1 病例介绍 患者,男,64 岁,2022 年 5 月 16 日因眼睑下垂、视物模糊2 周,伴头昏、恶心呕吐、胸闷至华中科技大学同济医学院附属协和医院就诊,行溴吡斯的明实验后眼睑下垂症状稍好转,以"重症肌无力"收住入院.

1 病例介绍 患者,男, 63 岁. 因"右侧腰部疼痛,间断发作3年"于2022年2月21日入武汉协和医院,既往有高血压、冠心病、糖尿病和胃部分切除病史. 平常口服坎地沙坦酯片8 mg,qd;二甲双胍缓释片1 g,qd;格列齐特缓释片60 mg,qd;阿托伐他汀钙片20 mg,qn;氯吡格雷片(杭州赛诺菲民生健康药业有限公司,规格:每片75 mg ) 75 mg,qd,血压、血糖控制良好.

1 病例介绍患者,男,55岁,2018年6月16日因"间断心慌、气促12年,加重1个月余"入住华中科技大学同济医学院附属协和医院,外院心电图示心房颤动（房颤）伴快速心室率,冠状动脉造影示冠状动脉粥样硬化,入院后初步诊断"阵发性房颤,冠状动脉粥样硬化",血红蛋白157 g·L-1,血小板149×109·L-1,食道超声检查提示:左房及左心耳未见血栓,于2018年6月21日行房颤射频消融术,手术成功,并于2018年6月23日出院,

新型口服抗凝药(NOACs)与胺碘酮是房颤患者的常用药物,凝血Ⅹa因子抑制药为临床广泛应用的NOACs,是细胞色素P4503A4和P糖蛋白(P-gp)的共同底物,胺碘酮是中等强度的CYP3A4和P-gp抑制药,两者联用可能会发生相互作用.本文对Ⅹa因子抑制药与胺碘酮联合用药后的相互作用机制、药动学、药效学、出血风险、特殊人群用药进行汇总分析,为临床合理用药提供参考.总的来说,联用后胺碘酮对Ⅹa因子抑制药影响轻微,其暴露量、抗血栓强度、出血风险较单用增加但并未产生显著影响.对于肝肾功能不全的患者,尤其是对于重度肾损伤合并高龄的患者,Ⅹa因子抑制药暴露量和患者出血风险会显著增加,因此在联合用药过程中需监测患者的肝肾功能,评估药物的抗凝功效,避免患者出血风险.

Coronavirus disease 2019 (COVID-19) patients are particularly critically ill, often accompanied by D-djurogen elevation, easy to induce or aggravate the occurrence of ischemic stroke. Both diseases have similar symptoms such as headache, vomiting, fever and shortness of breath in the early stages of their medical history, which can easily lead to misdiagnosis, missed diagnosis, and mutual influence, resulting in prolonged course of illness. For patients with COVID-19, anti-venom treatment should be actively taken as soon as possible, combined with stroke patients, the indicator change of D-diamer should be closely monitored, according to its indicators to give patients appropriate anti-thrombosis treatment, once the D-diamer rises, it is recommended to start anticoagulant immediately, while controlling the patient's blood pressure lipids and other high-risk factors. In this paper, combined with the research on stroke-related drug use, this paper discusses the rational drug use strategy and pharmacological care of high-risk groups such as COVID-19 combined with stroke, and provides reasonable drug use reference for such patients.

目的:探讨振荡溶解速率对注射用重组人促红素溶解后体内外活性的影响,为临床应用提供参考。方法:参照中国药典2015年版三部,按酶联免疫法试剂盒说明书测定高、中、低(800,1 600 2 300 min -1 )不同振荡速率下注射用重组人促红素及对照药品重组人促红素注射液B和C体外活性;参照通则3522方法,采用近交系6～8周龄雌性BALB/C小鼠测定不同振荡速率注射用重组人促红素及注射液的体内活性;采用单因素方差分析或非参数检验对各组体内外活性结果进行比较。结果:注射用重组人促红素在低速振荡频率时的体内外活性均显著低于其他各组（P＜0.01）;中、高速振荡速率组与注射液B和C组的体外活性相当但体内活性仍存在显著差异（P＜0.01）。结论:临床配置注射用重组人促红素时应尽量采用中、高速的振荡频率,以尽可能获得更佳的体内生物学活性。

