Patient-controlled intranasal diamorphine for postoperative pain: an acceptability study

A patient acceptability study was conducted using patient-controlled intranasal diamorphine. Patients undergoing nonemergency orthopaedic or gynaecological surgery self-administered intranasal diamorphine for 24 h postoperatively. Pain, pain relief, sedation, respiratory rate, nausea and vomiting were assessed regularly. After 24 h, patients and their attending nurses completed a questionnaire assessing satisfaction and practical aspects of the technique. Satisfaction was reported as good or complete by 69% of patients and 69% of nurses. Pain relief was assessed as better than expected by 45% of patients and better than normal by 50% of nurses. Seventy-nine per cent of patients would be pleased to use patient-controlled intranasal diamorphine again and 89% of nurses would be happy for their patients to use it again. Sedation was uncommon and mild and there were no episodes of significant respiratory depression. Fifty-three per cent of patients reported no nausea and 74% did not vomit at any stage. There were seven withdrawals, four due to problems with the device and three due to therapeutic problems. The nasal spray may need modification to improve reliability. However, we found patient-controlled intranasal analgesia an effective technique, which was well tolerated by patients and nurses and was without unpleasant side-effects. Further work to determine how it performs compared with intramuscular or intravenous analgesia is now needed.     

923份住院病历抗菌药使用情况调查分析

目的：调查住院患者抗菌药使用情况，提高临床合理使用抗菌药水平。方法：抽取深圳市属某综合医院2004年4月1、4、7、10、13、16、19、22、25、28日共10d34个临床科室的所有出院病历923份，对其抗菌药使用情况进行统计分析。结果：75．1％的患者(693／923)使用了一共86种抗菌药(其中头孢菌素类27种)，其中514例患者使用了2种以上的抗菌药，34例患者使用了6种以上的抗菌药，最多者使用了17种抗菌药。手术科室抗菌药使用率和联合用药率均明显高于非手术科室。仅87例进行了微生物学检查和药敏实验。没有一例进行血药浓度监测。结论：抗菌药使用广泛，比例偏高；多凭经验用药，缺少药敏实验依据。用药方案不尽合理，存在滥用现象。     

Treatment failures secondary to drug interactions with divalent cations and fluoroquinolone

We observed four cases of therapeutic failures while patients were simultaneously taking medications that contained divalent cations and oral fluoroquinolones. Patients improved after conversion to the intravenous formulation of the same antibiotics, proper spacing of the divalent cation, or conversion to a different antibiotic class. Patients prescribed oral fluoroquinolones should receive instructions on proper separations of these antibiotics with divalent cations. Health care professionals should be cognizant of these interactions and educated on their potential deleterious effect.     

奥美拉唑雷尼替丁预防颅脑损伤术后应激性胃出血比较

目的：探讨奥美拉唑,雷尼替丁预防颅脑损伤手术后应激性胃出血的效果。方法;将中,重型颅脑损伤（GCS12－4分）的手术后患者随机分为3组,各30例,奥美拉唑组,雷尼替丁组在对照组用药的基础上分别静脉滴注奥美拉唑40mg,qd,和雷尼替丁150mg,bid,观察临床出血程度,结果：奥美拉唑组,雷尼替丁组的预防效果分别为96．7％,93．3％,与对照组（76．7％）比较差异有统计学意义（P＜0．05）,在使用额外剂量后,奥美拉唑组的5例出血均停止,雷尼替丁组7例出血中仍有4例不能止血,结论：奥美拉唑,雷尼替丁均有预防颅脑损伤手术后应激性胃出血的作用,且预防效果几乎相等,但奥美拉唑较雷尼替丁的止血作用强。     

住院患者抗菌药物应用干预措施前后对比分析

目的探讨干预措施对规范抗菌药物应用的可行性,为抗菌药物的规范应用和管理提供参考依据。方法选取实施干预前的2008年8月患者作为对照组,干预后的2009年8月患者作为干预组,比较2组用药情况。结果干预后抗菌药物使用率、联合用药率显著下降;平均药费略有上升,而抗菌药物费用明显降低;喹诺酮类使用率显著下降;医院感染率下降。结论本研究所采用的合理用药干预措施具有可行性和有效性,其中最关键的是干预措施的完全实施。     

