目的:建立心力衰竭(心衰)住院患者全程化药学服务模式,考察其对患者用药安全性和有效性的影响.方法:采用前瞻性随机对照试验方法,选择我院心内科心衰住院患者随机分为试验组(43例)和对照组(62例).对照组患者接受常规用药指导,试验组患者在此基础上实施全程化药学服务.观察并比较两组患者72 h心功能改善率、平均住院天数、预约门诊复诊率、30 d和1年内心衰加重再住院率,以及出院1个月、3个月、6个月随访时的用药依从性、药品不良反应发生率、满意度和用药偏差.结果:两组患者72 h心功能改善、平均住院天数差异无统计学意义(P＞0.05).试验组预约门诊复诊率、住院满意度、出院1个月后的用药依从性等指标均明显高于对照组(P＜0.05),30 d和1年内心衰加重再住院率、不良反应发生率及用药偏差等指标则明显低于对照组(P＜0.05).结论:临床药师对患者进行全程化药学服务可降低心衰加重再住院率、用药偏差及药品不良反应;改善患者的用药依从性,提高患者满意度,保证患者用药的安全性和有效性.

目的 建立固相萃取柱净化高效液相二极管阵列检测法(SPE-HPLC-DAD)测定人血清伏立康唑血药浓度的实验方法,通过质控图和Westgard多规则法联合应用进行室内质控评估.方法 以甲硝唑为内标,使用Agela Cleanert S C18固相萃取柱处理血样,Hypersil C18柱作为分析柱.检测波长为254 nm,进样量为30μL,柱温30℃,考察该方法的标准曲线与专属性、定量下限、精密度与回收率.收集2021年1—12月湖北省中西医结合医院伏立康唑血清治疗药物浓度监测(TDM)的室内质控结果,分别绘制Levey-Jennings质控图和Z分数质控图,采用Westgard多规则法对质控进行评价.结果 内标和伏立康唑的保留时间分别为5.74 min和7.65 min,无其他物质干扰测定,伏立康唑血药浓度在0.44～14.00 mg/L范围内线性关系良好(r=0.9992);低、中、高3种浓度的样本回收率分别为101.80％、94.80％、100.10％;日内精密度相对标准偏差(RSD)为1.98％～3.57％,日间精密度RSD为2.26％～5.00％,稳定性RSD为2.20％～6.40％,2021年1—12月质控样品的批间RSD小于15.00％,符合《9012生物样品定量分析方法指导原则》,各质控样品的实际检测结果均可控.结论 该院建立的测定伏立康唑血药浓度方法敏感度较高,操作简便;质控图在TDM室内质控中能更合理、有效地进行质控,合理用药,提高临床医生及患者对TDM的信任度.

1 临床资料 患者,男,60岁,因"腰椎术后髋关节疼痛,下肢乏力,发热3天"于2017年1月3日入院.既往有高血压病史10余年.否认冠心病、肝炎、肺结核病史,否认外伤、输血史,否认药物及食物过敏史,有吸烟史30年,每日20支,已戒烟7个月,偶有少许饮酒.2016年5月11日于某医院行"髂骨取骨,腰椎病变清除病灶,植骨融合钉内固定术",术后间断感髋关节疼痛.近1个月感双下肢乏力,行走无力,未行特殊检查及治疗.

目的 为中西医结合治疗新型冠状病毒肺炎(COVID-19)提供参考.方法 选取某中西医结合医院2020年1月8日至2月28日收治的重型COVID-19患者616例,收集患者的一般临床资料、用药情况,同时比较西药组(117例)和中西药组(499例)人口学特征、住院时间、疾病转归.结果 COVID-19药物治疗结构合理,无非必要辅助用药情况;以中西药结合治疗为主,一人一方使用比例达81.01％(499/616);西药组和中西药组患者人口学特征无显著差异(P>0.05),但中西药组患者住院时间、危重型转化率及死亡率显著低于西药组(P<0.05).结论 中西医结合治疗能缩短COVID-19患者住院时间,减少重型向危重型转化,降低患者死亡率.

目的:对比泮托拉唑与奥美拉唑治疗消化性溃疡出血的效果.方法:研究对象为我院98例消化性溃疡出血患者,收治时间为2016年04月—2017年04月间,通过电脑随机的方式将98例研究对象平分为两组,即常规组与研究组.常规组49例患者应用奥美拉唑进行治疗,研究组49例患者应用泮托拉唑进行治疗,对两组患者临床治疗效果进行统计处理.结果:①对比两组临床治疗效果,研究组总有效率为91.84％,明显高于常规组81.63％的总有效率,组间结果比较存在统计学意义(P<0.05);②对比两组不良反应发生率,研究组不良反应发生率为14.29％,低于常规组16.33％的不良反应发生率,但组间比较无统计学意义(P>0.05);③对比两组治疗第2d、第4d、第6d出血量,研究组低于常规组,有统计学意义(P<0.05).结论:相较于奥美拉唑,泮托拉唑治疗消化性溃疡出血的疗效更优,不良反应发生率低,止血速度更快,具有一定的推广价值.

