.05);Logistic 回归分析显示,反复尿路感染病史、鹿角形结石、糖尿病史是老年人经皮肾镜术后SIRS发生的危险因素.结论 对于有反复尿路感染病史、鹿角形结石及糖尿病史的老年患者要提高警惕,术前积极控制感染,术中注意避免集合系统损伤,术后严密监控,以降低SIRS发生率.

帕金森病是一种神经退行性疾病,有明显的运动和非运动症状,选择性5-HT2A反向激动剂哌马色林于2016年4月在美国批准,用于帕金森病伴发有幻觉和妄想精神障碍的治疗.哌马色林为抗精神病药,治疗靶点相对特异即不作用于多巴胺受体.本文对哌马色林的作用机制、药动学、药效学、临床疗效和安全性进行综述.

目的:了解抑郁症患者用药情况.方法:通过医院信息系统,调取2014年9月至2017年12月新乡医学院第二附属医院3942例住院抑郁症患者的病历资料,对抗抑郁药的使用情况进行统计分析.结果:3942例患者共使用抗抑郁药8549例次,使用例次数排序居前3位的药品为米氮平(2047例次,占23.94％)、艾司西酞普兰(1339例次,占15.66％)和文拉法辛(1121例次,占13.11％);联合用药共14001例次,使用例次数排序居前3位的药品为劳拉西泮(1760例次,占12.57％)、阿普唑仑(1745例次,占12.46％)和丁螺环酮(1699例次,占12.13％).结论:选择性5-羟色胺再摄取抑制剂、去甲肾上腺素能和特异性5-羟色胺能抗抑郁药、5-羟色胺及去甲肾上腺素再摄取抑制剂以及新型的5-羟色胺平衡抗抑郁药成为治疗抑郁症的首选药物,抗抑郁药与苯二氮艹卓类药物联合使用率最高.

目的:分析用抗精神病药物治疗精神分裂症所致的不良反应.方法:选择2015年1月1日至12月31日期间河南省精神病医院收治的3838例精神分裂症患者作为研究对象.为这3838例患者均使用抗精神病药物进行治疗.然后,观察其中不同性别的患者用药后不良反应的发生率、不同年龄段的患者用药后不良反应的发生率、采用不同用药方式进行治疗的患者用药后不良反应的发生率及其用药后发生不良反应的类型及占比.结果:与男性患者相比,女性患者使用抗精神病药物后其不良反应的发生率更高(P<0.01).与年龄段为15～29岁、30～44岁、45～59岁、≥60岁的患者相比,年龄段为0～14岁的患者使用抗精神病药物后其不良反应的发生率更高(P<0.05).与单用一种抗精神病药物的患者相比,联用多种抗精神病药物进行治疗的患者其不良反应的发生率更高(P<0.01).这3838例患者使用抗精神病药物后其发生的不良反应包括锥体外系反应、心功能损伤、肝功能异常、糖脂代谢异常及白细胞减少.与心功能损伤、肝功能异常、糖脂代谢异常及白细胞减少相比,这3838例患者使用抗精神病药物后其锥体外系反应的发生率更高(P<0.05).结论:与单用一种抗精神病药物相比,为精神分裂症患者联用多种抗精神病药物进行治疗,可提高其不良反应的发生率,且其用药后锥体外系反应的发生率较高.

Objective To investigate the risk factors for infections after flexible uretero-renoscopy with laser lithotripsy and to evaluate the distribution and drug resistance rate of pathogens in preoperative urine cultures.Methods A total of 500 cases of nephrolithiasis who had undergone soft ureteroscopic laser lithotripsy were retrospectively collected at Hospital 252 between June 2013 and June 2017. All the patients were given urine cultures and urine culture positive patients had their multi-drug re-sistance of pathogens identified before operation. According to postoperative complications, patients were divided into the infec-tion group(45 cases)and non-infection group(455 cases). The clinical data of the two groups was compared. Logistic regres-sion analysis was used to analyze related risk factors. Results A total of 45 cases suffered from postoperative infectious complica-tions,and the incidence of infectious complications was 9%. There was no significant difference in gender,age,BMI,location of stones and previous history of surgery of stones between the two groups(P>0.05),but there was significant difference in his-tory of diabetes mellitus, stone size, preoperative urinary cultures, duration of surgey and length of hospital stay(P<0.05). There were a total of 69 cases of positive urinary cultures. Gram-negative bacteria outnumbered gram-positive bacteria in the in-fected pathogens. According to the results of multiple drug resistance analysis of pathogenic bacteria,preoperative urinary culture positive patients were divided into the multi-drug resistant group and non-multi-drug resistant group, and there was no signifi-cant difference in the distribution of pathogenic bacteria between the two groups(P>0.05). However,the drug resistance rates were significantly higher in the multi-drug resistant group(P<0.001). Multivariate logistic regression analysis showed that a preoperative urinary culture with multi-drug resistant bacteria was an independent risk factor for infectious complications after flexible uretero-renoscopy with laser lithotripsy(P=0.005). Conclusion Preoperative urinary cultures with multi-drug resistant bacteria are an independent risk factor for infectious complications after flexible uretero-renoscopy with laser lithotripsy. Gram-negative bacteria outnumber gram-positive bacteria in infected pathogens.

