目的 探讨药学监护模式在妊娠期肝内胆汁淤积症(ICP)患者中的应用效果,为药物治疗临床路径的制定提供参考依据.方法 选取2018年于安徽医科大学附属妇幼保健医院接受药学监护的ICP患者42例为监护组,同时选取2017年本院未行药学监护的ICP患者48例作为对照组.监护组实施药学监护模式.分析2组药物治疗情况,比较2组治疗前后总胆汁酸(TBA)、总胆红素(TBiL)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、妊娠结局指标(胎儿窘迫、早产与产后出血等),并观察2组药物不良反应发生情况.结果 ICP患者主要临床治疗药物包括熊去氧胆酸、S-腺苷蛋氨酸(SAMe)、多烯磷脂酰胆碱、还原型谷胱甘肽及甘草酸二铵等,其中监护组未使用甘草酸二铵.监护组多烯磷脂酰胆碱使用率高于对照组(P<0.05);2组其他药物使用率比较,差异无统计学意义(P>0.05).监护组熊去氧胆酸、SAMe用药疗程长于对照组(P<0.05);2组其他药物用药疗程比较,差异无统计学意义(P>0.05).治疗前2组TBA、TBiL、AST比较,差异无统计学意义(P>0.05),但监护组ALT高于对照组(P<0.05);治疗后监护组TBA低于对照组(P<0.05);治疗后2组TBiL、AST、ALT比较,差异无统计学意义(P>0.05).2组胎儿窘迫、早产发生率比较,差异无统计学意义(P>0.05).2组均未发生产后出血、药物不良反应.结论 临床药师参与ICP患者的临床药物治疗并提供全程药学监护,可有效改善ICP患者相关生化指标,达到良好的治疗效果.

目的:探讨阿奇霉素干混悬剂与盐酸氨溴索口服液对儿童支原体肺炎的治疗效果.方法:选取我院2019年1月—2020年9月收治的100例支原体肺炎患儿,应用随机数表法分为两组,对照组采用阿奇霉素干混悬剂治疗,研究组采用阿奇霉素干混悬剂与盐酸氨溴索口服液联合治疗,对两组患儿发热持续时间、咳嗽持续时间、肺部啰音持续时间、住院总时长进行对比.结果:与对照组相比,研究组患儿的各项指标均相对较优,临床效果更加显著,总效率达到96.00％,远远高于对照组的82.00％,两组数据差异具有显著性(P<0.05).结论:在小儿支原体肺炎治疗中,采用阿奇霉素干混悬剂与盐酸氨溴索口服液相结合的方式,与单纯使用阿奇霉素干混悬剂相比疗效更加显著,可有效缩短患儿的住院、咳嗽、发热与肺部啰音时长,有效率更高,疗程更短.

羟乙基淀粉(HES)是临床常用的人工胶体,用于血容量减少或有血容量减少风险患者的血容量扩充,其过敏反应可能与药物蓄积于网状内皮系统有关,药物分子量大小与过敏反应发生可能正相关.其用于预防卵巢过度刺激综合征(OHSS)应权衡用药的风险与收益,有限度地用药并关注不良反应的发生.本文报道1例使用HES后出现过敏反应的病例,分析不良反应发生机制与防治措施,并探讨其预防OHSS时的临床使用方法,并分析HES致过敏的机制与预防OHSS的临床用药方案,促进临床用药安全.

目的 调查安徽省妇幼保健院慢性射血分数降低的心力衰竭(heartfailurewithreducedejectionfraction,HFrEF)患者神经内分泌抑制剂——血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)或血管紧张素Ⅱ受体阻滞剂(angiotensin Ⅱ receptor blocker,ARB)、β受体阻滞剂(β-blocker,BB)和醛固酮受体拮抗剂(mineralocorticoid receptor antagonist,MRA)使用现状及其与指南的差距.方法 搜集并分析2018年1月-12月慢性HFrEF住院患者基本资料和3类神经内分泌抑制剂使用情况.结果 纳入研究的301例慢性HFrEF患者中,ACEI/ARB、BB和MRA使用率分别为77.4％,60.5％和94.0％,剂量达标率分别为44.2％,22.5％和100％.48.8％患者采用指南推荐的联合用药,包括1.3％两药联合(ACEI/ARB+BB)和47.5％三药联合(ACEI/ARB+BB+MRA).结论 笔者所在医院慢性HFrEF患者神经内分泌抑制剂应用现状与指南仍有差异,ACEI/ARB和BB的使用率、剂量达标率和两药联合用药率均不足,而MRA使用过度,需进一步提高医师对指南的依从性.

