目的 探讨电子计算机断层扫描（CT）增强碘对比剂急性不良反应发生及影响因素分析。方法 选取天津市肿瘤医院空港医院2020年10月—2023年10月收治的100例行CT增强出现碘对比剂急性不良反应的患者进行回顾性分析,将其分为观察组,另选取同期在我院行CT增强检查未发生不良反应的100例患者作为对照组。分析观察组患者碘对比剂急性不良反应情况,对比两组患者临床资料及碘对比剂注射情况,以急性不良反应作为因变量（发生急性不良反应=1,未发生急性不良反应=0）纳入Logistic回归模型,分析CT增强碘对比剂急性不良反应发生的独立影响因素。结果 100例发生碘对比剂急性不良反应的患者中轻度65例（65.00%）,中度34例（34.00%）,重度1例（1.00%）;观察组与对照组性别、年龄、体质指数（BMI）、高血压史、糖尿病史、心功能不全史、甲状腺功能亢进史、冠状动脉粥样硬化性心脏病史、碘对比剂使用史、食物过敏史对比差异无统计学意义（P>0.05）,观察组与对照组哮喘史（9.00% vs 2.00%）、肾功能不全史（13.00% vs 3.00%）、碘对比剂不良反应发生史（21.00 % vs 2.00%）、花粉过敏史（12.00% vs 4.00%）、药物过敏史（26.00% vs 7.00%）及其他过敏史（10.00 % vs 2.00%）,对比差异有统计学意义（χ²=4.710,P=0.030;χ²=6.790,P=0.009;χ²=17.740,P<0.001;χ²=4.350,P=0.037;χ²=13.100,P<0.001;χ²=5.670,P=0.017）;观察组与对照组碘对比剂剂量对比差异无统计学意义（P>0.05）,观察组与对照组碘对比剂注射速度（<3 mL/min为55.00% vs 69.00%;≥3 mL/min为45.00% vs 31.00%）、碘对比剂类型（碘克沙醇为34.00% vs 34.00%,碘佛醇为47.00% vs 30.00%,碘海醇为19.00% vs 36.00%）对比差异有统计学意义（χ²=4.160,P=0.041;χ²=9.010,P=0.011）;肾功能不全史、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度为发生碘对比剂急性不良反应的影响因素（P<0.05）。结论 CT增强碘对比剂急性不良反应多以轻度为主,且以往合并肾功能不全、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度过高可能为碘对比剂不良反应发生的影响因素。

Objective To explore the occurrence and influencing factors of acute adverse reactions of iodine contrast agents in enhanced computed tomography（CT）. Methods A retrospective analysis was conducted on 100 patients admitted to our hospital from October 2020 to October 2023 who experienced acute adverse reactions to iodine contrast agents during CT enhancement．They were divided into an observation group and another 100 patients who underwent CT enhancement examination in our hospital during the same period without any adverse reactions were selected as the control group．The acute adverse reactions of iodine contrast agent in the observation group of patients were analyzed,the clinical data and injection of iodine contrast agent between the two groups of patients were compared,and include acute adverse reactions as the dependent variable（occurrence of acute adverse reactions=1,absence of acute adverse reactions=0）was used in the Logistic regression model to analyze the independent influencing factors of acute adverse reactions of CT enhanced iodine contrast agent．Results Among the 100 patients who experienced acute adverse reactions to iodine contrast agents,65 were mild reactions,accounting for 65.00%,34 cases had were moderate reactions,accounting for 34.00%,and one cases had severe reactions,accounting for 1.00%．There was no significant difference between the observation group and the control group in gender,age,body mass index（BMI）,history of hypertension,diabetes,heart dysfunction,hyperthyroidism,coronary heart disease,use of iodine contrast agent,and food allergy（P>0.05）．The history of asthma（9.00% vs 2.00%）,renal insufficiency（13.00% vs 3.00%）,adverse reactions of iodine contrast（21.00 % vs 2.00%）,pollen allergy（12.00% vs 4.00%）,drug allergy（26.00% vs 7.00%）and other allergies（10.00 % vs 2.00%）were significantly different（χ²=4.710,P=0.030;χ²=6.790,P=0.009;χ²=17.740,P<0.001;χ²=4.350,P=0.037;χ²=13.100,P<0.001;χ²=5.670,P=0.017）．There was no significant difference in the dosage of iodine contrast agent between the observation group and the control group（P>0.05）．The injection rate of iodine contrast agent between the observation group and the control group（< 3 mL/min was 55.00% vs 69.00%;≥3 mL/min was 45.00% vs 31.00%）,and the types of iodoxanol （iodoxanol[34.00% vs 34.00%],iodoxanol[47.00% vs 30.00%],iodohexanol[19.00% vs 36.00%]） were significantly different（χ²=4.160,P=0.041;χ²=9.010,P=0.011）．History of renal insufficiency,adverse reactions to iodine contrast agents,drug allergies,other allergies,and injection speed of iodine contrast agents were independent risk factors for the occurrence of acute adverse reactions to iodine contrast agents（P<0.05）．Conclusions Acute adverse reactions to iodinated contrast agents in CT enhancement are mostly mild．Previous history of renal insufficiency,history of adverse reactions to iodinated contrast agents,history of drug allergies,other allergic histories,and high injection speed of iodinated contrast agents may be influencing factors for the occurrence of adverse reactions to iodinated contrast agents．

