我院2008～2009年基本药物使用情况分析

目的:促进基本药物在我院的应用。方法:按照《国家基本药物目录·基层医疗卫生机构配备使用部分》(2009版),将2008～2009年我院基本药物按品种数、品规数及销售金额等分类,并进行统计、分析。结果:我院2008、2009年基本药物品种数分别为194、200种,占药品总品种数的32.07%、31.55%;品规数分别为222、229个,占药品总比例的33.48%、33.09%;基本药物金额占药品总金额比例分别为24.27%、26.18%。结论:我院基本药物的销售金额比例远低于浙江省卫生行政部门要求的达到60%以上的标准,我院应进一步提高国家基本药物的应用比例,使广大患者受益。     

我院2013年门诊基本药物使用情况调查分析

目的:了解我院门诊基本药物使用状况,促进基本药物在我院的合理使用。方法:比较我院(眼耳鼻喉专科医院)2013年门诊各科及全院上、下半年基本药物处方品种占比和费用占比;对眼科、耳鼻喉科两个主要科室处方品种占比居前列的药品进行排序,并对4个季度的排序进行比较。结果:随着2012年版《国家基本药物目录》的施行,2013年下半年全院门诊基本药物处方品种占比和费用占比较上半年均显著上升(P<0.01)。眼科2013下半年基本药物处方品种占比和费用占比较上半年均有显著上升(P<0.01),处方品种占比前20位中收载入2012年版《国家基本药物目录》的有2种,收载入2010版上海市增补目录的有3种。耳鼻喉科2013下半年基本药物处方品种占比较上半年显著下降(P<0.01),费用占比显著上升(P<0.01),处方品种占比前20位中收载入2012年版《国家基本药物目录》的有2种,收载入2010版上海市增补目录的有3种。结论:我院基本药物的处方品种占比和费用占比呈上升趋势,但非基本药物仍占主导地位,基本药物的使用率有待提高。基本药物目录收载的眼耳鼻喉科等专科药品品种不足、剂型单一,未来基本药物目录的调整还需要更多考虑专科医院的用药特点。     

三级肿瘤专科医院基本药物应用情况调查分析

目的：了解国家基本药物制度在三级肿瘤专科医院的实施现状,为优化基本药物品种目录和肿瘤专科医院基本药物考核指标提供参考。方法：以本院作为样本,对2013~2015年使用的基本药物品种数及销售金额进行汇总、统计、分析。结果：按照《国家基本药物目录（2012版）》（简称《目录》）和《江苏省基层医疗卫生机构增补药物目录（2011版）》统计,本院2013~2015年平均基本药物品种配备率为38.51％;基本药物销售百分比：2013年为11.74%,2014年为10.90％,2015年为10.16％。肿瘤专科用药前10名的药物中仅紫杉醇注射液在《目录》中。结论：《目录》中收载的肿瘤专科用药品种少,很多临床常见肿瘤的治疗药物品种未收录,难以满足肿瘤专科医院用药需求。希望在今后修订《目录》时,应考虑增加肿瘤专科用药品种,对肿瘤专科医院的基本药物考核指标可参照同级别综合性医院的考核指标,作适当的下调,更好地满足临床用药需求。     

我院实施国家基本药物制度的措施及难点探讨

目的:探索我院实施基本药物制度的措施和难点,为医院更好的实施基本药物制度提供依据。方法:通过查阅国家关于实施基本药物制度的相关政策和具体实施办法,结合我省及郑州市在实施基本药物制度过程中存在的问题进行分析。结果:我院在执行基本药物制度过程中面临的主要问题是财政投入不足,导致基本药物实施力缺失;我院是一所三级专科(口腔、眼科)医院,《国家基本药物目录·基层医疗卫生机构配备使用部分》(2009版)中适合我院用药的药物很少,难以满足我院的用药需求,很难达到河南省规定的基本药物用药金额比例。结论:政府应逐步加大财政投入,在今后修订《国家基本药物目录》时,应考虑适度添加能满足专科医院临床需要的药物品种。     

我院基本药物应用情况分析

目的实施国家基本药物制度,促进基本药物在我院的应用。方法按照2010年《河南省二级以上医疗机构基本药物目录（试行）》,将我院所用药物分为基本药物与非基本药物两类,按品规数及销售金额进行统计、分析。结果我院2011、2012年上半年基本药物品规数分别为375、441种,占药品总品规数的71．02％、74．49％;基本药物销售金额占药品总金额比例分别为69．19％、76．83％。结论国家基本药物制度实施后,我院基本药物的使用比例不断提升,销售金额比例大于60％,我院应进一步提高国家基本药物的应用比例,使广大患者受益。     