目的 分析头孢孟多导致凝血功能异常的机制,促进临床用药安全.方法 本研究报告1例使用头孢孟多[一种含有N?甲基硫代四氮唑(NMTT)侧链的头孢菌素]后出现凝血功能异常的病例,病人2019年3月24日入院,2019年3月25日行子宫下段剖宫产术,因急性绒毛膜羊膜炎应用头孢孟多酯钠抗感染治疗后检测凝血功能指标异常,予VitK1肌肉注射治疗,2019年3月31日基本情况良好予出院.通过对凝血功能异常原因分析并行文献循证,探讨其发生机制与防治措施.结果 根据病人凝血功能异常发生的时机与处理情况,结合说明书和文献循证结果判断,病人凝血功能异常与使用头孢孟多酯钠有关.具有NMTT侧链的头孢菌素引起凝血功能异常或出血的风险较高,与其抑制维生素K(VitK)环氧化物还原酶活性,消耗VitK依赖性凝血因子有关,其作用机制与华法林类似.结论 医护人员及临床药师要充分注意该类药物引起不良反应,采取积极的预防与干预措施.

目的 评价国产与进口卡前列素氨丁三醇治疗产后出血的有效性、安全性与经济性.方法 收集2016年1—12月安徽医科大学附属妇幼保健院收治的400例产妇资料,将产妇依据治疗方式不同分为对照组和观察组,每组200例.对照组给予进口卡前列素氨丁三醇注射液治疗,观察组给予国产卡前列素氨丁三醇注射液治疗.比较两组病人治疗效果并依据药物经济学原理对其药物的成本效果进行评价.结果 两组病人一般情况、术后2 h出血量及总出血量、产后24 h血红蛋白(Hb)与红细胞(RBC)下降值、产后止血相关临床干预措施与临床总有效率比较,均差异无统计学意义(P>0.05);观察组平均药物治疗费用低于对照组(293.23元vs.473.96元),术中出血量与消化系统不良反应发生率均高于对照组,差异有统计学意义(均P<0.05);观察组与对照组的药物成本效果比分别为3.01、4.81.结论 国产卡前列素氨丁三醇治疗产后出血安全有效,但应注意药物不良反应;经成本效果分析后,国产卡前列素氨丁三醇用于治疗产后出血经济性更佳.

目的:探讨临床药师干预对转化糖电解质注射液合理使用的影响,为规范辅助治疗药物的临床应用提供参考.方法:随机抽取临床药师干预前(2017年7—12月)及干预后(2018年7—12月)使用转化糖电解质注射液的住院患者病历各420份,以循证医学的方法制定点评标准,组织专项处方点评小组进行系统点评,比较干预前后该药使用情况的变化.结果:干预后转化糖电解质注射液消耗总金额下降32.1％,用药不合理率从干预前的40.2％下降为干预后的19.5％;干预后的适应证不适宜、禁忌证和超疗程使用与干预前相比明显降低,以上差异均有统计学意义(P<0.05).结论:临床药师的干预可促进转化糖电解质注射液的合理使用.

目的 运用Meta分析方法 评价宫缩乏力性产后出血患者应用国产卡前列素氨丁三醇(商品名:安列克)与进口卡前列素氨丁三醇(商品名:欣母沛)治疗的有效性和安全性.方法 检索Cochrane database、Medline(Pubmed)、EMBase、中国期刊全文数据库(CNKI)及万方数据库,根据Cochrane系统评价手册评价纳入的随机对照试验(RCT)质量并进行Meta分析.结果 纳入5篇文献进行研究.其中4篇文献进行了有效止血患者比较,5篇文献进行了产后出血量与安全性比较.有效止血患者比例的合并OR(95％CI)为0.72(0.33,1.57);不良反应发生率合并OR(95％CI)为1.1(0.74,1.65);平均出血量的合并WMD(95％CI)为3.37(-5.20,11.94),3组指标差异无统计学意义(P>0.05).结论 安列克防治宫缩乏力性产后出血与欣母沛具有相近的有效性与安全性.

