目的:分析审方系统滤出的不合理医嘱与实际情况的相符性,为实现精准的临床用药事前干预提供依据.方法:选择2016年5月至2017年5月智能审方系统自动滤出的最严重级别警告,进行人工二次审核分析.按照审查类型细分,选择占比最大的"配伍禁忌"项深入研究.统计排名靠前的科室与药品,对系统警报结果进行分型和分析.结果:"配伍禁忌"严重警报8016条,占严重级别问题医嘱的比例达到84％,占问题医嘱比例为4.06％,占总医嘱比例为0.07％.排名靠前的科室主要为外科手术科室,药品为临床使用较频繁且物化性质不稳定的注射剂.系统警报结果分为3类:核查无误类、循证证据不足或存在争议类、系统误报类.其中系统误报类2360条,占比29.44％.结论:无效甚至错误的审核结果不利于临床安全合理用药的开展,智能系统亟需药师的深度参与,以提高数据的精准性.临床配伍禁忌问题需要行政干预、知识储备、医嘱规范录入、说明书完善等各方面的配合解决.

Compound amino acid injection, as the source of nitrogen in parenteral nutrition, is administrated to patients with compromised gastrointestinal function or whose nutritional needs cannot be satisfied via the GI tract.Therefore, compound amino acid injection is crucial in nutrition therapies.However, a consensus does not exist in China regarding its indications, formulations, dosages, and the timing of administration.Experts in the field are recruited by the Chinese Society for Parenteral and Enteral Nutrition (CSPEN) and the Chinese Society of Nutritional Oncology ( CSNO) to formulate a consensus paper.The current paper aims to provide standardized guidance for clinical use of compound amino acid injection.The consensus paper is a composite of systematically reviewing pertinent literature, Chinese clinical practice, and multiple sessions of debate, discussion, and composition, with reference to guidelines from American Society for Parenteral and Enteral Nutrition ( ASPEN), European Society for Clinical Nutrition and Metabolism ( ESPEN), CSPEN, and CSNO.This consensus presents 10 recommendations for protein needs and appropriate compound amino acid injection formulas to serve varied patients.

来那度胺是由美国Celgene生物制药公司开发的抗肿瘤药物,是沙立度胺的4-氨基一戊二酰基衍生物,为一种新型的免疫调节剂,具有免疫调节及抗新血管生成作用,对骨髓瘤、白血病、实体瘤等具有疗效,可联合利妥昔单抗治疗套细胞淋巴瘤(mantle cell lymphoma,MCL),两者具有协同作用[1-3].目前在临床上的应用越来越广,但同时需关注其发生的药物不良反应.来那度胺最常见不良反应包括中性粒细胞减少症、血小板减少症,其他较常见不良反应多集中在血液系统、全身性和胃肠道的损害,包括贫血、皮疹、血栓并发症、新发恶性肿瘤、白细胞减少、低钾血症以及感染等,还存在其他一些罕见的不良反应[4-5].本文为新发1例来那度胺致药物性心肌炎案例,通过查阅中外文献,暂未发现来那度胺致药物性心肌炎不良反应的相关报道.

目的:考察山萘酚对人卵巢癌SKOV-3细胞生长、凋亡的影响及作用机制.方法:采用CCK-8法检测山萘酚对SK-OV-3细胞增殖的影响;流式细胞术和AnnexinV-FITC/PI凋亡试剂盒检测SKOV-3细胞的凋亡情况;RT-PCR检测NICDmRNA的表达;Western Blot方法检测Notch1蛋白的表达.结果:山萘酚对卵巢癌SKOV-3细胞有显著的增殖抑制作用,且呈一定的剂量依赖性;凋亡检测结果表明,山萘酚能够促进卵巢癌SKOV-3细胞凋亡的发生;RT-PCR结果显示山萘酚干预组(80 μmol· L-)NICD mRNA的表达水平明显降低(P＜0.05),Western Blot结果显示山萘酚干预组(80 μmol· L-1)Notch1蛋白表达水平显著降低(P＜0.05).结论:山萘酚能明显抑制卵巢癌SKOV-3细胞的体外增殖,诱导细胞凋亡其机制可能是通过干预Notch1的表达.

目的 探讨利尿剂在心衰患者中的个体化用药.方法 临床药师通过对患者病因以及疾病特征的分析,利用药学知识,参与2例涉及利尿剂使用的心衰患者的用药方案设计与用药监护.结果 对于继发于慢性阻塞性肺疾病的肺心痛患者,当使用利尿剂风险大于获益时,应以抗感染、解决通气障碍为主,慎用利尿剂;反之,对于其他容量负荷过重的心力衰竭患者,应积极予以利尿,并加强用药监护.结论 临床药师可以利用专业知识,为医生和患者提供药学技术服务,协助临床个体化用药,从而进一步促进临床用药安全、有效、合理.