多途径动脉灌注化疗及栓塞治疗对伴发远处转移的晚期妇科恶性肿瘤疗效初步分析

目的：探讨多途径动脉灌注化疗及栓塞治疗对已有远处脏器转移的妇科恶性肿瘤的效果。方法：对有肝、肺脏转移的晚期恶性肿瘤２９例进行了选择性盆腔动脉、肝动脉和肺动脉插管造影，继行化疗及栓塞治疗。结果：经治疗１５～３０ｄ后，２１例（７２．４％）病灶直径缩小５０％以上，５例（１７．２％）病灶直径缩小不足５０％，３例（１０．４％）治疗效果不明显。结论：多途径动脉灌注造影，行药物及栓塞治疗对有远处脏器转移的晚期恶性肿瘤有一定疗效，不仅有较强的局部作用，而且副作用较轻。但本组例数较少，随诊时间短，有关问题有待进一步研究。     

中医药戒毒研究的思路与方法

当前,吸毒已成为全世界越来越严重的社会问题,药物依赖这一特殊的疾病已渐渐成为医学界关注的热点。由于本病机制复杂,涉及因素众多,现代医学尚未找到根治之法,目前常用的戒毒药物亦存在一定的副作用或成瘾性。中医药戒毒凭借其理论独到、副作用相对较小、临床疗效明显等特点已日益受到人们的重视,可为戒毒领域的研究提供新的思路。但由于中医戒毒的现代研究起步较晚,目前仍存在一些不足,针对于此,文章较系统地分析了现今中医戒毒工作中存在的问题,并提出了相应的研究思路和方法,以促进其进一步发展,为我国乃至世界戒毒工作做出自己的贡献。     

大剂量甲氨蝶呤静脉给药时间对淋巴瘤患者脑脊液中药物浓度的影响

背景与目的:甲氨蝶呤(methotrexate,MTX)在脑脊液中高于最小有效治疗浓度是治疗中枢淋巴瘤的必要条件,目前尚不明确大剂量MTX(high doseMTX,HD-MTX)静脉给药时间对MTX穿透血脑屏障的影响.本研究探索HD-MTX静脉不同给药时间对脑脊液中MTX浓度的影响,以获得更好的中枢淋巴瘤防治效果并尽可能减少MTX外周毒性.方法:34例非霍奇金淋巴瘤患者分别接受MTX 1～3g/m2 6 h持续静脉给药或24 h持续静脉给药,其中17例交替使用两种给药方法;采用高效液相色谱法检测MTX停药0 h、24 h、48 h的MTX血清浓度,及停药0 h后脑脊液中MTX浓度;比较两组血中和脑脊液中MTX浓度以及毒性反应,并对影响MTX浓度的因素进行相关分析.结果:给药结束时6 h给药组的MTX血清浓度显著高于24 h给药组:自身对照结果6 h给药组的脑脊液中MTX浓度为0.70 Ixmol/L,明显高于24 h给药组的0.49 Ixmol/L(校正值,P=0.044).MTX的脑脊液浓度与血清浓度呈正相关,中枢侵犯患者脑脊液MTX浓度显著高于无中枢侵犯的患者.自身对照结果6 h组和24 h组Ⅱ～Ⅳ度粘膜炎的发生率分别15.4%和37.8%.Ⅲ～Ⅳ度骨髓抑制的发生率分别为46.2%和67.6%.结论:在提高MTX的中枢浓度和降低外周毒性方面,HD-MTX 6 h给药方案优于24 h给药方案.     

全国9家肿瘤专科医院2010年抗肿瘤药利用分析

目的:评价全国9家肿瘤专科医院抗肿瘤药的应用情况。方法:采用回顾性方法,对全国9家肿瘤专科医院2010年抗肿瘤药的应用数据进行统计、分析。结果:所涉及的抗肿瘤药中,注射剂有68种,口服制剂有38种。口服制剂中,有27种出现用药频次错误。从处方单次用药剂量看,有40种药超出说明书用药剂量范围。结论:抗肿瘤激素药、铂类、紫杉烷类药应用最为广泛,分子靶向治疗药也应用较多。药品说明书应及时给予补充、修订、完善。     

Drugalities: the generative capabilities of criminalized ‘drugs’

Drawing on cultural studies and actor-network theoretical traditions, this article explores the generative capacities of the ‘drugalities’ or personalities of different drugs. This article explores technologies of generalisation as well as specification in order to show that the ways in which a substance behaves pharmacologically, as well as the ways in which it is constituted culturally and officially, work to shape attempts to control its use.