The 2017 NCCN Guidelines for NSCLC recommend epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) as the first-line treatment for patients with gene-sensitive mutations of pulmonary adenocarcinoma. The TKI combination can effectively inhibit the gene mutations caused by the drug resistance and enhance the antitumor effect. However, more clinical investigations are required of the efficacy and the adverse drug reactions (ADRs) of this combination. A 62-year-old female patient diagnosed as lung adenocarcinoma with brain metastasis, meningeal metastasis, multiple bone metastasis, and liver metastasis was treated with the combination of gefitinib and osimertinib. Evident improvement was observed after 10 days of combined treatment with these tyrosine kinase inhibitors (TKIs), including in the CT features and symptoms. The level of tumor marker CEA decreased significantly after 40 days. However, severe stomatitis occurred after 49 days. By analyzing the relationship between stomatitis and TKI combined treatment based on the temporal correlation, instructions and literature reports, mechanisms, and reaction, we discovered that the combination of the two TKI drugs can increase the incidence and severity of severe stomatitis. Following targeted treatment and drug withdrawal, the patient fully recovered. TKI combination may increase the incidence and severity of stomatitis, suggesting that closely care and timely withdrawal are necessary measures.

目的 系统评价帕瑞昔布钠与氟比洛芬酯用于外科手术超前镇痛的疗效及安全性.方法 全面检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、中国生物医学文献数据库、万方和维普数据库,收集关于帕瑞昔布钠和氟比洛芬酯用于外科手术超前镇痛临床疗效和不良反应的随机对照试验,检索时间从建库至2021年5月31日.使用Cochrane系统评价方法筛选文献,评价纳入文献的质量,并提取纳入文献的特征信息,采用RevMan 5.3软件对相应研究指标进行Meta分析.结果 最终纳入18篇随机对照研究,1056例患者.Meta分析结果显示,在术后1 h,帕瑞昔布钠组疼痛强度的视觉模拟评分(VAS)显著高于氟比洛芬酯组(MD=0.06,95％CI=0.01～0.11,P=0.02);在术后6 h,两组的VAS评分差异无统计学意义(P>0.05),镇痛效果相当;在术后12、24 h,帕瑞昔布钠组的VAS评分显著低于氟比洛芬酯组(MD=-0.40,95％CI=-0.63～-0.17,P=0.0007;MD=-0.24,95％CI=-0.44～-0.04,P=0.02),镇痛效果更优;在术后24 h内,两组中因疼痛难忍需要追加镇痛药的患者例数基本相当,差异无统计学意义(P>0.05);帕瑞昔布钠和氟比洛芬酯术前应用常见的不良反应为恶心、呕吐、头晕和嗜睡等,且前者不良反应发生率明显低于后者(OR=0.56,95％CI=0.39～0.80,P=0.002).Egger检验结果表明,纳入研究无明显的发表偏倚(P=0.088;P=0.512).结论 在外科手术中,术前静脉注射帕瑞昔布钠与氟比洛芬酯相比,后者在术后1 h镇痛效果更优,但在术后12、24 h,帕瑞昔布钠的镇痛作用更强更持久.与氟比洛芬酯相比,帕瑞昔布钠的安全性更高.

通过开展以"合理用药"为核心的重点监控药品管理,促进合理用药水平提升.采取事后处方点评及处方前置审核,建立和完善重点监控药品管理方案,对不合理用药进行拦截、宣教、绩效处罚、限量采购、约谈等,实现了重点监控药品规范化管理.实践后,不合理医嘱减少,处方点评合格率提升,辅助用药种类减少.认为建立重点监控药品管理的相关制度及流程,对提升合理用药水平有一定促进作用.