2012年版《国家基本药物目录》品种在部分省市二、三级综合性医院的使用现状分析

目的:为进一步提高基本药物在医疗卫生机构的使用率提供参考。方法:从北京、天津、河北、辽宁等12个省市,选取二级综合性医院15家、三级综合性医院22家,对其2012年版《国家基本药物目录》品种销售和配备情况进行汇总分析。结果:二级综合性医院基本药物销售额(含单独定价)占药品销售总额的比例平均为19.40%,如不统计单独定价药品销售额,平均为16.72%,平均下降2.68%;三级综合性医院基本药物销售额(含单独定价)占药品销售总额的比例平均为12.62%,如不统计单独定价药品销售额,平均为7.53%,平均下降5.09%。二级综合性医院配备2012年版《国家基本药物目录》占医院药品品种的比例平均为42.54%,三级综合性医院为29.57%。结论:二、三级综合性医院基本药物使用比例和配备率均偏低。建议统一基本药物使用比例的口径,引入更多科学的指标(如基本药物使用数量比例、医院配备基本药物品种比例)评价基本药物使用情况,同时加大舆论宣传,使基本药物深入人心,调动医务人员积极性,以提高基本药物使用率。     

医院基本药物临床应用中存在的问题及管理对策

目的:调查研究医院基本药物临床应用中存在的问题,探讨管理对策。方法:抽取我院2014年1月-2016年12月期间临床应用或门诊药房售出药品的相关信息,统计分析我院基本药物品种、品规及销售情况,评估我院基本药物应用情况。结果:在品种方面,近三年基本药物在国家基药目录总数中所占比例分别为50.58%、41.92%、65.7%,均低于国家要求的80.00%;品规数方面,2016年基本药物在总体药物中比重为30.39%,符合国家要求,但其他年份均未达到国家要求的30.00%;销售金额方面,近三年基本药物销售金额占医院总体药物销售金额的21.69%、20.01%、22.18%,基本药物的应用较国家要求的25.00%-30.00%仍略有差距。结论:基本药物在医院中的应用情况仍不够理想,仍需进一步加强监管,制定切实可行的基本药物采购、管理和应用政策,满足实际临床需求,实现合理用药。     

多层级基本药物目录中含儿科使用信息药物的对比分析

目的：从儿科药可获得性的角度比较分析WHO、国家和省三层级基本药物目录。方法：通过统计WHO 2013版《儿童基本药物示范目录》、2012版《国家基本药物目录》和2011版《江苏省基本药物目录》中含儿科使用信息的药物,对3个目录中儿科适宜药物进行比较分析。结果与结论：2012版《国家基本药物目录》能够满足一定的儿科需求,但缺乏一些儿科专用品种和适用剂型规格,我国应针对无明确儿童用法用量信息的药品进行儿科评价。江苏省可参考2011版增补目录并借鉴WHO《儿童基本药物示范目录》,针对本省的用药需求补充儿童适用的品种、剂型和规格。     

2019～2022版《医保药品目录》抗菌药物品种对比分析

目的 对《国家基本医疗保险、工伤保险和生育保险药品目录》（以下简称《医保药品目录》）抗菌药物品规设置变化进行对比分析,以期更好地贯彻执行医保政策,促进临床合理应用。方法 整理汇总2019～2022版《医保药品目录》中全身用抗菌药物,采用描述性分析方法,对比分析不同版本之间的差异。结果 抗菌药物品规数及协议期谈判品种逐年增加;四版抗菌药物剂型以注射剂型、口服常释剂型为主（两者之和在79.14%～80.65%）;限定支付条件药品2019版、2020版50种,在2021版增至54种,2022版锐减至44种;儿童抗菌药物专用药占比在3.76%～5.35%;《医保药品目录》涉及国家重点监控药物抗菌药物6个品种,9个品规。结论 抗菌药物可及性和用药公平性得到进一步提升;需扩大《医保药品目录》抗菌药物限定支付条件,达到与说明书、临床诊疗指南一致;加大对儿童抗菌药物专用药的关注;加强涉及国家重点监控抗菌药物医保目录品种的管理。     

六省区18家二级医院国家基本药物(中成药)使用情况调研

目的:为《国家基本药物目录.基层医疗卫生机构配备使用部分》(2009版)(以下简称"2009年版国家基本药物目录")中中成药部分的调整提供参考。方法:按照经济发达程度,选取广东省、江苏省、山东省、湖北省、四川省和宁夏回族自治区六省(区)的18家二级医院的中成药药品目录,分别与2009年版国家基本药物目录(中成药)和所在省(区)的基本药物增补目录(以下简称"省中成药增补目录")进行比较,分析国家中成药基本药物、各省中成药增补目录和各医院2009年版国家基本药物目录外(以下简称"目录外")中成药品种的使用情况。结果:国家中成药基本药物在18家医院的使用率平均为45%,六省(区)增补中成药目录的使用率为14%～41%,各医院目录外中成药品种使用比例平均为73%。结论:2009年版国家基本药物目录中成药部分的遴选与临床需求存在一定差距,该目录尚无法满足我国二级医院的医疗需求,特别是经济较发达地区。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.