目的 了解鲍曼不动杆菌在重庆地区的耐药特征,为临床合理选用抗菌药物提供参考.方法 回顾性分析2017年至2019年重庆市4家三级甲等综合医院[中国人民解放军陆军军医大学第一附属医院(以下简称西南医院)、重庆医科大学附属第二医院(以下简称重医附二院)、重庆市垫江县人民医院(以下简称垫江医院)和重庆市黔江中心医院(以下简称黔江医院)]鲍曼不动杆菌的检出和耐药情况,统计鲍曼不动杆菌的检出率、科室分布、菌株来源,以及对常用抗菌药物的耐药率.结果 2019年,除西南医院和黔江医院外,重医附二院和垫江医院鲍曼不动杆菌检出率均较2017年上升;各医院鲍曼不动杆菌均主要来源于痰液,主要分布在重症监护室、神经外科、烧伤科(西南医院).西南医院2017年至2019年鲍曼不动杆菌对大部分检测药品的耐药率呈下降趋势,主要为50％～75％,2019年对氨苄西林、氨曲南的耐药率较2017年升高且高于75％,对其余检测药品的耐药率均低于75％,其中2018年和2019年对左氧氟沙星的耐药率均低于35％;重医附二院鲍曼不动杆菌对检测药品的耐药率呈波动变化,2019年的耐药率整体上升,对大部分药品的耐药率超过75％,其中对阿莫西林克拉维酸、氨苄西林、氨曲南、头孢曲松的耐药率均为100％,对阿米卡星、庆大霉素、妥布霉素、复方新诺明的耐药率均为35％～75％;垫江医院2017年至2019年鲍曼不动杆菌对环丙沙星、头孢他啶、亚胺培南、头孢吡肟、哌拉西林他唑巴坦的耐药率持续上升,对左氧氟沙星的耐药率持续下降,对其余检测药品的耐药率呈波动变化,2019年对阿米卡星、美罗培南、哌拉西林他唑巴坦、头孢哌酮舒巴坦的耐药率均超过75％,对左氧氟沙星的耐药率低于35％;黔江医院鲍曼不动杆菌对检测药品的耐药率呈波动变化,除2017年的亚胺培南外,对所检测药品的耐药率均低于75％,对复方新诺明的耐药率低于35％.结论 同等级医院鲍曼不动杆菌的检出率和耐药率存在较大差异.建议细菌耐药率较高医院的临床医师严格参照鲍曼不动杆菌的药物敏感性试验结果合理选择抗菌药物,以减少耐药菌株的产生.

目的:了解重庆市垫江县人民医院骨科Ⅰ类切口手术期围术期抗菌药物预防使用的现状,为临床合理应用抗菌药物提供一定的参考.方法:采用回顾性调查分析法,抽取我院骨科2019年9月-2020年9月出院的Ⅰ类切口手术患者病历,综合分析围术期抗菌药物使用的合理性.结果:我院骨科593例Ⅰ类切口手术中,抗菌药物预防使用率达74.54％(442/593).手术切口感染率为8.6％(51/593).442例预防性使用抗菌药物的手术中,抗菌药物选择合理率为99.77％(441/442);术前30min-1h给药率99.55％(440/442);预防用药疗程≤24h者217例,占51.79％(217/419);预防用药中不合理95例,用药合理率为78.51％(347/442).抗菌药物使用不合理情况主要包括:无指征预防用药、药物选择不恰当、给药时机不合理、用药疗程偏长及用法用量不适宜.结论:我院骨科Ⅰ类切口手术围术期抗菌药物预防使用率较高,用药疗程偏长,存在较多不合理用药,需进一步加强监督管理,促进围术期抗菌药物的合理使用.

目的:为临床合理应用人血白蛋白提供参考.方法:采用回顾性分析方法,抽取某院2017-2020年应用人血白蛋白的住院患者病历,对科室用药情况分布、患者个人用量分布、用药前血清白蛋白水平进行统计分析,并以美国白蛋白应用指南(2010年版)、2018年《临床药物治疗杂志》人血白蛋白合理使用专栏和《人血白蛋白用于肝硬化治疗的快速建议指南》解读(2018年版)为标准进行评价.结果:该院339例应用人血白蛋白的患者主要分布在消化内科(24.5％)、重症医学科(17.4％)、肿瘤科(16.2％)及呼吸及危重症医学科(10.3％);用药前血清白蛋白水平以20～<25g﹒L-1(50.7％)为主;用药理由主要集中在以下方面:低蛋白血症(36.9％)、肝硬化腹水(11.2％)、癌症相关性水肿(9.1％)、营养支持(8.0％)和脓毒血症(7.1％);仅92例(27.1％)白蛋白用药理由与相关指南或循证医学证据相符合,最主要的不适宜用药理由为纠正低白蛋白血症.结论:该院白蛋白临床应用适应症与相关循证医学证据符合率偏低,存在不合理用药情况,需加强管理,规范人血白蛋白的合理使用.