目的 以注射用丹参多酚酸盐为例,探索中药注射剂临床应用的综合评价方法,为今后相关工作的开展和完善提供参考.方法 通过文献检索和获取相关文献资料,从有效性、安全性、经济性、顺应性和标签信息等方面对注射用丹参多酚酸盐进行系统综合评价.结果 除说明书适应证外,丹参多酚酸盐在心血管疾病、脑血管疾病等多种超说明书适应证中都存在具有一定质量的临床研究证据;在安全性、经济性方面的文献证据较为丰富.结论 注射用丹参多酚酸盐在有效性、安全性及经济性等方面的临床研究证据较多,且具有一定的体系.但作为一个临床应用大品种,该药依然需要在一些方面做出更多的研究努力.

目的 以注射用丹参多酚酸盐为例,探索中药注射剂的综合评价方法,为今后相关工作的开展和完善提供参考.方法 通过文献检索和获取相关文献资料,从药学特性、质量等方面对注射用丹参多酚酸盐进行药学综合评价.结果 在有效成分和药物作用机制方面,丹参多酚酸盐已经进行了大量的基础研究.质量方面的文献证据也较为丰富.结论 注射用丹参多酚酸盐在药学特性方面研究探索面非常广,相关基础研究还有待进一步探索.

目的 对乙状结肠和直肠肿瘤患者使用腹腔镜手术进行治疗的疗效进行观察.方法 对该次研究在2014年7月—2019年9月所选择的137例乙状结肠和直肠肿瘤患者使用腹腔镜手术进行治疗的相关临床资料进行回顾性分析,对患者手术成功的结果、具体的手术情况进行观察.结果 131例手术获成功,手术成功率为95.6％;6例中转开腹,所占比例为4.6％;成功手术中34例行结肠造瘘,所占比例为25.9％;97例行Ⅰ期吻合保留肛门,所占比例为74.1％;其中10例发生术后出现吻合口瘘现象.术后行Ⅰ期吻合患者吻合口瘘发生率为10.3％.结论 使用腹腔镜手术对乙状结肠和直肠肿瘤手术进行治疗安全性较高,对患者身体造成的伤害较小,且具有比开腹根治术更好的短期效果.

目的 探讨甲状腺术后并发淋巴瘘的临床经验.方法 回顾分析7例患者行甲状腺术后淋巴瘘的临床资料.结果 7例并发淋巴瘘患者,发生在左侧2例,右侧5例.淋巴瘘患者引流液为淡黄色清亮液体,给予禁饮禁食控制加静脉补液,生长抑素静脉泵入,至12 d停止瘘液.所有患者均经非手术治疗治愈,无一例发生皮瓣坏死、感染等并发症.结论 甲状腺癌术后并发淋巴瘘患者采取保守治疗效果显著,且淋巴瘘多发生在右侧,临床需加强手术操作规范性,减少淋巴瘘的发生.

目的:比较儿童及成人使用哌拉西林/他唑巴坦致血液系统不良反应(ADR)的发生情况及其影响因素,为儿童安全用药提供参考.方法:回顾性分析某三甲医院2017年4月至2018年3月使用哌拉西林/他唑巴坦的5 176例患者的病例资料,根据年龄分为0 ～28 d,1～12月,＞1 ～ 12岁,＞12～18岁,＞18 ～65岁,＞65岁6组,分析不同年龄组患者血细胞减少的发生率、发生时间、严重程度及转归等,并对患者血细胞减少相关危险因素进行Logistic回归分析,探讨儿童与成人使用该药的安全性差异.结果:血液系统ADR总发生率为2.99％,1～ 12月龄婴幼儿ADR发生率最高,达14.48％,＞65岁的老年人最低,仅1.38％.898例儿童中有88例(9.80％)血细胞(NEU、WBC、PLT)减少,15例(1.67％)3 ～4级严重中性粒细胞减少.Logistic多因素分析结果显示,年龄＜1岁(OR=5.399)是用药后血细胞(NEU、WBC、PLT)严重减少的独立危险因素.结论:哌拉西林/他唑巴坦在各年龄段儿童患者中血液系统ADR发生率均明显高于成人和药品说明书的报道,尤其是新生儿及1～12月龄的婴幼儿,应高度关注其血液系统ADR,加强监测血常规.

