146例药物不良反应报告分析

目的了解药物不良反应的发生情况及其给患者造成的危害,分析药物不良反应（ADR）的产生原因,促进临床合理、安全、有效用药。方法对2008年度146份ADR报告进行分类统计和分析。结果以抗感染药引起的不良反应最为常见,涉及的药物共113个品种,占报告的77％,静脉给药是引起药物不良反应的主要给药途径;所累及的器官以皮肤病变最为常见。结论提示临床医生严格掌握药物的适应症,促进合理用药。减少不良反应的发生。     

金华市居民合理用药认知度的调查分析

目的：调查浙江省金华市居民合理用药的知识以及选择和使用药品的现状,了解居民自我药疗的水平。方法：选取金华市的部分居民居住小区和部分社会药店为调查现场,采用统一方式,调查员入户访问和药店随机发放调查问卷表。内容包括：居民基本资料、合理用药的认知情况,购买药品考虑的因素、用药依从性、对药品说明书的认识。结果：发放问卷2185份,回收有效问卷1871份。被调查的居民中,只有16．0％的居民能正确理解药品不良反应的含义。79．3％的居民出现药品不良反应会选择停药和就医。76．2％的被调查者会阅读药品说明书,多数居民较注意阅读说明书中用法、用途和注意事项,药品不良反应阅读比例相对较少。结论：居民具备一定的合理用药知识。但存在一些误区．对药品不良反应知识欠缺。     

近三年我院抗菌药物应用情况分析

目的:调查分析铜陵市第四人民医院近三年抗菌药物的应用状况及趋势,以促进临床合理用药。方法:对本院2010-2012年抗菌药物品种、规格、销售金额、用药频度(DDDs)进行回顾性分析。结果:抗菌药物销售金额占西药销售总金额比例保持在35%左右,使用量逐年稍有上升;头孢菌素类药物销售金额最高,硝基咪唑类药物的用药频度最高。抗菌药物口服制剂DDDs远大于注射制剂DDDs。结论:本院抗菌药物结构合理,临床使用基本合理。     

外用抗菌药乱抹易惹祸

外用抗菌药物由于携带和应用方便,深受患者喜爱,在临床上多为皮肤科、耳鼻喉科、眼科、创伤外科等科的患者使用。外用抗菌药有很多优势：药物可选择性作用于病变部位,局部浓度较大、作用时间长,适于清除皮肤局部细菌;减少药物因进入体内受到代谢的影响;可针对患处的部位、严重程度等采用不同的剂型,且给药简单,方便患者自行用药;外用吸收少,可减少药物产生的不良反应等。     

老年人更要注意用药安全

生活中,很多人生病后都自行买药,根据感觉改变疗程、剂量。据统计,30％的家长都曾自行给孩子用药,其实这都可能给身体带来严重后果。而老年人由于身体机能衰退,对药物耐受性降低,更应注意安全、合理用药。现在我来阐述一下老年人用药的安全问题。关于药品,首先是其不良反应和注意事项问题。这些一般在药品说明书上都有明确标注,且每个不良反应都有一定的发生率。其次,药品的有效率。由于个体差异的存在,同样的药应用于不同人的效果也不一样,也就是说,每一种药品都有其有效人群。最后,不存在神药。所有药品中,包括中药,有益无害的药目前是不存在的,不要幻想存在药效奇好的神药。     

某院细菌耐药率与抗菌药物用药频度相关性分析

目的：分析细菌耐药率与抗菌药物用药频度的相关关系,为临床合理选用抗菌药物提供依据.方法：采用K-B法进行药敏检测,按美国临床和实验室标准化协会（CLSI）标准分析结果;采用用药频度分析法对本院近3年抗菌药物消耗量进行统计及排序;采用SPSS分析软件进行细菌耐药率与抗菌药物用药频度相关性分析.结果：3年抗菌药物用药频度平均下降率为21.23％;肺炎克雷伯菌对左氧氟沙星耐药率随左氧氟沙星用药频度升高呈上升趋势,而铜绿假单胞菌对环丙沙星的耐药率随环丙沙星用用药频度下降呈降低趋势.结论：细菌耐药率与抗菌药物用药频度变化趋势存在一定的内在联系,规范抗菌药物的临床合理应用可能减缓细菌的耐药趋势.     

