Objective To fully analyze irrational medical instructions in pharmacy intravenous admixture services(PIVAS) from various scope or aspect for promoting rational use of clinical drugs. Methods The data of medical instructions in the PIVAS of our hospital were collected and straightened out from January, 2017 to December, 2018. And the cases of irrational medical instructions were studied further by using the frequency and percentage composition by descriptive analysis methods. Results Six hundred and ninety-four irrational instructions, which were composed of 736 errors and involved a total of 132 kinds of drugs, were found. The irrational instructions were classified as amount of solvent, solvent, frequency of medication, dosage, operational error, unreasonable compatibility, and others. And their values of frequency, the percentage composition, and the type of drug involved were 213, 28.94％, and 53; 186, 25.27％, and 37; 94, 12.77％, and 16; 74, 10.05％, and 32; 133, 18.07％, and 66; 30, 4.08％, and 16; and 6, 0.82％, and 5, respectively, according to previous order. The frequencies and percentage compositions of irrational medical instructions in the top 10 drugs involved were as follow: 44 groups (6.34％) of fat-soluble vitamin(Ⅱ)/water-soluble vitamin, 39 groups (5.62％) of adenosine monophosphate (0.5g), 36 groups (5.19％) of Melon smut injection [4 ml], 34 groups (4.90％) of cefoperazone tazobactam [2.5 g], 32 groups (4.61％) of piperacillin sulbactam [0.75 g], 32 groups (4.60％) of Shuganning [2 ml], 24 groups (3.46％) of doxofylline injection [0.2 g: 20 ml] ,24 groups (3.46％) of cefoperazone tazobactam [2.0 g], 21 groups (3.03％) of Mannan peptide (water) [5 mg: 2 ml], and 19 groups (2.74％) of compound glycyrrhizin [20 mg]. These irrational medical instructions accounted for 42.95％ (340/694) of all. The types of irrational medical instructions and drugs involved were obvious different in various kinds of clinical departments. Conclusion It is essential to improve clinical rational medication that medical review ability of pharmacist must be strengthened and appropriate intervention measures implemented according to the characteristics of each clinical department.

目的 对盐酸克林霉素棕榈酸酯分散片和盐酸克林霉素片治疗急性扁桃体炎和急性支气管炎成本-效果分析,为临床合理用药提供参考.方法 采用盐酸克林霉素棕榈酸酯分散片与盐酸克林霉素片治疗急性扁桃体炎和急性支气管炎的临床观察的疗效和成本数据进行成本-效果分析.结果 盐酸克林霉素棕榈酸酯分散片组的临床痊愈率为76.47％,有效率为100％;盐酸克林霉素片组的临床痊愈率为48.98％,有效率为91.84％,盐酸克林霉素棕榈酸酯分散片组的临床痊愈率、有效率均显著高于盐酸克林霉素片组(P＜0.05).盐酸克林霉素棕榈酸酯分散片组总成本比盐酸克林霉素片组高43.09元,前者的成本-效果比(C/E)为2.27,优于后者的2.66;分别以痊愈率、有效率作为指标,前者每多获得一个百分点的痊愈率或有效率分别多花费1.57元和5.28元;分别以显效时间、痊愈时间作为指标,前者每多节省一天显效时间或痊愈时间分别多花费153.89元和307.79元.观察期间,盐酸克林霉素棕榈酸酯分散片组不良反应事件发生率为1.96％,盐酸克林霉素片组不良反应事件发生率为20.41％,经Fisher检验,组间差异具有统计学意义(P＜0.05).服药依从性(口感)评价,盐酸克林霉素棕榈酸酯分散片组口感“好”为82.35％,显著高于盐酸克林霉素片组8.16％ (P＜0.05).结论 盐酸克林霉素棕榈酸酯分散片在治疗急性扁桃体炎和急性支气管炎中的临床疗效、成本-效果比、安全性和口感均优于盐酸克林霉素片.

目的 调查评估我院静脉用药调配中心(PIVAS)医嘱的合理性,促进临床合理用药.方法 采集PIVAS 2014～ 2015年不合理医嘱814份进行统计分析.结果 不合理医嘱主要涉及溶媒用量(40.3％)和溶媒种类(26.8％)两类,其他尚包括给药剂量(14.7％)、药物配伍(5.8％)、用药频次(5.7％)、给药途径(1.7％)等;药师干预成功率为88.8％.结论 药师通过审方干预可以改善不合理医嘱的应用,由此改进和提高医院的合理用药水平.

异烟肼(INH)为一线抗结核药,常与其它药物合用治疗各型结核病,近年来有关文献报道了临床新用途.