OBJECTIVE To explore the approaches of clinical pharmaceutical care for elderly patients in neurology department to improve safe clinical medication.METHODS The classic cases with clinical pharmaceutical participation in SAP patient monitoring,medication dosage,antithrombotic drugs use in perioperative period and improved compliance of patients were reported to summarize experiences in pharmaceutical care and explore the work content and pattern.RESULTS Clinical pharmacists formed a team with the clinicians for clinical treatment through pharmaceutical care,which played an important role in the hospitalization patients,and made the effectiveness and rationality improvement of clinical treatment.CONCLUSION Clinical pharmacists should change from the traditional and passive thinking mode to the clinical thinking mode of pharmaceutical ef ficacy and safety,positively and actively combine the clinical practice to find and solve the problems in the drug therapy,and choose more reasonable treatment plan with the physician,which can reflect the value of clinical pharmacist in clinical diagnosis and treatment.

目的 对某院纳入临床路径的乳腺癌、结直肠癌术后辅助化疗患者发生药物性肝损伤(drug-induced livcr injury,DILI)的情况进行调查分析,初步探讨预防性使用保肝药是否可纳入临床路径.方法 回顾了2015年1月～2017年3月205例病例,将患者按是否预防性使用保肝药分为两组,用SPSS19.0软件对患者DILI的发生率、发生时间、严重程度及转归,是否预防性使用保肝药等信息进行统计分析,并对患者肝损伤相关危险因素进行Logistic回归分析,探讨预防性使用保肝药的必要性及给药时机.结果 在205例患者中有43例(20.98％)的患者预防性使用了保肝药,无DILI发生;未预防性使用组DILI的发生率为4.88％.在第一、第二周期化疗前两组均无DILI发生,只有在第三周期化疗前预防性使用保肝药组与未预防性使用组肝损伤的发生率有统计学差异(P＜0.05).多因素分析显示,预防用药为肝损伤的保护因素(OR =0.07).结论 乳腺癌、结直肠癌术后辅助临床路径治疗的第一、二周期加强肝功能监测即可,出现肝功能异常者在下一周期用药前可预防性给予保肝药.

Objective To retrospectively analyze the drug use of continuous intravenous pumping of high-dose morphine in the 2 patients with advanced cancer pain, and explore the rationality and management of morphine in clinical practice. Methods The pain nafure, causes, relief or exacerbation factors, quality of life, PS and NRS scores were comprehensively evaluated. Clinical pharmacists evaluated and adjusted the dosage of morphine dynamically, meanwhile, they gave some suggestions for the rational use of accessory analgesics. Results Continuous intravenous pumping of high-dose morphine could reduce the patients' NRS score and alleviate intractable severe pain effectively. The maximum daily dose of morphine was 1 000 mg and 4 000 mg in the 2 cases. Except for constipation, nausea, vomiting and lethargy, no coma, respiratory depression or other poisoning symptoms for morphine occurred. Conclusion Clinical pharmacists participate in the management and use of high-dose opoid drugs in standardized ward of cancer. It not only ensures the accessibility and safety of morphine use, but also plays an important role in standardized treatment of cancer pain.

目的 考察欧前胡素衍生物OW1对大鼠不同动脉的舒张作用,并探讨其可能的舒张作用机制.方法 采用多通道微血管张力测定方法,以高钾预收缩的大鼠主动脉、肾动脉、大脑中动脉、冠状动脉、肺动脉以及肠系膜动脉,评价OW1对这6种动脉的舒张效应;分别考察内皮、β-肾上腺素受体、3种钾离子通道考察其对OW1舒张曲线的影响;干预细胞内钙及外钙的浓度,检测其对OW1抑制收缩曲线的影响.结果 OW1可以完全舒张上述6种动脉,Emax均在90％以上,pEC50分别为(6.11±0.09),(5.76±0.01),(6.22±0.08),(5.78±0.05),(5.65±0.01)和(6.59±0.07).阻断内皮、β-肾上腺素受体、ATP敏感性钾通道和内向整流钾通道后均对OW1的舒张曲线无影响,阻断钙离子激活钾离子通道可使OW1的舒张曲线明显地非平行性右移,Emax降低,并且OW1可以抑制外钙的内流以及内钙的释放,降低细胞内的钙离子浓度,从而抑制血管收缩.结论 OW1可以舒张上述6种血管,其涉及的血管舒张机制主要包括抑制电压依赖性钙通道和受体介导的Ca2*的内流和释放.

