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长期服用糖皮质激素及免疫抑制剂致肺曲霉菌感染一例

吗啡缓释片直肠给药致蓄积中毒一例

【摘要】　目的　报道并分析1例疼痛患者使用吗啡缓释片直肠给药镇痛过程中出现蓄积中毒的不良反应。　方法　采用病例报告的形式并结合药品使用说明书进行分析。　结果　吗啡缓释片说明书上并未有直肠给药途径，该患者使用吗啡缓释片塞肛属于超说明书用药。　结论　在临床中不推荐吗啡缓控释制剂作为直肠给药，如果无法避免需要使用该途径时，也应从小剂量开始逐渐增加剂量，尤其老年患者，应更加谨慎使用。

去甲万古霉素静脉滴注致疑似红颈综合征一例

【摘要】　目的　报道并分析1例腰腹痛伴发热患者使用去甲万古霉素静脉滴注后致疑似红颈综合征的不良反应。　方法　对患者用药过程进行分析。　结果　患者使用去甲万古霉素800 mg加入到100 mL生理盐水中静脉滴注，浓度过大。　结论　红颈综合征为万古霉素特有的不良反应，临床使用时，需注意静脉用药浓度不宜过大，滴速不宜过快；密切监测患者的情况，一旦发生异常情况，应积极处理。

甲巯咪唑致粒细胞缺乏症一例

抗结核药致剥脱性皮炎一例

Incidence and Risk Factors of Myocardial Infarction Complicated by Non-Alcoholic Fatty Liver Disease

Objective　To investigate the incidence and risk factors of non-alcoholic fatty liver disease (NAFLD) in patients with myocardial infarction. Methods　A total of 634 patients with myocardial infarction from Beijing Anzhen Hospital were asked to take liver and gallbladder ultrasonography during hospitalization, and then divided into the NAFLD and non-NAFLD groups. The incidence and risk factors of the two groups were then analyzed. Results　The incidence of NAFLD was 52.2% (331/634). Both body mass index (BMI) and serum alanine aminotransferase of the NAFLD group were higher than those of non-NAFLD group, with significant difference (Plt;0.05). The incidence of NAFLD was positively increased following the severity of coronary diseases (χ2=7.275, P=0.03). The result of multivariable logistic regression analysis showed BMI, multi-vessel lesions of coronary disease, and left main coronary artery lesion were the independent risk factors of NAFLD. Conclusion　The myocardial infarction patients who are particularly complicated by overweight, multi-vessel lesions and left main coronary artery lesion have a higher incidence of NAFLD.

Relationship between Inducible Nitric Oxide Synthase and Endothelin mRNA Expression and Intestinal Damage and Effect of Salvia in Acute Pancreatitis

【摘要】目的探讨重症急性胰腺炎(SAP)时胰腺组织的诱导型一氧化氮合成酶(iNOS)、内皮素（ET1） mRNA表达状态, 以及与血浆中NO、ET1浓度和肠道损伤的关系及丹参治疗的影响。方法Wistar大鼠45只随机分为3组:SAP模型组(A组),SAP丹参治疗组(B组),假手术 组(C组),进行不同治疗和观察分析。结果A组血中淀粉酶(AML)、ET1、NO、内毒素(LPS)含量、125 I白蛋白累积指数及腹水量均显著高于C组(Plt;0.01);与A组比较,B组胰腺ET1和iNOS mRNA表达较弱,血中AML、ET1、NO、LPS及腹水量显著下降(Plt;0.01),125 I白蛋白累积指数较A组也有下降,但无差异(Pgt;0.05)。结论SAP时存在肠道损伤,胰腺组织ET1、iNOS mRNA的过度表达,使血中ET1、NO浓度升高,造成肠道屏障功能受损,肠通透性增加,引起内毒素血症。丹参注射液通过减轻SAP时胰腺的病理损害程度,下调胰腺ET1和iNOS mRNA的表达,使血中ET1、NO浓度下降,对SAP及其肠道损伤有一定治疗作用。

Clincal Aanlysis of 23 Cases with Craniocerebral Injury Combined with Optic Nerve Injury

目的:探讨颅脑损伤合并视神经损伤的发病机制及治疗.方法:对23例颅脑损伤合并视神经损伤患者的临床资料做回顾性分析。结果:经过积极治疗部分患者视力有不同程度改善。结论:治疗颅脑损伤合并视神经损伤,强调神经外科和眼科协同处理,掌握治疗时机。

国内外结核病诊疗指南中关于抗结核药物相互作用管理的分析

我国是世界结核病大国，患病人数位居世界第2位，仅次于印度。结核病严重危害人民健康，是我国重点防控的重大疾病之一。其为慢性传染病，需要长期多药联合治疗，而在长期治疗过程中患者往往因合并疾病需要同时使用其他药物，从而增加了药物相互作用的风险，导致药物不良反应增加或疗效降低。常见的合并疾病包括高血压、冠状动脉粥样硬化性心脏病、糖尿病、真菌性疾病和艾滋病等，需要β肾上腺素能受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、钙通道阻滞剂、口服降糖药、三唑类抗真菌药和抗逆转录病毒药等治疗，这些药物都与抗结核药存在相互作用。如何管理药物相互作用，是临床医师和药师共同关注的问题。通过检索国内外中英文结核病诊疗指南，总结指南中关于抗结核药物相互作用的管理办法，以期为临床医师和药师提供权威的参考意见。现就指南中药物相互作用管理的推荐意见进行综述。

Analysis of the Adverse Reactions/Events of Voriconazole:44 Cases Review

ObjectiveTo summarize the occurrence rules of adverse reactions/events of voriconazole, analyze the reasons of adverse reactions/events, and provide reference for clinical medication. MethodsUse China National Knowledge Infrastructure, Vip Journal Integration Platform and Wanfang Data Knowledge Service Platform to search the literatures published in 2015 and before with "voriconazole" "adverse reaction" and "adverse event", classify the adverse reactions/events according to gender, age, system-organs, drug combination, occurrence time, and outcome, and analyze the occurrence regularity and reasons of adverse reactions/events. ResultsA total of 29 literatures were searched, including 44 cases. In all the adverse reactions/events, elderly patients were the most (18 cases with the age of 61-80 years old, occupying 40.9%; 13 cases with >80 years old, occupying 29.5%). Adverse reactions/events mainly involved central nervous system (45 cases, 59.2%). Proton pump inhibitors (5 cases) were the more common drug combination in the 7 drug combination cases. Most adverse reactions/events occurred in 1-7 days after medication (35 cases, 79.5%). The outcome of adverse reactions/events included 39 improvement/recovery, 1 death, and 4 unknown. ConclusionUsing voriconazole should consider the drug characteristics. Choose the drug according to the specific condition of patients, at the same time pay attention to drug interactions, contraindications, and so on. If necessary, genetic testing and therapeutic drug monitoring can be done in order to reduce the occurrence of adverse drug reactions/events.