近年来,生物制剂快速发展,在医疗领域发挥着不可或缺的作用.生物制剂分子量大、结构复杂,分子结构不同功能也不同.生物制剂的生产和纯化是一个复杂的过程,储存、运输应满足一定的条件,临床使用应具有一定的规范性,其中任何环节出问题都可对生物制剂的安全性、有效性及稳定性产生特殊的风险.本文就生物制剂在生产、储存、运输和临床使用的风险及其风险管理进行了全面综述.

目的:排查和防控武汉市大中型医疗机构药品质量安全管理体系中存在的风险,规范医疗机构药品全流程的管理.方法:依据《医疗机构药事管理规定》、《湖北省药品使用质量管理规定》等要求,药学专家和药品监管人员以全市56家大中型医疗机构为评估对象,对组织机构与人员管理、文件管理、药库管理、药房管理、医院制剂配制管理、特药抗菌药及ADR监测管理进行药品质量安全风险评估,排查药品安全管理中存在的风险点,提出合理化建议.结果:本次评估56家医疗机构的平均得分率为88.2％,评级优秀的占76.8％;药库管理是6个大项中风险最高的项目,82.1％医疗机构此项目存在风险;按子项目风险级别排序,排名前5的分别是冷链管理、临床药师配备、药库药品存放、药品养护和特药管理.三级医院药品质量安全风险管理情况优于二级医院、综合医院风险管理情况优于专科医院.结论:该市大中型医疗机构药品质量安全管理还存在一定的风险,各级医疗机构应加强药品管理,降低药品质量安全风险,保障患者用药安全.

该文对中国、美国、英国、日本4国药典收载的华法林片的质量标准，包括性状、鉴别、有关物质检查、含量均匀度、溶出度及含量测定各方面进行比较，为华法林片的质量控制提供参考。

Objective To prepare nephritis dripping pills and study its pharmacodynamic effects. Methods The nephritis dripping pills were self-made, and the preparation was optimized by using orthogonal method. The model of chronic renal failure was established through resection of 5/6 kidney, the effect of nephritis dripping pills on rats was investigated by urinary protein and renal pathology analysis. Results The optimal preparation for nephritis dripping pills was as follows:taking PEG4000:PEG6000 =2:1, drug:matrix =1:3, setting temperature at 80 ℃ and dropping distance as 7 cm. The pharmacodynamic results showed that:compared with the model control groups, the nephritis dropping pills and renal failure pills significantly reduced the 24 h urine protein levels (P<0. 01),and the nephritis dripping pills were significant superior to renal failure pills (P<0. 05). The histopathological results showed that the renal tubular of treated groups remitted to normal, renal interstitial presented a small amount of inflammation cell infiltration and renal interstitial fibrosis was suppressed. Conclusion The preparation of nephritis dripping pills is relatively stable,and have good therapeutic effects on chronic renal failure,but the optimal dose should be further verified.

Objective: To investigate the effects of different extracts of Smilax china L on the activity of ovarian cancer cells. Methods:Solvent extraction method was used to extract the active ingredients of Smilax china L. , and CCK-8 assay method was ap-plied to detect the influence of different Smilax china L. extracts (0, 50, 100, 150 and 200μg·ml-1 ) on the survival rate of ovarian cancer cells including low invasiveness A2780 cells and high invasiveness HO-8910PM cells. At the same time, the status of the two kinds of ovarian cancer cells at different time points (24, 48 and 72 h) was observed. Results:The IC50 of N-butanol extracts (SCR-B) on HO-8910 and A2780 ovarian cancer cells was 47. 5 μg· ml-1 and 69. 2 μg· ml-1 , respectively, and that of ethyl acetate ex-tracts (SCR-E) on A2780 and HO-8910 cells was 147. 9 μg· ml-1 and 166. 0 μg· ml-1, respectively. Smilax china L. extracts had the inhibition against both A278 and HO-8910PM ovarian cells in a dose-and time-dependent manner. Conclusion:The inhibitory activity of SCR-B against ovarian cancer cells is stronger than that of SCR-E, and SCR-B has stronger inhibition against A2780 cells than against HO-8910 cells. SCR-B has better inhibition against ovarian cancer cells.