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:探索新型冠状病毒肺炎疫情下方舱医院药学服务新模式方法:满足方舱医院患者药学服务需求,开展以微信等形式为主的线上药学服务模式。结果与结论:通过开展以微信为主要方式的线上药学服务模式,不仅能够有效减少医院获得性感染机会,还能提高药学服务效率,实现患者全程及时有效的得到专业用药指导。

新型冠状病毒肺炎（COVID-19）患者尤其是重症类型,疾病后期机体凝血/纤溶系统功能紊乱十分常见,极易诱发或加重深静脉血栓形成（DVT）,甚至发生肺栓塞（PE）等严重致死性临床结局。COVID-19合并妊娠及产褥期这一类高危人群,其机体一系列生理、血流动力学改变会增加患者发生静脉血栓栓塞症（VTE）的风险;同时VTE患者血液高凝和纤溶酶原亢进状态容易造成机体免疫识别障碍,有助于新型冠状病毒（SARS-CoV-2）的免疫逃逸,使COVID-19患者病程延长,两种疾病相互影响。因此采取及时有效的预防治疗方案能减少妊娠期COVID-19患者发生VTE的风险、缩短病程、改善预后。本文结合VTE合理用药相关研究,探讨妊娠及产褥期COVID-19合并VTE患者的抗病毒、抗凝及溶栓治疗方案与药学监护服务,以期为这类特殊患者合理用药提供参考。

OBJECTIVE To make a comprehensive evaluation of the clinical application of tigecycline,and provide references for the rational application and monitor program of this drug.METHODS Tigecycline used in our hospital from June 1,2013 to May 31,2016 was investigated,and its clinical use by the hospital centralized monitoring method was evaluated.The patient characteristics,medications,dosage regimes,treatment plans,combination treatment and pathogen test results,clinical outcomes and safety were summarized and analyzed.RESULTS The total number of cases was 1 415,including 63.96％ males,63.25％ were 18-69 years old;72.93％ (1 032) patients were treated by medication mainly against lung,abdominal and soft tissues infections.The top 3 pathogens were Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli.The mainly irrational uses of tigecycline included no indications medication,improper dosages,long course of treatment and irrational combination use.The total ADR number was 27 (1.91 ％),all were considered mild.The irrational use of tigecycline showed a decreased trend after the centralized monitoring and management measures were improved.CONCLUSION The clinical use of tigencycline in our hospital is basically reasonable,but there's still several irrational medication which still need special management to prompt the rational medication for tigecycline.

OBJECTIVE To evaluate the teaching effect on clinical pharmacotherapy,and discuss to develop the cooperative teaching model for undergraduate students of clinical pharmacy by universities and hospitals.METHODS The course was given by the clinical pharmacists in hospital in English to overseas students of Huazhong University of Science and Technology.The teaching content and effect was investigated through survey and literature research.RESULTS The chapters of the course are comprehensive,while the time of teaching is relatively limited.The contents more emphasized on basic concepts,while the practical ability training was slipped.CONCLUSION Based on the hospital pharmacy practice,the clinical pharmacists should focus on building capacities on pharmaceutical servicesthrongh multiple teaching forms and assessments.

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

Objective: To investigate the principles of rational drug use for the patients suffering from heart failure complicated with diuretic-induced gouty arthritis.Methods: The clinical pharmacist participated in the diagnosis, treatment and drug adjustment of one patient suffering from heart failure complicated with furosemide-induced gouty arthritis.Taking the disease symptoms and potential gouty-inducing drugs into full consideration, clinical pharmacist suggested the withdrawal of related-drugs and the adjustment of treatment plan.Results: Considering the characteristics of the patient, clinical pharmacist adjusted the rational drug treatment.After the adoption of the suggestions, the gouty symptoms were relieved, heart failure was controlled and the condition was improved.Conclusion: Loop diuretics can easily trigger an acute attack of gout, especially for the patients with heart failure and gout history.Clinical pharmacist can make full use of professional advantages to optimize the treatment plan in order to reduce adverse reactions and promote the rational drug use by participating in clinical practice.