目的 探讨特殊健康儿童预防接种评估及不良反应处理。方法 选取2018年1月–2022年12月经预防接种门诊主动筛选的出生日期在2004年6月1日—2022年6月1日的特殊健康儿童,收集临床资料,以此进行预防接种评估建议,随访不良反应。结果 本研究共纳入944例特殊健康儿童,其中精神发育迟滞231例（24.47%）、脑性瘫痪440例（46.61%）、先天愚型115例（12.18%）、癫痫74例（7.83%）、先天性心脏病54例（5.72%）、唐氏综合征30例（3.18%）。其中男、女分别有519例（54.98%）、425例（45.02%）。在特殊健康儿童中,建议可正常接种疫苗918例（97.25%）,建议接种灭活疫苗但避免接种减毒活疫苗8例（0.85%）,建议暂缓接种所有疫苗18例（1.91%）。建议接种疫苗的特殊健康儿童中,已接种疫苗926例（98.09%）,接种灭活疫苗842例（89.19%）,接种减毒活疫苗612例（64.83%）;926例儿童共接种疫苗8 480剂次,其中灭活疫苗6 770剂次、减毒活疫苗1 770剂次;62例儿童进行68剂次疫苗接种后出现不良反应（包括局部反应15例次、全身反应53例次）,总发生率为8.02‰（68/8 480）,其中灭活疫苗、减毒活疫苗发生率分别为6.79‰（46/6770）、1.29%（22/1 710）。所有不良反应案例经处理,除口干1例处理后好转外,其他均达治愈,治愈率达98.53%（67/68）。结论 特殊健康儿童经医学评估后大多可接种疫苗,接种后不良反应发生风险在可控范围内。