目的 探讨上尿路结石经皮肾镜碎石术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素,评估术前中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)在预测术后SIRS中的作用.方法 经皮肾镜取石术后患者323例,收集其术前术中资料,根据术后是否出现SIRS分为SIRS组和非SIRS组,比较2组糖尿病史、感染性结石、多通道手术、术前尿培养阳性率、NLR、血红蛋白含量、白蛋白含量、结石负荷和手术时间.结果 323例患者中,48例术后出现SIRS.SIRS组糖尿病史、感染结石史、围手术期输血史发生率均高于非SIRS组,SIRS组结石负荷、NLR高于非SIRS组,差异有统计学意义(P<0.05).Logistic回归分析显示NLR(OR=8.886,P=0.000)、感染性结石(OR=6.742,P=0.000)为经皮肾镜术后SIRS发生的独立危险因素.ROC曲线图分析显示术前NLR最佳截断点为2.31,其敏感度为72.9％,特异度为75.6％,曲线下面积为80.8％.结论 术前NLR水平可用于预测经皮肾镜术后SIRS的发生,其具有简便易于测量的特点,且其费用低廉,是预测术后感染的一个良好指标.

Objective To explore risk factors of upper urinary tract lithiasis in young soldiers by assessing the relevance among serum electrolyte,routine urine test and the development of lithiasis.Methods Between March 2011 and March 2014,a total of 129 young soldiers who suffered from upper urinary tract lithiasis were involved in this research.Other 192 health young soldiers were considered as control.Serum levels of K,Na,Cl,Ca,CO2-CP,and urine PH and urine specific gravity (SG) were analyzed between these two groups.Results There was significant difference in levels of serum K,Na,Ca,and urine PH.Logisitic regression analyse showed that K and urine PH were protective factors,while Na,Ca,and SG were risk factors for upper urinary tract lithiasis in young soldiers.The risk equation was established by Logistic regression.Y =exp(-128.67-1.91 × K +0.35 ×Na+4.42×Ca-1.75×PH+82.89×SG)/[1 +exp(-128.67-1.91 ×K+0.35×Na+4.42×Ca-1.75 × PH + 82.89 × SG)] Conclusions Serum K,Na,Ca,and urine PH and SG may play role in pathogenesis of upper urinary tract lithiasis,and the use of risk equation may contribute to preventing and curing this disease with individualized pattern.

目的：探讨后腹腔镜输尿管切开取石术治疗孤立肾并输尿管上段结石的方法及疗效。方法后腹腔镜输尿管切开取石术治疗孤立肾并输尿管结石16例，男性11例，女性5例，年龄42~68岁，平均（53.5±11.5）岁，左侧9例，右侧7例，术前肌酐168~562 umol/L，平均（346.3±108.9）umol/L，其中12例术前留置D-J管未成功后8例行输尿管碎石失败，4例未成功后直接改后腹腔镜输尿管切开取石，其余4例术前未行其他治疗，结石直径15~28 mm，平均（16.9±6.7）mm。结果6例手术均获成功，无中转开放手术，手术时间56~132 min，平均（78.6±12.1）min；术中出血量20~60 ml，平均（32.6±5.3）ml，一次手术清石率100%。术后2~4天拔除腹膜后引流管，无1例漏尿。术后复查卧位腹平片未见残留结石，双J管位置良好；随访3~24月，5例肾功能恢复正常，11例明显改善。未发现结石复发及输尿管狭窄。结论后腹腔镜输尿管切开取石术治疗孤立肾并输尿管上段结石疗效确切，损伤小，最大限度的保护肾脏功能。对于孤立肾并输尿管结石可作为首选方法。

目的:探讨B超引导下运用经皮肾穿刺套件行耻骨上膀胱穿刺造瘘术来替代膀胱切开造瘘术治疗低容量膀胱患者的可行性、安全性.方法:从2010年1月到2015年12月对54例低容量膀胱患者,运用经皮肾穿刺套件行耻骨上膀胱穿刺造瘘术.结果:54例患者均成功穿刺造瘘,术中及术后均无明显并发症.结论:运用经皮肾穿刺套件行耻骨上膀胱穿刺造瘘术是一种简单、安全、可靠的方法,对于低容量膀胱患者,可显著提高穿刺的成功率和安全性,可以代替膀胱切开造瘘术,临床应用价值较高,值得推广.

