KANGGANRAN YAOXUE

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  • 2019 Volume 16 Issue 12
    Published: 25 December 2019
      
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  • Discussion on Development and Prospect of Dissolution Method for Oral Solid Dosage Form
    WANG Qi-shuai, LI Er-yong, SUN Yan, YAN Bo
    2019, 16(12): 2025-2029. https://doi.org/10.13493/j.issn.1672-7878.2019.12-001
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    Appropriate dissolution methods are most frequently used. They are most important quality control methods for pharmaceutical research units in the formulation development and process optimization of oral solid dosage form. In view of the National Medical Products Administration（NMPA）'s promotion of generic drug consistency evaluation, the implementation and promotion of “4+7” quantity procurement, and the encouragement of new drug research and development,the researches of oral solid dosage form preparation formulation and processes have been given more attention. In order to develop an appropriate dissolution method, this paper focuses on the determination of solubility and the development of the dissolution method with distinguishing force. Based on the theory and combined with the practice, we conduce exploration and analysis, hoping to provide reference for the researchers of oral solid dosage form.
  • Opportunities and Challenges for Development of Traditional Chinese Medicine Preparations in Hospitals under New Situation
    WANG Si-qi, ZHOU Feng, CHENG Jun-ping
    2019, 16(12): 2030-2033. https://doi.org/10.13493/j.issn.1672-7878.2019.12-002
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    Hospital Traditional Chinese medicine(TCM) preparation is of great significance under the demand of clinical drug use and medical scientific research. Due to the limitations of relevant policies and poor management of the hospital itself, the development of hospital preparations has stopped. The continuous implementation of the relevant policies provides policy support for the application of experienced TCM preparations, as well as new opportunities for the development of TCM preparations in medical institutions. In the face of the problems in the development of TCM in hospital, this chapter proposes to seize the opportunity, dare to meet the challenge and put forward some policies to deal with it.
  • Status and Research Progress in Clinical Medication of Hepatitis B Drugs
    JI A-fang, PAN Yun-zhi, CHENG Jun-ping
    2019, 16(12): 2034-2039. https://doi.org/10.13493/j.issn.1672-7878.2019.12-003
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    Hepatitis B virus (HBV) infection is still a global problem that needs attention and solutions. Current clinical treatment methods cannot completely eliminate covalently closed circular DNA (HBV cccDNA) to achieve the goal of completely curing hepatitis B. Based on the progress of modern scientific research,the interaction between the hepatitis B virus and the host has gradually become clear,and some drugs targeted at various stages of the HBV life cycle are being developed and utilized. Hepatitis B is mainly treated by direct antiviral therapy and immunotherapy. The current literature on the clinical medication of hepatitis B drugs is reviewed in this paper,and its research progress is also analyzed.
  • Pharmacological Action and Recent Situation of Clinical Medication of Matrine on Skin Diseases
    ZHANG Ming-fa, SHEN Ya-qin
    2019, 16(12): 2040-2045. https://doi.org/10.13493/j.issn.1672-7878.2019.12-004
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    Matrine inhibits proliferation and collagen synthesis of hyperplastic scar fibroblasts, and induces apoptosis and expression of matrix metalloproteinase(MMP), and it has the effect of prophylaxis and treatment of hyperplastic scar. Matrine inhibits proliferation and induces apoptosis of skin carcinoma cells, and too inhibits proliferation of epidermic keratinocyte and melanogenesis. Matrine has anti-inflammatory effects against various immune and non-immune dermatitis. In clinic practice matrine has been tried on the treatment of dermatitis. The data of the pharmacological effects of matrine on skin diseases and its clinical medication were reviewed in this article and its the pharmacological action was also analyzed.