Objective To discuss the evaluation of vaccination and treatment of adverse reactions in healthy special children. Methods From January 2018 to December 2022,healthy special children with birth dates from June 1,2004 to June 1,2022 who were screened by the vaccination clinic were selected. Clinical data were collected to conduct vaccination assessment recommendations and follow up adverse reactions. Results A total of 944 healthy special children were included in this study,including 231 cases(24. 47%)of mental retardation,440 cases(46. 61%)of cerebral palsy,115 cases(12. 18%)of congenital foolishness,74 cases(7. 83%)of epilepsy,54 cases(5. 72%)of congenital heart disease and 30 cases(3. 18%)of Down syndrome. There were 519 males(54. 98%)and 425 females(45. 02%). Among the healthy special children,918 cases(97. 25%)were recommended to get vaccinated normally,8 cases(0. 85%)were recommended to be vaccinated with inactivated vaccine but avoid to be vaccinated with attenuated live vaccine,and 18 cases(1. 91%)were recommended to suspend all vaccination. Among the special healthy children recommended for vaccination,926(98. 09%)had been vaccinated,842(89. 19%)had been vaccinated with inactivated vaccine,and 612(64. 83%)had been vaccinated with live attenuated vaccine. A total of 8 480 doses of vaccines were administered to 926 children,including 6 770 doses of inactivated vaccines and 1 770 doses of attenuated live vaccines. Adverse reactions occurred in 62 children after 68 doses of vaccination(including 15 cases of local reactions and 53 cases of systemic reactions),with a total incidence of 8. 02 ‰(68/8480). The incidences of inactivated vaccine and attenuated live vaccine were 6. 79 ‰(46/6 770)and 1. 29%(22/1710),respectively. All cases of adverse reactions were treated and basically cured,with a cure rate of 98. 53%(67/68),except for the case of dry mouth. Conclusions Most of the healthy special children can be vaccinated after medical evaluation,and the risk of adverse reactions after vaccination is controllable.

目的 探究硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤的疗效及对患者不良反应发生的影响。方法 研究对象为我院2016年1月—2020年12月收治的60例骨髓瘤患者,将其随机分为研究1组(n=20)、研究2组(n=20)与对照组(n=20)。对照组给予硼替佐米联合沙利度胺及地塞米松化疗,研究1组给予硼替佐米联合环磷酰胺及地塞米松化疗,研究2组给予硼替佐米联合来那度胺及地塞米松化疗。对比三组治疗效果、免疫功能变化情况、相关血清因子水平以及骨代谢因子水平变化情况。结果 对照组治疗有效率85.0%比研究1组95.0%、研究2组90.0%低(P＜0.05);三组治疗前的免疫对比无较大差异(P＞0.05),对照组经治疗后的免疫功能比研究组差(P＜0.05);三组治疗前的相关血清因子水平比较无较大差异(P＞0.05),对照组经治疗后的相关血清因子水平比研究1组、研究2组高(P＜0.05);对照组经治疗后的骨代谢因子水平变化比研究1组、研究2组差(P＜0.05)。结论 硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤效果理想,药物不良反应发生率下降,患者生活质量得到改善,可在临床推广应用。

Objective To investigate the clinical efficacy of bortezomib,dexamethasone combined with cyclophosphamide in the treatment of myeloma and the effect on the occurrence of adverse reactions in patients. Methods The subjects were 60 myeloma patients admitted to our hospital from January 2016 to December 2020, and they were randomly divided into study group 1 (n=20), study group 2 (n=20) and control group (n=20). The control group received bortezomib combined with thalidomide and dexamethasone chemotherapy, the study group 1 received bortezomib combined with cyclophosphamide and dexamethasone chemotherapy, and the study group 2 received bortezomib combined with lenalidomide and dexamethasone chemotherapy. The therapeutic efficacy, the changes of immune function,serum factors and bone metabolism factors were compared among the three groups. Results The effective rate of control group was 85.0%, which was lower than those of study group 1 and study group 2 (P＜0.05). There was no significant difference of immune function among the three groups before treatment (P＞0.05), which of the control group after treatment was worse than that of the study groups (P＜0.05). There were no significant differences in the levels of related serum factors among the three groups before treatment (P＞0.05),which in the control group after treatment was higher than those in the study group 1 and study group 2 (P＜0.05). After treatment, the changes of bone metabolic factors in control group were worse than those in study group 1 and study group 2 (P＜0.05). Conclusion Bortezomib, dexamethasone combined with cyclophosphamide in the treatment of myeloma had ideal effect, and the incidence of adverse drug reaction was reduced, the quality of life of patients was improved, which can be popularized in clinical application.