目的：观察EMS四代碎石清石系统用于膀胱血块填塞的临床疗效。方法选取50例膀胱血块填塞患者，均于尿道黏膜麻醉下用EMS四代碎石清石系统的超声碎石探针行经尿道血块碎吸清除术，观察治疗时间、血块清除情况及不良反应。结果50例均一次性清除膀胱血块，治疗时间5～15min，血块清除率100％；术中发现的明确出血点均电凝止血，无二次血块清除病例，无不良反应发生。结论 EMS四代碎石清石系统用于膀胱血块填塞，血块清除率高，且操作简单、安全。

Objective To investigate the clinical efficacy of RevoLix 2 μm continuous wave laser treatment on bladder neck contracture after benign prostatic hyperplasia operation. Methods A total of 21 cases were enrolled in current research and they all accepted 2 μm continuous wave laser treatment of bladder neck contracture after benign prostatic hyperplasia operation in the 252th Hospital of the Chinese People's Liberation Army. The clinical efficacy was recorded. Results The operation of the 2 μm continuous wave laser vaporesections were successfully performed on 21 cases. The maximum urine flow rate was increased from(6. 86 ± 1. 97)ml/ s to(16. 31 ± 1. 61)ml/ s,and the difference was significant(t = 15. 49,P < 0. 01). After 3 to 23 months(median 14 months)follow-up,20 cases were cured and 1 case was combined with bladder residual urine 110 ml. Conclusion The therapy of 2 μm continuous wave laser is a superior micro-invasive surgery method for patients with Bladder neck contracture,which shows little blood loss,high level safety,convenient operation and infrequent complications.

Objective To explore the efficacy of 2μm laser vaporesection in treating pediatric posterior urethral valves(PUVs) by ureterscopy. Methods A total of 27 cases with PUVs who received 2μm laser vaporesections were reviewed. All patients were male with a mean age of(5.0±2.9) years. The clinical efficacy was reviewed. Under monitoring by F8/9.8 ureteroscopy, incisions were carried at 5 and 7 o'clock positions of PUVs, and then remnant valves were evaporated by 2μm laser. Routine follow-ups were conducted at the 1st, 3rd, and 6th months. Results All operations were successfully performed. Of the 27 cases, 25 cases got satisfied results during follow-up with successful operation rate of 92.6%(25/27). 1 case received re-operation, and 1 case lost follow-up. Conclusion Transurethral 2μm laser vaporesection by ureteroscopy is a superior micro-invasive surgery method for pediatrics with posterior urethral valves, with little blood loss, high safety, convenient operation and infrequent complications.

OBJECTIVE To explore the distribution and drug resistance of the pathogens causing respiratory tract infections in the elderly psychiatric patients so as to provide guidance for reasonable use of antibiotics .METHODS A total of 320 elderly psychiatric patients with respiratory tract infections who were hospitalized from Jan 2012 to Dec 2013 were enrolled in the study ,then the sputum specimens were cultured and identified by using API identifi‐cation system of BioMerieux ,France ,and the drug susceptibility testing was performed .RESULTS Totally 412 strains of pathogens have been cultured from the 320 patients ,including 248 (60 .2% ) strains of gram‐negative bacteria ,81 (19 .7% ) strains of gram‐positive bacteria ,and 83 (20 .1% ) strains of fungi .Among the gram‐nega‐tive bacteria ,the K lebsiella pneumoniae , Pseudomonas aeruginosa ,and Escherichia coli accounted for 16 .7% , 15 .5% ,and 12 .1% ,respectively ;the Staphylococcus aureus was the predominant species of the gram‐positive bacteria ,accounting for 10 .2% ,and the isolation rate of the methicillin‐resistant S .aureus (MRSA) was 71 .4% ;the Candida albicans was dominant among the fungi ,accounting for 10 .9% .The gram‐negative bacteria were highly susceptible to imipenem and meropenem ,with the drug resistance rate of 0;no strain of vancomycin‐resist‐ant S .aureus was found .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing the respiratory tract infections in the elderly psychiatric patients ,and the incidence of fungal infections shows an up‐ward trend .It is necessary for the hospital to strengthen the surveillance of the pathogens and the drug susceptibil‐ity so as to reasonably use antibiotics .