Objective To analyze and discuss the factors and preventive measures of incomplete drug-abortion.Methods The clinical data of 820 cases of drug abortion in a class A hospital were analyzed.Results There were 124 cases of incomplete drug-abortion in 820 cases of drug abortion.The incomplete drug-abortion would largely occur in the women who had risk factors,including over sized gestational sac,diameter>2 cm,gestational age over 7 weeks,age>35 years old,scar uterus,medical abortion times>2,uter-ine retroversion and retroflexion,having a history of cervical physical therapy or with contraceptive ring (P <0.05 ).Conclusion Analyzing the factor of incomplete drug-abortion is helpful to choose the way of abortion and proposing the intervention measures timely is of benefit to relieving the pain in patients.

目的 系统评价肾康注射液(大黄、黄芪、丹参、红花)治疗慢性肾功能衰竭的有效性及安全性.方法 以“肾康注射液”、“慢性肾功能衰竭”为关键词,计算机检索中国知网(CNKI)、万方医学网数据库、中国生物医学文献服务系统(SinoMed),手工检索相关资料,选择符合纳入标准的临床对照研究.按照Cochrane系统评价的方法对纳入文献进行质量评价,并采用RevMan5.2进行Meta分析.结果 共25篇随机对照试验、1 897例病人符合纳入标准,治疗组与对照组总体效应检验,有效率P ＜0.000 01,OR=4.56,95％ CI [3.55,5.85];内生肌酐清除率(Ccr)的影响,P ＜0.000 01,WMD =4.45,95％ CI [3.65,5.26];血清肌酐(SCr)的影响,P＜0.000 01,WMD=-65.70,95％ CI[-91.49.-39.91];尿素氮(BUN)的影响,P＜0.000 01,WMD=-3.90,95％CI[-4.93,-2.86];对血清蛋白(Hb)、24 h尿蛋白定量(24 h TP)、血清磷(P)、血清钙(Ca)和胆固醇(TC)的影响,实验组均优于对照组(P＜0.05).结论 肾康注射液治疗慢性肾功能衰竭是安全有效的.

目的：提示临床重视大剂量静注蛇毒血凝酶注射液致深静脉血栓。方法回顾性分析1例结肠息肉术后大剂量静注蛇毒血凝酶注射液致深静脉血栓的病例，记录其年龄、性别、诊断、既往史、给药方法、静脉血栓形成不良反应的过程、形式及处理措施，并分析发生因素。结果患者术后静脉注射蛇毒血凝酶注射液1U预防术后出血，8h给药1次，用药3d。患者静脉血管由发青、发硬、疼痛等症状发展至血管变细、对热不敏感等，最终导致上、下肢深静脉血栓形成。结论血栓性病史患者术后大剂量静注蛇毒血凝酶注射液可致深静脉血栓，临床应用时应严格把握适应证并注意给药途径和剂量。

Objective To investigate the off-label drug use of Ambroxol Hydrochloride Injections in hospitalized elderly patients in our hospital .and to provide the reference and basis for its rational use .Methods By using the method of retrospective survey , 239 cases were investigated in terms of age ,dose of drug ,cure ,medicine diagnosis ,and expense ,etc .Results The ratio of off-la-bel use cases was 96 .23% .The off-label drug use was mainly in chronic obstructive pulmonary disease and interstitial lung dis-ease ,occupied 84 .15% and 9 .15% respectively .Conclusion Off-label use of Ambroxol Hydrochloride Injections generally exists in the treatment of respiratory diseases among hospitalized elderly patients .