目的 为临床治疗卡他莫拉菌耐药提供参考.方法 回顾性分析重庆市陈家桥医院(简称陈家桥医院)、重庆市垫江县人民医院(简称垫江医院)、重庆市黔江中心医院(简称黔江中心医院)、重庆医科大学附属儿童医院(简称儿童医院)2015年至2019年卡他莫拉菌的检出及耐药情况.结果 陈家桥医院、黔江中心医院、垫江医院2015年至2019年卡他莫拉菌检出率均呈升高趋势;2019年,儿童医院卡他莫拉菌的检出率为6.33％(1089/17215),陈家桥医院的检出率为18.00％(282/1567),黔江中心医院的检出率为16.61％(745/4484),陈家桥医院和黔江中心医院检出率无显著差异(χ2=1.57,P=0.21),但均显著高于儿童医院(χ2=289.08,486.69,P<0.01).与2019年第1,2,3季度比较,儿童医院、陈家桥医院和黔江中心医院第4季度检出率均最高.陈家桥医院儿科病房2015年至2017年的检出量占总检出量的百分比逐年升高,垫江医院儿科病房2016年至2019年的检出量占总检出的百分比逐年下降.2017年至2019年,陈家桥医院、黔江中心医院、垫江医院分离的卡他莫拉菌在革兰阴性菌中的检出率均逐年升高.陈家桥医院2015年至2019年卡他莫拉菌呼吸道样本中的检出率均在20％以上;垫江医院2019年卡他莫拉菌呼吸道样本中的检出率均高于2015年至2018年;黔江中心医院2018年至2019年卡他莫拉菌呼吸道样本中检出率均高于2015年至2017年.2015年至2018年,陈家桥医院分离的卡他莫拉菌对红霉素的耐药率均超过20％.2015年至2019年,垫江医院分离的卡他莫拉菌对氨苄西林耐药率高,在82.21％ ～95.78％之间;对复方新诺明的耐药率为23.10％ ～43.92％;对头孢克洛的耐药率为9.79％ ～34.32％;对头孢呋辛的耐药率为8.83％ ～23.31％;对头孢克洛、头孢呋辛、复方新诺明的耐药率均高于陈家桥医院.结论 2015年至2019年,重庆不同医院卡他莫拉菌的耐药情况均不同,临床应根据卡他莫拉菌药物敏感性试验结果合理选择抗菌药物,以减少耐药菌的产生.

OBJECTIVE: To evaluate the effects of special prescription comment model intervention on prophylactic application of antibiotics during perioperative period of clean operation in our hospital. METHODS: By founding specialist group and prescription comment group, formulating unified form for evaluating prophylactic application of antibiotics during perioperative period of clean operation, establishing comment criteria referring to Guidelines for Clinical Antibiotics Use (2015 edition), Notice on Further Strengthening the Management of Clinical Antibiotics Use, drug package inserts and so on; havivg the aid of administrative intervention and quality assessment, The special prescription comment model was established. Based on stratified sampling (according to the clinical departments, kind of procedure), Each 180 medical records were collected from our hospital during Jan. -Jun. 2015 (before intervention) and Jan. -Jun. 2016 (after intervention). The unified form for perioperative period of clean operation was formulated to comment each medical record in respects of prophylactic utilization rate of antibiotics, medication indication, medication timing, drug selection, usage and dosage, medication course, drug combination, etc. RESULTS: After the following intervention measures were adopted, such as The prophylactic utilization rate of antibiotics of our hospital during perioperative period of clean operation decreased from 96. 7％ before intervention to 25. 0％ after intervention (P< 0. 05). The rates of drug use without indication, irrational medication timing before surgery, irrational drug selection, irrational usage and dosage, irrational medication course and irrational drug combination were decreased from 71. 3％, 72. 4％, 65. 5％, 23. 0％, 97. 1％, 17. 8％ before intervention to 4. 4％, 0, 8. 9％, 11. 1％, 22. 2％, 0 after intervention (P<0. 05) respectively. Before intervention, 8 categories 20 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation; 86 patients used 2 kinds of or more antibiotics, among which there were 31 cases of drug combination and 55 cases of drug replacement. After intervention, 3 categories 4 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation; there was no drug combination and drug replacement. CONCLUSIONS: Special prescription comment model can obviously improve rational use of antibiotics during perioperative period of clean operation.