Objective To explore the role of clinical pharmacist in individualized treatment of hypertension.Methods A patient with " H" hypertension receiving pharmaceutical care from clinical pharmacists was retrospectively analyzed.Results Patient's MTHFR (C677T) gene type was TT homozygous.Clinical pharmacist suggested doctor modify treatment,and then patient's plasma homocysteine dropped from 61.5 to 16.0 μmol·L-1,and blood pressure dropped from 173/ 111 mmHg(1 mmHg =0.133 kPa) to 130/80 mmHg.Conclusion Clinical pharmacist provides individualized treatment for patient with hypertension to ensure the safety and effectiveness of the drug by genotyping.

OBJECTIVE:To investigate the clinical characteristics and gene polymorphism of oxcarbazepine (OXC)- induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS:Retrieved from CNKI,Wanfang,VIP, PubMed,EMBase,SpringerLink and other databases,case reports about OXC-induced severe ADR were summarized and ana-lyzed. RESULTS:Twelve literatures were collected,and 13 case reports about OXC-induced SJS/TEN were obtained. Male had more OXC-induced severe skin ADR than female. ADR mostly occurred during 1-14 d after medication. All patients were cured with treatment of glucocorticoid and antiallergy,without death case. Genotyping for 8 patients were performed and 6 of them showed the presence of HLA-B*1502 allele. While HLA-B alleles of 2 patients were HLA-B*1518/B*4001,which was the variation of HLA-B*1502. CONCLUSIONS:OXC-induced ADR should be monitored closely. Great importance should be attached to patient education and follow-up program. HLA-B*1502 gene detection should be performed to guide rational use of OXC and optimize clini-cal drug use plan.

目的:从原发性高血压(HPN)与慢性心力衰竭(CCF)的双视角,利用Cochrane方法系统评价缬沙坦与卡托普利的疗效,为临床药物选择提供循证证据.方法:计算机检索PubMed、EMbase、Web of Science、Cochrane Library、 CBM、CNKI、维普和万方等数据库,检索时限均为从建库至2013年6月.由2名评价者按照纳入与排除标准以及Cochrane协作网推荐的方法独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 4.2软件进行Meta分析.结果:HPN有效性部分纳入13个研究,1 222例患者,CCF有效性部分纳入9个研究,852例患者.与卡托普利比较,缬沙坦治疗HPN和CCF的效果总体上优于卡托普利.在治疗HPN方面,缬沙坦降低收缩压效果优于卡托普利[WMD=-1.88(95％CI,-3.84 ～0.08),P=0.05];在治疗CCF方面,缬沙坦提高左心室射血分数(LVEF)效果优于卡托普利[WMD=-3.15 (95％ CI,0.79 ～5.52),P＜0.01].安全性部分纳入17个研究,合并分析结果显示缬沙坦治疗HPN和CCF的不良反应发生率低于卡托普利[OR =0.23(95％ CI,0.16 ～0.32),P＜0.01].结论:基于现有临床循证医学证据,缬沙坦治疗原发性高血压与慢性心力衰竭的有效性和安全性均优于卡托普利,是临床治疗高血压及慢性心力衰竭较好的用药选择.

1例63岁男性患者因甲状腺功能亢进给予甲巯咪唑片5mg,2次/d。给药前肝功能正常,1w后,患者复查肝功能异常。实验室检查院AST 131IU/L,ALT 95IU/L。伴有食欲下降,乏力。肝功能异常考虑与甲巯咪唑有关,遂停药。停药1w后复查肝功能示肝酶正常,但碱性磷酸酶176U/L尹,直接胆红素24.0μmol/L尹,总胆红素27.5μmol/L尹,肝功能仍异常。进一步给予还原性谷胱甘肽粉针、异甘草酸镁注射液护肝治疗,治疗4d后患者要求出院,出院后继续给予口服水飞蓟素胶囊护肝,1w后门诊复查肝功能正常。