抗菌药物不良反应分析及预防

目的:分析抗菌药物导致不良反应发生的原因,促进临床合理用药。方法:回顾性分析本院2009年1月至2011年6月临床科室上报的抗菌药物不良反应病例66例,对引发的不良反应进行客观、科学分析。结果:经分析总结得出:66例病例引起不良反应的抗菌药物种类有:青霉素类11例、头孢菌素类20例、碳青霉烯类1例、氟喹诺酮类23例、大环内酯类2例、林可霉素类5例、硝咪唑类2例、万古霉素1例、枸橼酸铋钾片/替硝唑片/克拉霉素片组合1例。结论:根据上述不良反应发生症状的差异,本院分别采用不同的预防治疗措施,未发生致残、致死病例。     

浅谈药品不良反应与安全用药

随着社会的发展,如何安全、有效、合理的用药已成为社会关注的热点.近年来关于药物不良反应(adverse drug reaction,ADR)的报道和讨论比较多,已引起了各方面的注意.临床上对药品的要求不仅仅局限于对疾病的治疗作用,同时也要求在治疗疾病的同时,所使用的药品应当尽可能少地出现ADR.根据WHO报告,全球死亡人数中有近1/7的患者是死于不合理用药.在我国,据有关部门统计,药物不良反应在住院患者中的发生率约为20%,1/4是抗生素所致.每年由于滥用抗生素引起的耐药菌感染造成的经济损失就达百亿元以上.     

铜陵市女性人工流产、性行为及避孕情况调查

目的：了解铜陵市女性人工流产及避孕情况。方法：随机对500例要求进行人工流产的女性进行匿名问卷调查。结果：进行人工流产女性平均年龄为26．3±5．4岁（16—44岁）,其中已婚妇女328例,平均年龄29．5±4．8岁（21岁-44岁）,未婚妇女172例,平均年龄21．6±3．1岁（15—8岁）。每次性行为都采取避孕措施的占18．4g,偶尔采取避孕措施的占62．2％,从未采取避孕措施19．4％。人工流产的危害68-4％知道出血、感染,约15％的调查对象完全不知道人流的不良反应。结论：现代女性首次性生活及首次人流年龄提前,并呈年轻化趋势,与已婚人群相比,未婚青年对生殖健康、避孕知识及人工流产了解严重缺乏,加强生殖健康和避孕知识的教育刻不容缓。     

药物不良反应与药物警戒概述

通过药物不良反应(ADR)历史的回顾,简述了ADR的分类和影响因素,阐明了重视药物警戒、关心国际药物监测中心ADR信息的重要意义,对促进合理用药、减少ADR、提高医疗质量、创造健康人生起到一定的积极作用。     

648例中药注射剂不良反应的调查与分析

目的分析中药注射剂不良反应发生特点及规律,为临床合理用药提供参考。方法采用回顾性分析方法对2010年1月至2012年12月收到的648份中药注射剂不良反应报告表进行统计分析。结果中药注射剂诱发的不良反应648例,涉及30种药物,累及人体7个系统,最常见的为皮肤及其附件损害,严重的不良反应为93例。结论临床应合理使用中药注射剂,加强对中药注射剂不良反应的监测,提高用药水平。     

硝普钠与拉贝洛尔对高血压急症患者血液流变学影响的对比观察

目的：观察硝普钠与拉贝洛尔对高血压急症患者血液流变学的影响。方法：高血压急症56例,随机分为硝普钠组与拉贝洛尔组。28例采用硝普钠治疗,其它28例给予拉贝洛尔。两组均静脉持续用药6小时。每例于治疗开始和结束时分别进行血液流变学检测。结果：降压总有效率硝普组为100％（28／28）,拉贝洛尔组92．9％（26／28）,两组差异无统计学意义（P〉0．05）,但硝普钠组起效快于拉贝洛尔组。患者经硝普钠治疗后,血液流变学显示低切变率下全血粘度、高切变率下全血粘度、血浆比粘度、红细胞取集指数及血小板聚集率均显著下降（P〈0．01或P〈0．05）,与拉贝洛尔组比较,差异有显著性（P〈0．05）。拉贝洛尔组血液流变学各指标值虽有下降,但未达到统计学显著性程度（P〉0．05）。与药物有关的不良反应,硝普钠组明显低于拉贝洛尔组（3．6％,vs 21．4％,P〈0．05％）。结论：硝普钠治疗高血压急症疗效确切、起效快、不良反应少,且该药有改善血液流变性作用,优于拉贝洛尔。     

咪达唑仑持续静脉推注治疗小儿难治性惊厥的疗效观察

目的:观察咪达唑仑持续静脉推注治疗小儿难治性惊厥的临床疗效及不良反应。方法:选择以频繁惊厥为主要表现且按传统方法抗惊厥治疗无效的住院儿童42例。研究分两组,对照组21例在出现频繁惊厥采用苯巴比妥联用安定治疗无效后以安定加入葡萄糖溶液静脉持续滴注,研究组则给予咪达唑仑静脉持续推注。对比两组疗效,同时观察两组的不良反应。结果:研究组21例患儿有20例惊厥完全得到控制,1例无效,有效率为95.2%,且气道分泌物少,无明显呼吸抑制及其他不良反应。对照组仅12例惊厥被完全控制,9例无效,有效率为57.1%,且部分患儿在治疗过程中出现呼吸抑制,气道分泌物增加等不良反应。两组有效率具显著性差异(P<0.01)。结论:咪达唑仑对小儿难治性惊厥疗效明显,不良反应少,可作为治疗小儿难治性惊厥的首选方法。     

Occult drug exposure in young children evaluated for physical abuse: An opportunity for intervention