Objective To establish an HPLC method for the determination of Adefovir Dipivoxil Tablets and its related substances . Method The analytical column was Hypersil C18 and the mobile phase was acetonitrile-water (45∶55) adjusted with phosphoric acid to a pH of 4 .0 .The detection wavelength was 261 nm and the flow rate was 1 .0 mL · min-1 .Results Adefovir dipivoxil was linear in the range from 1 .036 to 62 .161 μg · mL -1 (r=0 .999 8) .The limit of detection was 0 .24 ng and the average recovery was 100 .6% .Conclusion The method was accurate ,sensitive ,precise ,and can be used for the content assay ,as well as the analysis of the related substances in Adefovir Dipivoxil Tablets .

Objective To investigate the preventive use of hemostatic drugs in the 589 cases of typeⅠand Ⅱ incision in the perioper-ative period in clinic ,to evaluate the use rationality ,and to provide the reference and basis for its application .Methods By using the method of retrospective survey ,the cases of typeⅠ and Ⅱ type incision in the hospital during January 2013 to April used he-mostatic drugs to prevent bleeding were analyzed in the aspect of operation types ,kinds ,administration time ,dose of drug ,time of therapy ,expense ,etc .Results The reasonable utilazition rate of cases of type Ⅰ and Ⅱ incision respectively were 30 .98% and 24 .48% ;The utilization ratio of snake venom haemocoagulase was in the top order .Irrational use of hemostatic drugs was mainly in the form of pre-operative administration but not administration after surgery ,time of therapy post-operative medication more than 3 days ,a single overdose of drugs used ,or unreasonable drug combination . The proportion of the rate were 51 .52% , 18 .84% ,13 .83% ,and 7 .45% ,respectively .Conclusion The reasons causing irrational hemostatic drugs use of type Ⅰ and Ⅱincision in the perioperative period were inappropriate administration time ,too long time medication ,or unreasonable drug combi-nation .Therefore ,operative application of guiding principles of the hemostatic drugs in the perioperative period should be devel-oped ,while hospitals need to strengthen the standardized management of the relevant departments .

Objective:To analyze the drug use of a patient with intestinal obstruction induced by high dose of morphine to explore the role of clinical pharmacists during the therapeutic process. Methods:The dose titration of morphine, choice of analgesic drugs and dose conversion were adjusted by doctors and pharmacists using NRS scores of dynamic assessment for the patient. The pharmaceutical care was implemented for the patient induced by high dose of morphine. Results:The pharmaceutical supervision by clinical pharma-cists improved medication compliance of the patient. After fentanyl patches were used to replace morphine, the intestinal obstruction was relieved in the patient and the quality of life was improved. Conclusion:Clinical pharmacist can promote the rational use of opi-oids for patients with intestinal obstruction. The successful treatment of the patient with intestinal obstruction provides the reference for patients with intractable pain treated by opioids.

采用回顾性分析对2010年10月至2013年9月期间在昭通市第一人民医院内分泌科门诊就诊及住院的1260例糖尿病患者使用定量超声测定仪筛查糖尿病人群骨密度.结果:按照年龄、性别分组、分别计算女性、绝经后妇女、绝经前女性及男性骨质疏松、骨量减少的患病率.糖尿病患者随着年龄的增加骨量异常(骨质疏松和骨量减少)患病率是增加、绝经后女性骨质疏松患病率明显升高.结论:糖尿病患者骨矿物质密度减低,尤其是年龄大和绝经后女性应进行骨质疏松的筛查、及时有效的治疗,减少致残、致伤率.并且定量超声波骨密度仪(QUS)设备小巧,便于携带,价格便宜,没有电离辐射,使用方法简便,尤其适合基层医院人群的筛查.