目的 对比两种术式治疗不同年龄段老年股骨转子间不稳定型骨折的效果.方法 将我院骨科收治的190例老年股骨转子间不稳定型骨折患者,随机分为动力髋组(动力髋螺钉内固定术)及人工置换组(人工股骨头置换术),各95例.根据年龄将2组患者各分为60岁~70岁组、71岁~80岁组、81岁~90岁组.比较2组不同年龄段患者手术情况、疗效优良率及并发症发生率.结果2组各年龄段手术时间比较,差异无统计学意义(P>0.05);人工置换组各年龄段术中出血量及术后下床锻炼时间均明显少于动力髋组,疗效优良率均明显高于动力髋组,并发症发生率显著低于动力髋组,差异有统计学意义(P<0.05).结论 在不同年龄段老年股骨转子间不稳定型骨折治疗中,人工股骨头置换术优势显著,与动力髋螺钉内固定术相比,手术安全性更高,术后恢复更快,髋关节功能更佳.

多囊卵巢综合征（polycystic ovary syndrome，PCOS）是妇科常见的生殖功能障碍与糖代谢异常并存的内分泌紊乱综合征，临床上可表现为痤疮、多毛、肥胖、月经稀发、持续无排卵、不孕症、雄激素过多及胰岛素抵抗等。应用促排卵治疗可促使患者恢复月经、排卵和受孕，但这些孕妇妊娠并发症与不良妊娠结局较普通孕妇有所增加，故对其加强妊娠管理并及时诊治相关并发症十分重要。我院2014年收治1例多囊卵巢综合征促排卵后三胎妊娠的患者，现将详细情况报道如下。

Objective To systematically evaluate the effectiveness and cost of laparoscopic myomectomy(LM) vs.traditional abdominal myomectomy(TAM) in treating Chinese patients with hysteromyoma.Methods-Such databases as The Cochrane Library(Issue 4,2012),PubMed,EMbase,CNKI,CBM and WanFang Data were searched from their inception to September,2012 to collect the randomized controlled trials(RCTs) about LM vs.TAM in treating Chinese patients with hysteromyoma,and the references of the included studies were also retrieved.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and assessed the methodological quality.Then meta-analysis was conducted using RevMan 5.2 software.Results-A total of 8 RCTs involving 1 000 Chinese patients were included.The results of meta-analysis showed that,LM was superior to TAM in postoperative exhaust time(WMD= -15.21,95%CI -20.19 to -10.24,P0.000 01) and postoperative hospital stay(WMD= -3.07,95%CI -4.25 to -1.90,P0.000 01),with significant differences.But it was inferior to TAM in operation time(WMD=28.33,95%CI 18.07 to 38.59,P0.000 01) and hospital costs(WMD=2 028.87,95%CI 1 190.75 to 2 866.98,P0.000 01),with a significant difference.There was no significant difference in intraoperative bleeding amount between the two groups(WMD= -2.78,95%CI -41.56 to 36.00,P=0.89).Conclusion-This study shows LM is superior to TAM in fastening postoperative recovery and shortening hospital stay,but it is longer in operation time and higher in cost.The intraoperative bleeding amount is similar in the two groups.Due to low methodological quality and small sample size of the included studies,this conclusion has to be further proved by more high-quality RCTs.

<正>患者,27岁,G5P2,因"孕34周,阴道少许流血8天"于2012年3月5日收入院。LMP 2011年7月10日,停经48天尿妊娠试验(+),孕50天出现早孕反应,持续1+月,孕20周自觉胎动,未行正规产检。2008年剖宫产时发现有双子宫畸形,未作特殊处置。2012年2月27日患者出现阴道少许流血,无腹痛,入院诊断:双子宫畸形,瘢痕子宫,阴道纵膈,先兆早产。患者