BackgroundAlthough screening for drug exposure is an important consideration in the evaluation of suspected child maltreatment, limited data are available on the frequency of drug exposure in children with suspected physical abuse.ObjectiveTo examine occult drug and pharmaceutical exposure in young children with suspected physical abuse.Participants and settingChildren ages 2 weeks –59 months evaluated for physical abuse by a tertiary referral center Child Protection Team.MethodsCross-sectional study of young children diagnosed with high, intermediate, or low concern for physical abuse and tested for occult drug exposure from 2013-2017. Chart review was performed to determine adherence to recommended testing and drug test results with comparison between groups.ResultsOccult drug exposures were found in 5.1% (CI 3.6–7.8) of 453 children tested: 6.0% (CI 3.6–10.0) of 232 children with high concern for physical abuse, 5.0% (CI 2.7–9.3) of 179 children with intermediate concern, and 0% of 42 children with low concern. As adherence to protocol-based screening improved during the second half of the study, so did the overall rate of detection of occult drug exposures (7.9%, CI 5.2–11.9) in 252 children with intermediate or high concern for physical abuse. Most exposures were to cocaine, although non-prescribed pharmaceutical exposures were also detected.ConclusionsUp to 7.9% of young children suspected of being physically abused also had an occult drug exposure. Given the adverse health consequences associated with exposure to a drug-endangered environment, screening for occult drug exposure should be considered in the evaluation of young children with intermediate or high concern for physical abuse.     

刍议减少中成药制剂不良反应的对策

目的对近年来中成药制剂的不良反应情况报道和分析。方法通过中成药制剂不良反应典型病例的报告。结果说明中成药不良反应,必须引起临床工作的高度重视,研究对策,减少中成药不良反应。结论应该重视中成药制剂新剂型的发展,科学合理用药,对临床应用的重大意义。     

Effects of fructose-1,6-diphosphate on concentration of calcium and activities of sarcoplosnic Ca^2＋-ATPase in cardiomyocytes of Adriamycin-treated rats

Objective: To observe the effects of fructose-1,6-diphosphate (FDP) on serum levels of cardiac troponin 1 (cTnl) and creatine kinase-MB (CK-MB), as well as the concentration of calcium in cardiomyocytes (Myo[Ca2 ]) and activity of sarcoplosnic Ca2 -ATPase (SRCa2 -ATPase) in Adriamycin (ADR)-treated rats. Methods: Rats were intraperitoneally injected with ADR (2.5 mg/kg every other day for 6 times) and then with different dosages of FDP (every other day for twenty-one times). Bi-antibodies sandwich Enzyme linked immune absorption assay (ELISA) was performed to detect serum level of cTnl. CK-MB was detected by monoclonal antibody, Myo[Ca2 ] was detected by fluorescent spectrophotometry and the activity of SRCa2 -ATPase was detected by inorganic phosphate method. Results: FDP (300, 600, 1200 mg/kg) significantly reduced the serum levels of cTnl and CK-MB, while at the same time decreased calcium concentration and increased SRCa2 -ATPase activity in cardiomyocytes of ADR-treated rats (P<0.01). Conclusions: FDP might alleviate the cardiotoxic effects induced by ADR through decreasing calcium level as well as increasing SRCa2 -ATPase activity in cardiomyocytes.     

Evaluation of drug-endangered children: The yield of toxicology and skeletal survey screening

BackgroundDrug endangerment is known to be associated with child maltreatment. However, even with the high association between physical abuse and drug endangerment there is no standard for screening in this population. Skeletal survey screening may facilitate the identification of children in this population who have also been physically abused.ObjectiveOur objective was to determine the characteristics of drug endangered children and specifically the yield of skeletal survey screening.Participants and settingThe participants in this study were children referred by Child Protective Services (CPS) due to concerns of drug exposure. They were seen in a child abuse outpatient clinic by a child abuse pediatrician or pediatric nurse practitioner.MethodsThis study is a retrospective chart review of the Child Advocacy Resource and Evaluation (C.A.R.E.) Team records between January 1, 2011 and December 31, 2017. We measured the yield of toxicology, additional abuse endured, and skeletal survey findings.ResultsOver the 6-year period, 1252 cases were referred to C.A.R.E. Team for drug endangerment. 1150 cases had hair toxicology performed with 595 cases (52%) testing positive for at least one illegal substance. The compound most frequently identified was methamphetamine followed by marijuana and cocaine. In addition to drug endangerment, other forms of abuse were identified in 162 cases including sexual, physical, and neglect. Using the American Academy of Pediatrics (AAP) and American College of Radiology (ACR) guidelines, 340 skeletal surveys were performed. Twelve cases (4%) had occult skeletal injuries none of which had cutaneous findings. Of those with skeletal injury, 11 cases out of 11 tested by hair toxicology were positive for at least one illegal substance.ConclusionsThe application of the AAP and ACR guidelines for skeletal survey screening to those children referred for drug endangerment is useful in identifying children with physical abuse.