  • Analysi on Risk factors and Resistance in Anti-infection Medication of Stroke Associated Pneumonia in Patients with Acute Cerebral Infarction*1
    ZHANG Xiu-mei, CHOU Xiao-hua, MA Cui
    2019, 16(12): 2046-2051. https://doi.org/10.13493/j.issn.1672-7878.2019.12-005
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    Objective: To explore the risk factors, distribution characteristics of pathogenic bacteria and drug resistance of stroke associated pneumonia (SAP) in patients with acute cerebral infarction, and to provide references for effective prevention and treatment of stroke associated pneumonia. Methods: Clinical data of 211 patients with acute cerebral infarction in the department of neurology of the hospital in 2018 were collected for retrospective analysis. Univariate and multivariate logistic regression analysis was used to analyze the risk factors, main pathogenic bacteria and drug resistance of apoplexy related pneumonia, combining with the treatment effect, and to analyze the rationality of the anti-infection treatment plan of patients. Results: Univariate and multivariate Logistic regression analysis was used, and the results showed a positive correlation between endotracheal intubation or ventilator use, hypoproteinemia, and nasal feeding as well as the occurrence of SAP (P<0.05). Among the 211 patients with acute cerebral infarction, 69 strains of pathogenic bacteria were found, mainly Gram-negative bacteria, and the main pathogenic bacteria were Acinetobacter baumannii (28.99%), Pseudomonas aeruginosa (15.94%), Staphylococcus aureus (14.49%) and Klebsiella pneumoniae (11.59%). Drug resistance of pathogenic bacteria was relatively serious. The initial anti-infection treatment for SAP patients was mainly combined with cefotaxime-sulbactam and moxifloxacin. Only 36 of the 105 patients with SAP were effective. Conclusion: The occurrence of SAP was associated with major risk factors for patients such as endotracheal intubation or ventilator use, hypoproteinemia, and nasal feeding. The main pathogenic bacteria were Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. The multi-drug resistance of the pathogenic bacteria was relatively common, and the initial treatment scheme was more empirical, and the anti-infection treatment effect was not ideal.
  • Enlightenment of Existing Foreign Management Strategies on Integrated Operation of Anti-microbial Stewardship to China
    WANG Wen-bo, CHEN Ya-fang, DONG Wen-bin, WEN Ting-ting
    2019, 16(12): 2052-2057. https://doi.org/10.13493/j.issn.1672-7878.2019.12-006
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    Objective: To understand the work done in antimicrobial stewardship(AMS) integration in foreign countries, and to provide a reference for developing strategy of AMS integration in China. Methods: Embase, Pubmed and Cochrane library were searched in electronic medical databases, and the literatures were screened according to the inclusion criteria, and collated according to pre-designed tables and evaluation methods. Results: AMS integration operation in foreign countries has been well tried achieving definite results. Although vavious countries have many limitations in the process of promoting integration due to their economic, cultural, social foundation and other factors of countries or regions, valuable experience has still been provided for the comprehensive development of AMS strategy. Conclusion: To standardize the use of antimicrobial agents and curb the development of bacterial resistance, it is imperative to apply AMS integrated management strategy.
  • Influence of PDCA Cycle Management on Reducing Antimicrobial Usage Density(AUD) in Hospitalized Patients
    TIAN Zhi-qiang, KE Gui-lan
    2019, 16(12): 2057-2061. https://doi.org/10.13493/j.issn.1672-7878.2019.12-007
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    Objective: To explore the influence of PDCA circulation management on reducing the antimicrobial usage density (AUD) in hospitalized patients and its countermeasures, and to provide reference to promote the rational use of antimicrobial drugs. Methods: The data of patients' clinical medication of antibiotics before PDCA cycle management were implemented in the hospital from January to December 2017 were extracted. In addition, the data of clinical antimicrobial use of patients after PDCA cycle management were implemented from January to December 2018 were extracted. The differences between the two groups of patients in terms of the AUD and the current indicators (AUD value of the whole hospital and the reasons for the AUD) and their departments were compared and analyzed. Fish bone diagram and Plato analysis were used to find out the causes of its existence and solutions, determining the target, formulate countermeasures and implement intervention. Results: After the PDCA cycle management intervention in 12 months, AUD decreased from 53.86 DDD to 34.57 DDD, and the proportion of departments failing to meet the standards decreased from 54.2% to 20.8%. Compared with the AUD value before intervention, the difference was statistically significant (P<0.05). Conclusion: The application of PDCA circulation management has a significant effect on the control of the AUD of clinical use of antibiotics in hospitals and to promotes the rational use of antibiotics.