OBJECTIVE:To investigate the role of clinical pharmacists on drug therapy for acute exacerbations of chronic ob-structive pulmonary disease(AECOPD)patients with benign prostatic hyperplasia(BPH). METHODS:Clinical pharmacists partici-pated in drug therapy for a AECOPD patient with BPH. According to clinical guideline and relevant literatures,based on the history of disease,the characteristics of bronchodilators and the symptoms of acute urinary retention,it was suggested to stop taking Ip-ratropium bromide solution for inhalation but receive Finasteride capsules 5 mg,po,qd,to reduce prostate volume and improve ob-struction+Terazosin hydrochloride tablets 2 mg,po,qd,to relax urethral smooth muscle;the occurrence of ADR was monitored closely. Salmeterol xinafoate and fluticasone propionate powder for inhalation was suggested and medication guidance for patients af-ter discharge was given by clinical pharmacists. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The pa-tient was stable and had no dysuria. The patient was allowed to leave the hospital with drugs. CONCLUSIONS:Rational use of bronchodilators is directly related to the remission of clinical symptoms and prognosis in AECOPD patients. In view of patient's dis-ease history,drug characteristics and clinical symptoms,clinical pharmacists point to possible risks of anticholinergics use,and as-sist physicians to formulate and adjust therapy plan so as to guarantee the safety and effectiveness of drug use.

OBJECTIVE:To prepare paeonol-HP-β-cyclodextrin (PAE-HP-β-CD) inclusion compound and to optimize its pre-scription technology. METHODS:PAE-HP-β-CD was prepared by freeze drying method and validated. Using inclusion rate as in-dex,main drug-accessory ratio,inclusion time,inclusion temperature and stirring speed as factors,the preparation technology was optimized by central composite design-response surface methodology. RESULTS:Prepared PAE-HP-β-CD underwent phase transfor-mation. The optimal inclusion technology was as follows as main drug-accessory ratio of 3.39∶1,inclusion temperature of 50 ℃, inclusion time of 3.2 h, stirring speed of 350 r/min. Relative error between measured value (87.46%) and predicted value (89.12%) of inclusion rate was 1.86%(n=6). CONCLUSIONS:PAE-HP-β-CD inclusion compound is prepared successfully, and its prescription technology is stable and feasible.

OBJECTIVE:To investigate the characteristics and factors of ADR caused by Chinese patent medicine(CPM)and to provide reference for rational drug use and safety evaluation in the clinic. METHODS:158 cases of ADR caused by CPM collect-ed from our hospital during Jan.2009-Dec.2014 were analyzed. RESULTS:The occurrence of ADR caused by CPM was related to patient’s age,route of administration,category of drugs,irrational drug-use and so on. The incidence of ADR in patients over the age of 60 was the highest (31.01%),the largest number of ADR were caused by intravenous injection (79.11%),ADRs were most likely caused by blood-regulating preparation and dissipate blood stasis preparation (79.75%);ADR manifested as lesion of skin and its appendents(43.01%),followed by gastro-intestinal injury(16.06%)and whole-general injury(10.36%). The severe ADR was anaphylactoid reaction;after symptomatic treatment,the prognosis is good. CONCLUSIONS:According to syndrome differentiation and individual difference,CPM should be used rationally,and great importance should be attached to drug use moni-toring to reduce the incidence of ADR.

目的:探讨辛伐他汀治疗冠心病的效果及机制。方法:将收治的60例冠心病患者分为治疗组和对照组,对照组采用心内科常规治疗,治疗组在对照组的基础上加用辛伐他汀治疗,比较两组患者的治疗效果、心血管不良事件的发生率及内皮功能的变化。结果:治疗组的总有效率为83.3%,显著高于对照组的66.7%(P<0.05)。治疗组血浆内皮素(ET)、一氧化氮(NO)的含量的改善显著高于对照组(P<0.05)。两组随访6～12个月,治疗组的心血管不良事件的发生率显著低于对照组(P<0.05)。结论:辛伐他汀可有效预防冠心病的不良心血管事件,可能与其改善血管的内皮功能有关。