目的:新冠肺炎疫情期间为慢性病复诊患者提供治疗用药和药学服务,降低非新冠肺炎患者的死亡率并减缓病情进展,积极探索门诊药学服务线上线下相结合（online to offline,O2O）模式。方法:基于我院线上问诊平台,增加线上处方和药品邮寄模块,统计分析2020年2月19日-2020年3月7日线上门诊药学服务实践中患者年龄、就诊科室以及处方审核、药品调剂等相关数据。结果:开展线上药学服务后,线上问诊10 269人次,就诊科室主要为心内科、神经内科、感染科、内分泌科等慢性病科室;医院药师调剂线上处方6 880张,调剂药品总数125 864盒/瓶,有效缓解了慢性病患者用药困难。患者就诊年龄集中于20～70岁,35岁以上患者达到74.30%,表明中老年患者可通过自身或他人帮助享受慢性病线上就诊服务。药师处方审核率100%,审核不通过处方483张,不合格率7.02%,主要不合理因素为用法用量不适宜。结论:新冠肺炎疫情期间,开展线上门诊药学服务对防控疫情和救治慢性病患者具有重要作用,也表明公立医院和患者已具备共同参与"互联网+医疗"的能力。门诊药师应积极探索药学服务O2O模式,借助"互联网+"重构药品供应保障服务体系,挖掘和重塑药师的专业价值。

目的:观察保胃宁颗粒(Boweining Granule,BG)对胃溃疡大鼠模型的影响.方法:制作大鼠20％乙酸型胃溃疡模型,观察保胃宁颗粒对胃溃疡的治疗作用;制作幽门结扎性大鼠胃溃疡模型,观察保胃宁颗粒大鼠溃疡指数、溃疡抑制率、胃酸酸度及胃蛋白酶的影响;制作水浸应激性大鼠胃溃疡模型,观察保胃宁颗粒大鼠溃疡指数、溃疡抑制率及胃黏膜组织一氧化氮(nitric oxide,NO)、血清超氧化物歧化酶(Serum superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)的含量.结果:20％乙酸型胃溃疡模型:模型组大鼠胃部可见明显溃疡,其溃疡指数显著高于假手术组,差异具有统计学意义(P＜0.01).与模型组比较,BG中剂量组、高剂量组及雷尼替丁组均能显著降低模型大鼠的溃疡指数(P＜0.01).幽门结扎性大鼠胃溃疡模型:BG中剂量组、高剂量组及雷尼替丁组能显著降低模型大鼠胃酸浓度、胃蛋白酶活性及溃疡指数,与模型组比较,差异具有统计学意义(P＜0.05).水浸应激性大鼠胃溃疡模型:与模型组比较,BG高剂量组及雷尼替丁组均能显著降低大鼠溃疡指数,差异具有统计学意义(P＜0.05).与空白对照组比较,模型组NO及SOD含量显著下降,MDA含量显著增加,差异均有统计学意义(P＜0.01).与模型组比较,保胃宁中剂量组、高剂量组及奥美拉唑组能著增加NO及SOD含量,降低MDA含量,差异均有统计学意义(P＜0.05).结论:保胃宁颗粒对大鼠实验性胃溃疡具有较好的保护作用,其可能是通过降低胃酸酸度及胃蛋白酶活性,增加胃黏膜NO和SOD含量并降低MDA含量发挥作用的.

Objective To investigate the medical effect of the ethanol extract of Acorus gramineus Sol.on arthritis of mice induced by collagen-Ⅱ,and explore the potential pharmacological mechanisms.Methods Arthritis mouse model was established by injection of admixture containing type Ⅱ collagen and Freund's complete adjuvant (FCA) in male BALB/c mice.Mice were divided into five groups:the normal control group (0.9% of sodium chloride solution),the model control group (0.9% of sodium chloride solution),tripterygium group (15 μg·kg-1 of tripterygium tablets), the high-dose of extract of Acorus gramineus Sol.group (60 mg·kg-1 extract of Acorus gramineus Sol.) and the low-dose of extract of Acorus gramineus Sol.group (15 mg·kg-1 extract of Acorus gramineus Sol.).Each group was administered once a day,lasting 21 days.During the experiment,ankles of all mice were measured at predetermined time.At the end of the experiment,blood of the mice was exsanguinated and centrifuged to get serum for measuring the levels of IL-1β,RF and TNF-α.Spleens of mice were dissected and weighed to calculate the spleen index.All arthritis ankles were dissected to make tissue section,and observed under microscope.Results Compared with the model control group,the perimeter of ankle joints of the high-dose of extract of Acorus gramineus Sol.group significantly changed 6 days after administration (P<0.05);That of the low-dose of extract of Acorus gramineus Sol.group significantly changed 12 days after administration (P<0.05);That of tripterygium group significantly changed 9 days after administration (P<0.05).As compared with the normal control group, the spleen index of the model control group was significantly different (P<0.01).As compared with the model control group,the spleen index of tripterygium group,high-dose and low-dose of extract of Acorus gramineus Sol.groups were significantly different (P<0.05).As compared with the normal control group,levels of IL-1β,RF and TNF-α of the model control group were significantly different (all P<0.01).As compared with the model control group,levels of IL-1β,RF and TNF-α of tripterygium group,high-dose and low-dose of extract of Acorus gramineus Sol.groups were significantly decreased.Conclusion Ethanol extracts of Acorus gramineus Sol.have significant therapeutic effect on arthritis mice.The anti-arthritic mechanism is associated with its ability to regulate levels of IL-1β,RF and TNF-α.

目的:探讨基于绩效考核的适合本院院情的处方点评模式及其效果.方法:通过改进处方点评制度和流程,建立奖惩制度,采用回顾性分析方法,比较改进前后处方的合格率、医生接受率等指标变化.结果:采用新的处方点评模式之后,本院2015年下半年处方合格率(72.95％)和医生接受率(95.08％)均高于2015年上半年(59.67％,71.49％),差异有统计学意义(P＜0.05).结论:该模式具有可行性和操作性,最大限度地对门诊不合理用药进行主动干预,切实提高医院合理用药水平,同时增加临床接受度和认可度.