Objective To investigate the measures for intervening the application of antibacterials in perioperative period by the clinical pharmacists. Methods From July 2014 to June 2015, 150 cases of Ⅰsurgical incision and 50 cases of Ⅱ surgical incision in Department of General Surgery in the hospital were selected, with a total of 200 cases, which were set as the control group, and the intervention control study was used. After intervention, 150 cases of Ⅰ surgical incision and 50 cases of Ⅱ surgical incision in Department of General Surgery in the hospital were selected,with a total of 200 cases, which were set as the intervention group, the related indexes were studied. Results With the intervention of clinical pharmacists, the problems of the application of antibacterials in the perioperative period have been improved obviously, the irrational use rate of antibacterials has been significantly reduced, and the selection of drug category, dosage selection, drug use route and preventive drug use time were more rational. Conclusion In the management of the use of antibacterials in the perioperative period, the corresponding measures should be formulated and the drug intervention should be carried out on the irrational situation.

目的 探讨布地奈德序贯吸入治疗咳嗽变异性哮喘(CVA)的临床疗效及其对患者气道炎性反应的影响.方法 选取湖北省中西医结合医院2015-2016年收治的CVA患者90例,随机分为对照组和序贯组,各45例.对照组患者给予布地奈德粉吸入剂治疗,序贯组患者在对照组基础上雾化吸入布地奈德混悬液治疗3 d.两组患者均持续治疗1周.比较两组患者的临床疗效、治疗前后咳嗽症状评分及呼出气一氧化氮(FeNO)值,并观察患者不良反应发生情况.结果 治疗前,两组患者咳嗽症状评分及FeNO值比较,差异无统计学意义(P>0.05);治疗后,序贯组患者咳嗽症状评分及FeNO值低于对照组(P<0.05).两组患者治疗期间均未出现明显不良反应.结论 采用布地奈德序贯吸入疗法治疗CVA的临床疗效确切,可有效改善患者临床症状,缓解气道炎性指标,且安全性高.

Objective To investigate the value of tracheoscopy in extubation of patients with tracheotomy.Methods An analysis was conducted on 160 extubation patients with tracheotomy in our hospital from June 2013 to September 2016.The study group was given tracheoscopy before extubation, and the control group was given traditional test tube plugging before extubation.Blood routine test and chest CT were conducted to assess the situation of lung infection for comparing the success rate of extubations.Results In the study group, 22 cases were found with granulation hyperplasia on the inwall at trachea incision, 1 case of tracheostenosis at the upper part of trachea incision, 2 cases of increased airway secretion.55 cases were judged as being ready for extubation, and the actual success rate was 67.5%.As to the traditional method, 42 cases were judged as being ready for extubation, and the actual success rate was 51.25%.The statistical difference between the two groups was P<0.05.Conclusion Tracheoscopy is effective in accurately judging the feasibility of extubation in patients with tracheotomy, with a low risk and a high success rate, so it is worthy of being used in clinical applications.

Objective To explore the clinical value of GLCCI1 gene detection in guiding administration of inhaled corticosteroids in patients with asthma.Methods Eighty asthma patients were divided into wild type allele group (n =64) and mutant type allele group (n =16) according to GLCCI1 gene detection.Both groups were treated with budesonide aerosol,and the clinical effect was compared between two groups.Results In wild type allele group,the total effective rate was 92.2％ and the incidence rate of adverse reaction was 7.8％,which were significantly better than 75.0％ and 25.0％ in mutant type allele group (P ＜ 0.05).There were significant differences in FEV1,FEV/FVC ratio,FVC and PEF between two groups (P ＜ 0.05).Conclusion The GLCCI1 gene detectiou can significantly improve the effect of inhaled corticosteroids and reduce the incidence rate of adverse reactions.