Objective To investigate the effect of endoplasmic reticulum stress and apoptosis of peritoneal macrophage in rat induced by Gadolinium chloride.Methods Rat peritoneal macrophage(PMΦ)were isolated and cultured.After PMΦ treated with Gadolinium chloride and Tunicamycin,the expression of ARMET was determined by immunohistochemical method,immunoflurorescent double staining were employed to detect the expression of CHOP and ARMET,PI stain was used to observe PMΦs apoptosis.Results The amount of cells were greatly reduced and the cell body were shrinked to round in GdCl3 group.The percentage of cell ARMET positive-expressed were(42.1±6.6)% in GdCl3 group(5×10-6 mol/L),while the value of control group were(6.1±1.6)%,the difference between the two groups was significant(P<0.01).But compared with the value of GdCl3 group were(43.4±5.9)%,there was no significant statistical difference in ARMET expression.The expression of ARMET and CHOP were markedly high in GdCl3 group by immunofluorescence double labeled stain.PI stain revealed the apoptosis feature that cells were deeply red-stained and nuclear fragment.Conclusion GdCl3 can induce endoplasmic reticulum stress and apoptosis of peritoneal macrophage in rat,the potential meachnism is related to endoplasmic reticulum Ca2+ efflux producing unfolded protein response(UPR).

OBJECTIVE:To study the application of antimicrobials in patients undergoing elective cesarean section and to promote rational use of drugs in our hospital. METHODS: 240 cases of elective cesarean section were randomly selected from our hospital during Jan.～Apr. in 2009 and Jul.～Oct. in 2009, respectively (n=120). Retrospective analysis was applied to analyze the application of antimicrobials in those cases. RESULTS: Prophylactic application of antimicrobials was rational after intervention with cephalosporins as the main category. The phenomena of excessive dose of drugs were controlled effectively to shorten medication duration. The rate of medication 0.5～2 h before operation increased and the cost of medicines reduced. CONCLUSION: Relevant measures of intervention can improve rational use of drugs in perioperative patients undergoing elective cesarean section in our hospital and reduce the cost of operation.

Objective To investigate whether gadolinium chloride inhibits the expression of CD68 in rat peritoneal macrophages (PMΦs).Methods PMΦs were isolated from normal SD rats and treated with different concentrations of gadolinium chloride (GdCl3). Rat adjuvant arthritis (AA) was induced by Freund's complete adjuvant (FCA). PMΦs were harvested after injection of GdCl3 through tail vein. Double immunofluorescence labeling and western blotting were used to determine the expression of CD68. The nuclus were stained by DAPI. TUNEL staining was used to determine the apoptotic PMΦs.Results GdCl3 dose-dependently inhibited the expression of CD68 in PMΦs from normal rats. The optimal concentration was 5×10-6 mol/L. The higher concentrations of GdCl3 were toxic to PMΦs,including the changes in cellular morphologies and nuclus. Furthermore,it up-regulated the expression of ARMET,a secreting protein inducible to ER stress at the higher concentrations. GdCl3 also turn some of the CD68-positive PMΦs of AA rats to negative ones and promoted these negative PMΦs differentiation at the dose of 10 mg/kg. Meanwhile,GdCl3 induced some of the activated PMΦs apoptosis.Conclusion GdCl3 inhibits the expression of CD68 both in normal and activated PMΦs and induces PMΦs apoptosis,which probably is one of the mechanisms that contribute to the inhibition of PMΦ activation.

抗菌药物后效应(post-antibiotics effect, PAE)是指细菌与抗菌药物短暂接触,当药物浓度降至最低抑菌浓度(MIC)以下或被消除后,细菌的生长仍受到持续抑制的效应.传统的抗菌药物临床给药方案主要是依据平均抑菌浓度(MIC)、最小杀菌浓度(MBC)与血药浓度、半衰期、清除率、组织分布等药动学参数来确定给药剂量和给药间隔,而忽略了药物对细菌繁殖规律的影响及人体免疫机制在杀灭细菌过程中所起的作用.

Objective:To study the adsorbability of disposable infusion set on Tinidazole injection.Methods:The contents of Tinidazole which flowed through the disposable infusion set were determined by UV-spectrophotometry.Results:Tinidazole injection was not adsorbed by the disposable infusion set within 4 hours(P>0.05).Conclusion:Tinidazole injection may be constantly infused by the disposable infusion set within 4 hours.

为了解我院住院病房注射用抗菌药物使用情况,笔者对1999年度我院住院患者临床应用抗菌药物的情况调查分析如下.