总结1例在完全胎盘支持下产时运用胸腔镜行胎儿膈疝修补的护理体会.护理要点:术前多学科联合制订手术方案,术中维持胎盘循环的稳定、产科组和儿科组人员明确分工并密切配合、母婴多模式体温管理、预防感染,加强术后转运及护理等确保产妇和胎儿安全.该例患儿成功完成产时手术,手术时间60 m in,术后产妇和患儿生命体征平稳,产妇剖宫产术后第6天出院,患儿术后转至新生儿重症监护室,术后第11天痊愈出院.

目的 收集并分析我院不良反应案例发生的特点,促进临床合理用药.方法 搜集2014年1月1日-2016年1月1日我院ADR监测中心数据库的ADR报告,就收集到的483例ADR相关信息按患者性别、年龄比例、给药途径、药物种类、ADR损害类型及临床表现等进行系统分析.结果 在483例报告中,50～69岁患者ADR的发生率最高;不同于国内有关文献报道,我院口服给药发生ADR病例(51.76％)多于注射制剂发生的ADR病例(45.13％);抗肿瘤药引起的ADR病例居首位(29.56％);ADR临床主要表现为皮肤及其附件损害,共142例,占29.40％.结论 在临床实践中,应该遵循个体化给药原则,关注中老年的用药安全,以减少或避免ADR的发生;加强口服药物的宣教活动,减少口服给药ADR的发生;应加强肿瘤患者严重不良反应的监测,以便根据肿瘤患者的自身特点,有目的性地进行合理给药.

A case of urinary incontinence induced by combination of gemcitabine and docetaxel was reported inthisresearch.Naranjo probability scale was used to analyze the relationship between the combination of gemcitabine and docetaxel and the urinary incontinence.This study analyzed the clinical research of adverse reaction of the combination of gemcitabine and docetaxel and made clear the possible mechanism of the caused urinary incontinence.According to Naranjo probability scale,there was a great possibility of urinary incontinence induced by combination of gemcitabine and docetaxel based on the valve of the total score being 7,yet the mechanism of urinary incontinence induced by combination of gemcitabine and docetaxel is not clear,which was speculated that might be with the neurotoxic effect of docetaxel induced bladder and urethral smooth muscle dysfunction.The pathogenesis of urinary incontinence is related to many factors,therefore,more cases are needed to clarify its mechanism to reduce the incidence of adverse drug reactions and to improve the living quality of the patients.