OBJECTIVE:To study the antitumor effects and associated mechanisms of extract of the Smilax china L. rhizome (SCR) on ovarian cancer cells.METHODS:Ovarian cancer cells A2780 were treated with different concentrations of SCR extract (SCRE), and compared with controls. Effects on cell growth were evaluated by cell counting kit-8 (CCK-8) assay; proliferation effects by EdU incorporation assay; cell cycle by propidium iodide staining; apoptosis by annexin V-fluorescein isothiocyanate/propidium iodide; cellular distribution of nuclear factor-κB (NF-κB) by immunofluorescence; protein levels of NF-κB, caspase-3, poly-adenosine diphosphate (ADP)-ribose polymerase (PARP), Bcl-2-associated X protein (Bax), cellular inhibitor of apoptosis (cIAP)-1, anti-X-linked inhibitor of apoptosis protein (XIAP), B-cell lymphoma-extra large (Bcl-XL), B-cell lymphoma-2 (Bcl-2) and AKT by Western blotting; and effects of SCRE combined with cisplatin or adriamycin on A2780 cells by CCK-8 assay.RESULTS:SCRE suppressed A2780 cell proliferation in a dose-dependent manner (P<0.05,P<0.01), arrested cells in G2/M phase and induced apoptosis by activating caspase-3, PARP and Bax. SCRE treatment also correlated with inhibition of NF-κB and downregulation of Bcl-2, Bcl-XL, cIAP-1, XIAP and AKT. SCRE can promote chemosensitivity to cisplatin and adriamycin in A2780 cells (P<0.01).CONCLUSION:SCR effectively inhibits NF-κB, induces apoptosis and reduces chemoresistance to cisplatin and adriamycin in ovarian cancer cells, which might be its molecular basis for treating ovarian cancer.

目的:考察阿利吉仑单用或与阿托伐他汀联用对动脉粥样硬化小鼠炎症因子的影响.方法:将12周龄apoE-/-雄性小鼠给予高脂饮食,随机分为6组(n=8),包括模型对照组,肼屈嗪组、阿利吉仑低剂量组、阿利吉仑高剂量组、阿托伐他汀组、阿利吉仑与阿托伐他汀联合用药组,均治疗12周.采用酶联免疫吸附的方法(ELISA)测定血浆中白介素-6(IL-6)、C反应蛋白(CRP)和单核细胞趋化蛋白-1(MCP-1)的水平;光学显微镜下测定动脉粥样硬化病变区与总主动脉面积.结果:与模型对照组相比,阿利吉仑单独用药对炎症因子MCP-1的影响无显著性差异.阿利吉仑单独或者联合阿托伐他汀用药能够显著降低炎症介质IL-6、CRP的血浆水平(P＜0.05),且阿利吉仑高、低剂量组之间对CRP和IL-6水平的影响亦有差异;阿利吉仑联用阿托伐他汀与阿托伐他汀组对MCP-1、IL-6、CRP水平的影响均无显著性差异(P＞0.05).组织病理学结果显示:单用阿利吉仑或联合应用阿托伐他汀都有不同程度的降低动脉粥样硬化面积,与模型对照组相比均有显著性差异,且单用阿利吉仑组、阿托伐他汀组均与联合用药组有显著性差异(P＜0.05).结论:阿利吉仑对动脉粥样硬化小鼠体内炎症因子水平有一定影响,并显示出一定的剂量依赖性,同时与阿托伐他汀合用有一定的联合治疗作用.

目的:建立高效液相色谱—串联质谱法(HPLC-MS/MS)同时测定人血浆中瑞格列奈和二甲双胍浓度的方法,并进行人体药动学研究.方法:以乙腈沉淀蛋白处理血浆样品,替米沙坦做内标,采用Kromasil 60-5CN色谱柱(2.1 mm×100 mm,5 μm),流动相为20 mmol· L-1醋酸铵水溶液(含0.2％甲酸)—乙腈(45:55);质谱采用电喷雾离子化—多反应离子监测(ESI-MRM).并测定12名健康志愿者单剂量口服瑞格列奈盐酸二甲双胍复方片(2mg:500mg)后瑞格列奈和二甲双胍的血浆浓度.结果:瑞格列奈和二甲双胍分别在0.05～50 μg·L-1、2～2 000 μg·L-1范围内线性良好,定量下限分别为0.05 μg·L-1和2μg·L-1,日内日间精密度均小于8％,提取回收率分别为77.32％～80.65％和78.98％～82.46％.瑞格列奈和二甲双胍的主要药动学参数C瑚x分别为(29.50±9.57),(1 167±197.77)μg·L-1;tmx分别为(0.83±0.39),(1.88±0.64) h;t1/2分别为(1.11±0.38),(4.31±0.86) h;AUC0→..分别为(56.90±20.31),(7 407.32±1 653.25)μg·L-1·h-1.结论:建立的分析方法灵敏、准确可靠,样品处理快速、简便,适用于瑞格列奈/盐酸二甲双胍复方片人体药动学和生物等效性研究.