  • Analysis on Results of Etiology Examination and Resistance to Antimicrobial Agents in 72 Patients with Sepsis in ICU of a Hospital
    JIANG Jian-ze
    2019, 16(12): 2062-2064. https://doi.org/10.13493/j.issn.1672-7878.2019.12-008
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    Objective: To analyze the clinical characteristics, the results of pathogenic examination and the resistance to antimicrobial agents in patients with sepsis in intensive care unit (ICU) of hospital. Methods: 72 cases of ICU sepsis patients admitted from January 2016 to January 2018 were collected and divided into the death group (23 cases) and the survival group (49 cases). The types of pathogenic bacteria and drug susceptibility test results in the samples and the distribution of pathogenic bacteria and their drug resistance were analyzed. Results: 166 strains of pathogenic bacteria were isolated from 72 patients with sepsis, including 46 strains of gram-positive bacteria (27.71%), 104 strains of gram-negative bacteria (62.65%) and 16 strains of fungi (9.64%). Among the gram-positive bacteria, Staphylococcus aureus had higher resistance to ciprofloxacin, ampicillin, penicillin G and piperacillin, and Epidermis Staphylococcus aureus to ampicillin, cephalosporins resistance was higher. Among the gram-negative bacteria, the E. coli to erythromycin, compound sulfamethoxazole, cefoperazone resistance were higher, and Pseudomonas aeruginosa to ceftriaxone, compound sulfamethoxazole, cefoperazone and cefoxitin resistance were greater than 65%. The measured values of procalcitonin and serum lactic acid in the survival group were lower than those in the death group (P<0.05), while the measured values of other indicators were not statistically significant between the two groups (P>0.05). Conclusion: sepsis patients infected by the pathogen of mainly gram-positive bacteria and gram-negative bacteria, among them gram-positive bacteria Staphylococcus aureus and gram-negative bacteria in the drug resistance of E. coli was high;to conduct in the treatment of patients with clinical against sepsis should be according to the results of drug susceptibility, a reasonable choice of antimicrobial drugs, to ensuring the efficacy and safety of the patients in drug use.
  • Analysis on Related Factors of Antimicrobial Medication in 369 Patients with Breast Cancer During Perioperative Period*1
    WANG Li, DONG Xue, LI Lin-kai, Yang Fu heng, XU Hui-fang
    2019, 16(12): 2065-2069. https://doi.org/10.13493/j.issn.1672-7878.2019.12-009
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    Objective: To investigate and analyze the related factors and effects of antimicrobial prophylaxis in perioperative patients with breast cancer before and after antibiotic remediation. Methods: Retrospective investigation was conducted to collect data of 901 patients with benign and malignant breast tumors in the fourth quarter of 2010 (before the treatment), 2012, 2014, 2016 and 2018 (after the treatment) by using the hospital's HIS system. The rationality of the use of antibiotics during the perioperative period was analyzed. Results: In the 901 cases of breast surgery, the rate of prophylactic drug use, the timing of drug use, and the selection of drug varieties were basically reasonable. The utilization rate of antibiotics decreased from 100% before treatment to 14.16% after treatment. The reasonable rate of timing of prophylactic medication increased from 0.00% before treatment to 100.00% after treatment. The selection of drug varieties after treatment also tends to be more reasonable and the first generation cephalosporins were selected, but the proportion of drug withdrawal within 24 hours after treatment course of preventive drugs was still higher than 40.00%. Conclusion: The special regulation of antibacterial drugs significantly improved the unreasonable phenomenon of drug use in breast surgery patients during perioperative period; however the use of time and other aspects still need to increase the intensity of intervention to ensure the rationality of drug use.
  • Evaluation on Rationality of Clinical Medication for 208 Hospitalized Children with Pneumonia in a Hospital
    CAO Ying, SHI Xiang-kui, XIA Xiao-bing
    2019, 16(12): 2069-2072. https://doi.org/10.13493/j.issn.1672-7878.2019.12-010
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    Objective: To evaluate the rationality of clinical medication for hospitalized children with pneumonia, and to provide reference for rational clinical medication for children. Methods: The clinical information and medication data of 208 hospitalized children with pneumonia who met the diagnostic criteria from May 2008 to May 2019 were extracted to analyze the etiology, drug susceptibility test results and the rationality of clinical medication. Results: Among 208 cases of pneumonia, in 128 cases was conducted sputum culture, accounting for 61.54%. The 208 children were treated with combination drugs, among which 102 with 2 antibacterial drugs accounted for 49.04%, 24 with more than 2 antibiotics accounted for 11.54%, and 82 with antiviral drugs accounted for 39.42%. The unreasonable combination of antibiotics, antipyretic and detoxifying Chinese patent medicine injections, glucocorticoids and proton pump inhibitors (PPI) were used. The main reasons for unreasonable prescription are unreasonable choice of varieties, unreasonable choice of solvent and dosage, and unreasonable combination of drugs. Conclusion: The reason for unreasonable drug use in children with pneumonia is the excessive combination of antibiotics and other varieties, auxiliary drug use and off-label PPI drug use. Therefore, it is necessary to strengthen the pre-examination of doctor's advice to improve the rationality of drug use for children with pneumonia.
