目的 研究慢性病患者药物相关问题(DRPs)现状并分析其影响因素.方法 提取重庆市垫江县人民医院2020年10月至2021年2月慢性病患者293例的病历资料,统计其DRPs发生情况.按是否发生DRPs将其分为发生组(132例)和未发生组(161例),比较两组临床资料,并采用二元logistic回归模型分析慢性病患者发生DRPs的影响因素.结果 本研究中DRPs发生率为45.05％,共发现165个DRPs,Bayliff评估结果显示DRPs引起0级危害6个,1级危害有133个,2级危害26个.两组年龄、并发症数量、用药种类、用药依从性比较,差异有统计学意义(P<0.05).多因素分析结果显示,年龄60～75岁、用药种类多、并发症数量多、用药依从性差是慢性病患者发生DRPs的独立危险因素(OR>1,P<0.05).结论 慢性病患者DRPs的发生率较高,患者年龄、并发症数量、用药品种及用药依从性均能影响DRPs的发生风险.

目的 研究妊娠中期(妊娠21～24周)25羟维生素D[25(OH)D]水平与妊娠糖尿病(GDM)发生风险的相关性,以及孕妇血清25(OH)D水平的影响因素.方法 选取2018年10月至2020年10月于该院行产前检查的妊娠21～24周孕妇325例作为研究对象,进行问卷调查,并采集其外周静脉血检测25(OH)D水平.依据25(OH)D水平分为维生素D(VD)正常组[25(OH)D水平大于50 nmol/L]、轻度缺乏组[25(OH)D水平为30～50 nmol/L]和严重缺乏组[25(OH)D水平小于30 nmol/L].采用趋势性χ2检验分析血清25(OH)D与GDM发生风险的相关性,运用Logistic回归模型筛选25(OH)D水平的危险因素.结果 325例孕妇中,25(OH)D缺乏的发生率为69.8％(227/325),GDM的发生率为20.3％(66/325).随着25(OH)D水平的升高,GDM的发生率呈显著下降趋势(χ2趋势=5.791,P=0.016).单因素筛选结果显示,25(OH)D水平与孕妇孕次、妊娠前6个月补充VD和钙片、户外活动时间小于1 h/d相关(筛选界值P<0.1).logistic回归分析结果显示,孕妇孕次、户外活动时间小于1 h/d、妊娠前6个月补充VD和钙片与VD缺乏显著相关(P<0.05).结论 妊娠中期25(OH)D水平不足将会显著增加GDM发生的风险,孕妇应通过增加户外活动时间、及时补充VD和钙片等方式来预防VD水平缺乏,降低孕妇GDM的发生风险.

目的:探讨临床药师在药害事件处理中发挥的作用.方法:临床药师参与了 1例头孢曲松所致假性胆囊结石的会诊及后续随访,根据患者用药史,病情变化、辅助检查,结合文献报道,分析了患者药物导致假性胆囊结石的可能性.考虑到头孢曲松引起的假性胆囊结石,遂建议患者立即停用注射用头孢曲松,结合患者急性胆囊炎,换用注射用头孢哌酮舒巴坦3g q12h ivgtt联合注射用奥硝唑0.5g q12h ivgtt(首剂1g)继续抗感染治疗,并对该患者实施了药学监护,同时对医师和护士作了用药建议.使用注射用头孢曲松时,需避免高浓度、大剂量、长时间用药,用药期间应定期超声检查胆道系统或泌尿系统.结果:医师采纳了药师建议,经对症处理后6天,患者假性胆囊结石消除,好转出院.结论:临床药师通过参与头孢曲松引起的假性胆囊结石的救治和药学监护,有效地降低此类药害事件所致的不良影响,利于提高临床合理用药水平.

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:评价PDCA循环法干预人血白蛋白合理使用的效果.方法:采用回顾性分析方法,选取某院PDCA循环管理干预前(2018年1-12月,干预前组)98例、第1轮PDCA循环管理干预后(2019年1-12月,第1轮干预组)90例和第2轮PDCA循环管理干预后(2020年1-12月,第2轮干预组)58例,对比分析持续干预前后人血白蛋白使用情况.结果:经2轮PDCA循环管理干预后,该院人血白蛋白使用率、人均用药量、平均用药疗程由干预前的0.18％、88.06g、4.45±3.53d由干预前降低至干预后的0.11％、51.55g、3.95±2.63 d;用药前血清白蛋白水平(≤25 g﹒L-1)的比例由干预前的71.4％增加至第2轮干预后87.9％,人血白蛋白用药指征合理率由干预前的24.49％增加至第2轮干预后的50％,差异有统计学意义(P<0.05).结论:PDCA循环法降低了人血白蛋白的使用率、人均用药量、缩短了用药疗程,提高了人血白蛋白用药指征合理率,但人血白蛋白用药指征合理率仍未完全达到100％,待进一步持续干预.

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 研究五官科手术护理工作中使用医护一体化护理形式的临床价值.方法 选择我院在2019年1月—2019年12月接收的五官科手术诊疗患儿,共计70例,将以上患儿划分成为研究组和对照组两组,每组35例.其中研究组使用医护一体化护理模式,对照组使用常规五官科手术护理模式,比较两组患儿护理过程中面对的风险,以及临床效果差异.结果 研究组患儿在护理风险、不良事件等方面出现的问题频率明显低于对照组,且两组数据对比具有统计学意义,P＜0.05.结论 在五官科手术护理工作中使用医护一体化护理能够有效降低患儿面临的护理风险,提升其护理满意度,进而能够建立良好的医患关系,促进我国医疗卫生事业发展.

目的 探究循证护理在五官科患者护理工作中的有效性.方法 选择本院在2018年6月～2019年6月之间收治的五官科住院患者100例,将以上患者作为研究样本,随机划分为研究组和对照组,研究组患者使用循证护理,对照组患者使用常规护理形式,比较两组患者护理效果.结果 根据数据研究能够看出,接受循证护理患者护理满意度较高,可有效提升患者的诊疗效果,且两组患者数据对比具有统计学意义,P<0.05.结论 在五官科患者的日常护理工作中使用循证护理形式,能够提升患者的护理满意度,应当在五官科临床护理工作中广泛应用.

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.