Objective To evaluate the clinical efficacy and safety of valsartan alone or combined therapy in the treatment of essential hypertension.Methods The CENTRAL ,CBM ,Medline ,Embase ,PubMed ,CNKI ,VIP and Wanfang data were searched for RCTs published until June 2015 on valsartan monotherapy or combination therapy for the treatment of essential hypertension.Two reviewers independently retrieved RCTs based on inclusion and exclusion criteria ,assessed the quality of in‐cluded trials ,and extracted relevant data.The data were analyzed by using RevMan 5.3.5 software package.Results A total of 21 RCTs ,including 8 743 patients ,were finally included.Meta‐analysis results showed that the efficacy of valsartan monothera‐py was superior to that in control group.There were no significant differences in the systolic blood pressure ,diastolic blood pressure and the incidence of adverse side effects between valsartan monotherapy group and control group.However ,the im‐provement in the systolic blood pressure ,diastolic blood pressure and the incidence of adverse side effects were better in valsar‐tan combination group than in valsartan monotherapy group and there was a statistically significant difference(P<0.05) .Con‐clusion Valsartan combined with one or more antihypertensive drugs is more safe and effective than valsartan monotherapy in the treatment of essential hypertension.Valsartan combination administration is recommended to treat essential hypertension in clinical practice.

Objective: To introduce the practice and experience of establishing ADR/ADE online reporting information platform, as a reference for medical institutions in China. Methods: An analysis was conducted on the structure, work flow, function of the ADR/ADE reporting platform based information. Results: The ADR/ADE reporting work has been enhanced through establishing ADR/ADE online reporting information platform. Conclusion: ADR/ADE online reporting information platform contribute greatly to ensuring rational drug use. But the importance of ADR/ADE monitoring still need pharmacists' continuing propaganda.

目的:探讨合理用药监测信息平台的管理模式和流程,为医院利用信息技术实现临床合理用药提供参考.方法:调派专职药师管理用药监测平台,建立科学的平台运行流程,实行临床用药事前智能化分级管理.结果:通过专职药师对平台的不断完善和改进,寻找到适宜的管理策略和模式,为医院不合理用药的管理和干预提供了有利保障,并推进了药学与信息学交叉学科的发展.结论:建立合理用药监测信息平台过程中需要创新思维,发挥人的主导作用,增强沟通协作,不断完善和改进系统,使其符合医院的实际需求和长效管理.

Objective: To develop the informatization management mode of rational use of the psychotropic drugs of category II in order to decrease adverse drug events and increase therapeutic efficacy Methods: To control the psychotropic drugs of category II abuse, we took the following measures with information technology, such as set the special prescription, define the maximum doses and days of single prescription, open special channel et al.. Results: several departments together put forward the effective intervention measures to prevent irrational prescriptions. Conclusion: The informatization management mode is adapted for the needs of hospital pharmaceutical practice with sufficient utilization of hospital information system's resource. It appears to be a rapid, scientific and practical system for monitoring and analyzing the clinical use of the psychotropic drugs of category II.

本文通过阐述多元谱效关联技术的研究现状，研究国内外相关文献，结合工作实践，分析多元谱效关联技术的局限性，提出扩展多元谱效关联技术的研究新思路，利用先进的计算机技术方法对获取的中药指纹图谱和药效学数据进行分析，为中药多元谱效关联技术应用于中药的质量评价和控制提供新的思路和方法。

研究与开发一种光化学反应装置，保证光化学反应实验的顺利进行。方法：通过研究国内外相关文献，实际操作、设计正交试验对比等方法确定解决方案。结果：确定了反应装置的工作原理与设计图样，并详解了反应装置的组装方式和操作方法。结论：该反应装置组装简便，光源易获得且成本低；与相关文献比较，缩短了光化学反应时间，节约成本，提高产率，减少副产物的生成。

A 45-year-old woman received an intravenous injection of levofloxacin( 0. 4 g,once daily),Suhuangzhike(苏黄止咳)capsules(3 capsules,thrice daily)by mouth,and montelukast sodium (10 mg at bedtime,once daily)by mouth for acute attack of chronic bronchitis. About 30 min after the first administration of montelukast sodium,the patient developed numbness of extremities and tremor,dyspnea, and generalized weakness,followed by nausea and vomiting and the symptoms lasted for about 2 hours without alleviating. Montelukast sodium was discontinued,levofloxacin and Suhuangzhike capsules were applied continuously,and symptomatic treatments were given at the same time. The numbness of extremities and tremor and dyspnea relieved,nausea and vomiting did not recur until 16 :00 of the following day.