  • Prescription Review and Analysis on Rational Drug Usage of Antimicrobial Agents in Out-patients of a Hospital in 2018
    YANG Wei, GE Da-chun
    2019, 16(12): 2073-2075. https://doi.org/10.13493/j.issn.1672-7878.2019.12-011
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    Objective: To analyze the medication of antibacterial drugs in the out-patients of the hospital, to explore the types and causes of unreasonable drug use, and to provide a reference for the continuous improvement of clinical use of antibiotics. Methods: 8 109 prescriptions of antibacterial drugs were selected from the out-patient clinic from January to December 2018, and the reasons for unreasonable drug use were analyzed. Results: Among the 8 109 prescriptions of antibacterial drugs, 639 prescriptions of unreasonable drug use accounted for 7.88%, among which the main reasons for unreasonable drug use were the use of antibacterial drugs with no infection symptoms and the selection of antimicrobial drugs being not appropriate. Conclusion: The use of antimicrobial drugs in outpatient of hospital was reasonable, but there were still unreasonable conditions.Therefore it is necessary to strengthen the training and supervision of clinical use knowledge of antimicrobial drugs, so as to continuously improve the quality of medical service and the level of rational drug use.
  • Analysis on Epidemiological Characteristics of 5 860 Cases of Infectious Diseases in A District of Suzhou in 2018 and Its Countermeasures
    LI Shuxian, LIU Yang
    2019, 16(12): 2114-2117. https://doi.org/10.13493/j.issn.1672-7878.2019.12-025
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    Objective: To understand and analyze the epidemiologic feature of notifiable diseases in Gusu District of Suzhou in 2018, and to provide the scientific reference for making prevention and control strategies. Methods: The 5 860 cases of notifiable diseases in Gusu District of Suzhou in 2018 were collected from national notifiable disease report system. And descriptive epidemiological methods were used to analyze the epidemiological characteristics of infectious diseases. Results: During the period of 2018, 5 860 cases of notifiable diseases were reported and the total incidence was 523.20/100 000. No class A infectious diseases were reported. The incidence rate of class B infectious diseases was 211.51/100 000, and the incidence rate of class C infectious diseases was 311.69/100 000. Cases were found in 8 streets of the whole Gusu District. The cases of intestinal infectious diseases were the most, followed by the blood and sexually transmitted diseases, as well as the respiratory infectious disease.The top five infectious diseases were hand-foot-mouth disease, syphilis,hepatitis B, other infectious diarrhoea and gonorrhea.The first incidence peak of the year was in June,and the second peak was in september. The incidence is higher in men than women. Most of the cases were scattered children,young children and business service group and concentrated in children under 10 years old. Conclusion: It is important to strengthen the prevention and control of hand-foot-mouth disease, syphilis and other major infectious diseases, meanwhile to strengthen the prevention and control of the intestinal infectious diseases, the blood and sexually transmitted diseases and other infectious diseases, ensuring effectivel control the epidemic and outbreak of infectious diseases.
  • Study on Epidemic Characteristics of M.Pneumonia in Patients with Acute Respiratory Tract Infection in Beijing Area and Its Countermeasures
    HUI Li
    2019, 16(12): 2118-2121. https://doi.org/10.13493/j.issn.1672-7878.2019.12-026
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    Objective: To study the epidemic characteristics of M. Pneumonia in acute respiratory infections(ARI) in Beijing area and to provide scientific and effective prevention and control methods. Methods: 14 326 samples of patients with acute respiratory infection admitted to hospitals in Beijing from January 2017 to December 2018 were collected. The results of M. Pneumonia and its genotype in sputum, nasopharyngeal aspiration and other respiratory tract samples detected by real-time PCR were analyzed. The positive rate of M. Pneumonia genotype was compared by using Chi-square test. Results: Of the 14 326 samples, M. Pneumonia was detected in 660 cases, the positive rate was 4.61%, among them P1-Ⅰ, P1-Ⅱ and not parting positive samples in the order of 235, 229 and 196. P1-Ⅰ and P1-Ⅱ positive rate by comparing the differences between groups had no statistical significance (P>0.05). The positive rate of male cases (4.46%) was lower than that of female cases (5.17%) (P<0.05). The age group with the highest positive rate and the lowest positive rate were between greater than 6 to 15 years old and greater than 60 years old respectively. The positive rate of M. Pneumonia was higher than that of acute upper respiratory tract infection (P<0.05). Conclusion: In the Beijing area in patients with acute respiratory tract infection, P1-Ⅰ, P1-Ⅱ M. Pneumonia infection high-risk groups were mainly for women, youth and between greater than 6 to 15 years old children. The susceptibility genotype of M. Pneumonia infection is related to the patient's age, and is still the main inducer of mycoplasma pneumoniae. Scientific and effective prevention and control measures should be taken according to its inducing factors to curb its prevalence.