Objective To investigate the diagnostic value of procalcitonin( PGT)detection in patients with acute ex-acerbation period chronic obstructive pulmonary disease( AEGOPD). Methods A total of 180 AEGOPD patients were admit-ted in the Hubei Province Ghinese and Western Medicine Hospital from May 2014 to May 2015,according to the results of blood culture positive patients were divided into A group of 6 cases,according to the results of the quantitative sputum culture was not detected in blood culture were divided into bacterial infection group( B group) and 102 patients with non bacterial infection group(G group)52 cases(excluding 20 cases of mixed infection). According to the quantitative bacterial species isolated,B group was subdivided into G-group of 66 cases and G+ group of 36 cases. The level of PGT among the 3 groups were compared, the observation group B patients detected pathogenic bacteria. The B patients were randomly divided into D group and E group, 51 cases in each. Patients in D group were treated with empiric antibiotic therapy,patients in group E were treated with antibiot-ics according to the level of PGT. Hospital stays,group E,the time of antibiotic use,double infection rate,recurrence rate be-tween D group and E group were compared,B group on admission and infection control after 1 months of PGT level were ob-served. Results PGT of A group was higher than that of G- group,the difference was statistically significant(P〈0. 05);PGT of A group was higher than that of G+ group,the difference was statistically significant( P〈0. 05);PGT of A group was higher than the G group,the difference was statistically significant(P〈0. 05);PGT of G- group was higher than that of G+group,the difference was statistically significant(P〈0. 05). Among the pathogen detection in patients of B group,Strepto-coccus pneumoniae,Klebsiella pneumoniae,Haemophilus influenzae had a higher proportion. Hospitalization time,antibiotics use days of D group were longer than E group,mortality rate,double infection rate were lower than the E group,the differences were statistically significant(P〈0. 05);the recurrence rate of the two groups was compared,the difference was not statistically significant(P〉0. 05). B group with infection control 1 month after the PGT level was lower than the admission,the difference&nbsp;was statistically significant( P〈0. 05). Conclusion PGT can indicate that AEGOPD exists in patients with bacterial infec-tion,and can prompt the patient's severity of bacterial infection and identify pathogenic categories,according to the continuous monitoring of PGT developed anti infection scheme can reduce hospitalization days and the use of antibiotics in time.

目的：评价磷霉素治疗耐碳青酶烯－肺炎克雷伯菌感染患者的临床疗效及安全性。方法回顾性分析我院2012年5月～2015年9月间收治的64例耐碳青酶烯－肺炎克雷伯菌感染患者的临床资料，将患者分为观察组和对照组，每组32例，观察组患者均经中心静脉导管给予滴注磷霉素钠治疗，对照组患者给予替加环素治疗，观察两组患者的临床疗效及不良事件发生情况。结果观察组患者治疗后细菌清除23例，假定清除6例，治疗过程中死亡3例，死亡率为9．4％，对照组患者细菌清除率为56．3％，死亡率为25．0％，两组患者在细菌清除率和死亡率方面的差异有统计学意义（ P＜0．05），两组患者未发生不良反应。结论磷霉素治疗耐碳青酶烯类肺炎克雷伯菌感染是一种合理的选择，临床疗效可靠，安全性较高。

目的：评价糖皮质激素与环磷酰胺联合应用治疗肾病综合征的疗效。方法回顾性分析我院2014年6月～2016年6月间收治的82例肾病综合征确诊病例资料，所有患者均给予甲泼尼龙联合环磷酰胺治疗，观察患者治疗前后肾功能相关指标变化情况。结果本组患者治疗后的24Upro、BUN、Scr、ALB以及尿量水平均较治疗前有明显改善，经统计学检验表明具有统计学意义（P＜0.05），治疗后随访6个月无复发病例。结论糖皮质激素甲泼尼龙与环磷酰胺联合应用治疗肾病综合征能够起到协同增效的作用，应在临床进一步推广使用。

对我院收治的一例因联用吡贝地尔与降压药而发生急性低血压的老年患者的临床资料进行回顾性分析.该老年患者同时罹患高血压、帕金森病与股骨头骨折,因发生肺部感染而来我院就诊.在该患者入院后,我们对其进行了对症支持治疗,使其病情稳定.此后,我们继续应用多芭丝肼片、吡贝地尔缓释片和氨氯地平片对其进行治疗.该患者因存在吞咽困难的情况,需将上述药物捣碎、化成药水后服用,但在用药后发生了低血压休克、心率加快等不良反应.经抢救后,该患者病情趋于稳定,我院药师指导其将吡贝地尔缓释片捣碎后分4次服用,此后其未再出现低血压.我们考虑,该患者发生的低血压可能与其所用吡贝地尔缓释片的剂型被破坏及服用方法有误有关.

探讨目前社区医院开展药学服务的模式,促进患者合理用药,提升药学服务质量。通过自身开展力所能及的药学服分析不足,思考对策。采取相应措施,外界支持,自身提高,努力提高药师服务水平。

目的通过对2010年四个季度我院门诊用药情况的分析,了解门诊用药情况,促进临床合理用药。方法回顾分析法抽查处方,分别按处方用药品种、处方注射药物、不合理用药、处方金额几方面进行分析。结果 4个季度共抽查3215张处方,各季度大于等于6种处方比例为3.2～9.3%,平均每张处方金额在在63～90元之间,注射剂使用在处方比率中占18.9%～23.2%,抗菌药比率最大。结论通过调查分析觉得门诊用药基本合理,但还有改进的地方,促进今后患者用药的合理性。