  • Correlation between Bacterial Contamination of Ventilator Line and VAP in 62 Patients with Mechanical Ventilation and Its Countermeasures
    GAO Kang-yang, XIONG Chao-yang
    2019, 16(12): 2122-2125. https://doi.org/10.13493/j.issn.1672-7878.2019.12-027
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    Objective: To analyze the correlation between bacterial contamination of ventilator line and ventilator associated pneumonia (VAP) in patients with mechanical ventilation and its intervention measures. Methods: The Data of 62 patients with mechanical ventilation admitted in hospital from January 2015 to May 2019 were selected, and bacterial culture results of lower respiratory secretions and ventilator line samples were statistically analyzed, as well as the correlation between bacterial infection in ventilator line and mechanical ventilation time and the incidence and mortality of VAP were analyzed. Results: There were 723 specimens from different pipelines and 156 specimens from lower respiratory tract of 62 patients with mechanical ventilation, and 608 and 182 specimens were detected respectively. The bacteria detected in the secretions of lower respiratory tract and ventilator pipe specimens were mainly gram-negative bacteria.With the extension of the application time of the ventilator, the growth rate of bacteria at the inlet and outlet of the condensate water collecting cup and the interface of the ventilator had shown an increasing trend, and the growth rate of bacteria was relatively fast in the first 3 days, and the growth rate had shown a gentle trend after the third day. The incidence of VAP (28.57%) and mortality (25.00%) in patients with pollution were higher than those in patients without pollution (5.88% and 2.94%).The duration of mechanical ventilation and the total length of hospital stay were both longer than those of non-contaminated patients (P<0.05). Spearman analysis showed that there was a significant positive correlation between bacterial contamination of ventilator pipeline and VAP incidence, mechanical ventilation duration, total hospital stay and mortality (P< 0.05). Conclusion: There is a positive correlation between bacterial contamination of ventilator pipeline and the incidence of VAP, mechanical ventilation duration, total length of stay and mortality. The monitoring of bacterial infection in ventilator pipeline can provide evidence-based support for clinical prevention of VAP, so as to ensure the safety of mechanical ventilation treatment for patients.
  • Pharmacological Care in Clinical Medication of a Case of Neonatal Thrombocytopenia Complicated with Fungal Infection
    BI Yue-hua
    2019, 16(12): 2138-2142. https://doi.org/10.13493/j.issn.1672-7878.2019.12-032
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    Objective: To analyze the entry point of pharmaceutical care by clinical pharmacists in the treatment of neonatal thrombocytopenia with fungal infection, and to explore the process of pharmaceutical care. Methods: According to the pathophysiological characteristics of neonates and the latest relevant guidelines for diagnosis and treatment at home and abroad, the clinical pharmacist participated in the whole process of treatment of a case of neonatal thrombocytopenia complicated with fungal infection, and assisted the clinician in formulating individual drug treatment plan for the patient. Based on the change of the condition of the child, the pharmaceutical suggestion is put forward, the adverse reaction of the medicine is monitored and and the comprehensive pharmaceutical monitoring of the child is carried out. Results: The clinical pharmacist conducted comprehensive pharmacological monitoring of the course of treatment of the neonatal thrombocytopenia complicated with fungal infection.Through taking the point of the safety and rationality of the use of antimicrobial agents, as well as the monitoring and management of adverse drug reactions, the clinical pharmacist provides individualized pharmaceutical care for the patient combining with the special pathophysiological characteristics of neonates. Conclusion: The clinical pharmacists can participate in the clinical diagnosis and treatment by carrying out the medical monitoring in combination with the professional knowledge, and they greatly promote the safe, reasonable and effective use of the clinical medicine during the day-to-day work.
  • Analysis on Pharmaceutical Technique Thinking of Handmade Pills of Gaoshoutai Old Pharmacists*1
    PANG Hui-ming, YAO Yi
    2019, 16(12): 2143-2146. https://doi.org/10.13493/j.issn.1672-7878.2019.12-033
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    By following the old pharmacists of Gaoshoutai, the author sums up the techniques of Gaoshoutai's handmade pills, including the tools of hand pills, excipient, hand pills technique, technical process, pharmaceutical thinking, etc.. The technical points and matters needing attention of handmade pan-pill are expounded emphatically. It is of certain reference value to pass on the Traditional Chinese Medicine technique of hand pills and to carry out the Chinese medicine small material processing in the hospital of Traditional Chinese Medicine, which embodies the characteristics of one individual person and one individual side of Traditional Chinese Medicine.