目的 分析葡萄糖酸钙口服液在预防单采献血不良反应特别是心血管不良反应的价值。方法 随机选取3 504例在我中心单采血小板献血者作此次研究对象,将抽取对象分为比对组(n=1 728)和探析组(n=1 776),对探析组献血者进行血小板采集前为其提供葡萄糖酸钙口服液,比对组献血者不接受任何预防措施,献血过程中对献血者进行动态血压检测及动态心电图检测。结果 对比组共发生不良反应为278例(16.08%):其中全身性不良反应无晕厥78例(4.51%);全身不良反应晕厥18例(1.04%);单采相关性的不良反应中的枸橼酸盐反应为182例(10.53%);未见溶血反应和过敏反应。探析组共发生不良反应为155例(8.72%):其中全身性不良反应无晕厥54例(3.04%);全身不良反应晕厥20例(1.12%);单采相关性的不良反应中的枸橼酸盐反应为85例(4.78%);未见溶血反应和过敏反应。探析组单采相关性的不良反应中的枸橼酸盐反应显著减少。2组差异均有统计学意义(P<0.05)。比对组与探析组中,出现血压异常48例(2.78%)和12例(0.68%);心电图异常的89例(5.15%)和32例(1.80%);心率异常112例(6.48%)和38(2.14%)。为探析组的心血管不良反应的发生率低于比对组献血者,2组差异均有统计学意义(P<0.05)。结论 在献血者单采血小板为其提供葡萄糖酸钙口服液能够有效减少心血管不良反应,降低单采血小板不良反应发生率。

目的 调查分析中山市某三甲医院抗菌药物不良反应的发生和分布情况,为临床合理应用抗菌药物提供相关信息。方法 以中山市某三甲医院2013—2015年上报国家药品不良反应监测系统的528例抗菌药物的不良反应为考察对象,按照给药途径、不良反应严重程度、年龄、性别、药物种类、不良反应累及的系统-器官、不良反应发生时间进行分类、整理、归纳和总结。结果 累及系统-器官涉及皮肤及其附件、血液系统、神经系统、消化系统、泌尿系统等。其中皮肤及其附件损害、神经系统、胃肠道反应容易发现,消化系统、血液系统、泌尿系统、肝胆系统的反应具有隐匿性。结论 临床在使用抗菌药物时,既要关注其抗菌效应,也要高度警惕其不良反应的危害性。避免无指征用药,合理选用抗菌药物,科学地开展ADR 监测工作,确保临床安全、有效、合理用药。

Objective To investigate occurrence and distribution of adverse drug reaction ADR of antibiotic drugs in a hospital of Zhongshan, in order to provide relevant information for clinical rational use of antibacterial drugs. Methods We classified and analyzed 528 cases of adverse drug reaction of antibiotic drugs which was reported to National center for ADR Monitoring during 2013～2015, according to the administration route、the severity of ADRs、age、sex、types of drugs、the organs systems involved by ADRs, the time of ADRs occurrence. Results Adverse drug reaction of antibiotic drugs involved in skin and its appendix、hematological system、nervous system、digestion system、urinary system and so on. Among them skin and its appendix、nervous system and gastrointestinal reactions were easy to acquire, others were obscure and difficult to find. Conclusion When the clinical use of antibacterial drugs, should not only focus on its antibacterial effect, also need to keep high vigilance against the dangers of its adverse reactions. To ensure the clinical safety, effective and rational drug use, we need to avoid no indication of medicine, take rational use of antibiotic drugs,scientifically to carry out the ADR monitoring.

       目的   探讨电子计算机断层扫描（CT）增强碘对比剂急性不良反应发生及影响因素分析。方法   选取天津市肿瘤医院空港医院2020年10月—2023年10月收治的100例行CT增强出现碘对比剂急性不良反应的患者进行回顾性分析，将其分为观察组，另选取同期在我院行CT增强检查未发生不良反应的100例患者作为对照组。分析观察组患者碘对比剂急性不良反应情况，对比两组患者临床资料及碘对比剂注射情况，以急性不良反应作为因变量（发生急性不良反应=1，未发生急性不良反应=0）纳入Logistic回归模型，分析CT增强碘对比剂急性不良反应发生的独立影响因素。结果  100例发生碘对比剂急性不良反应的患者中轻度65例（65.00%），中度34例（34.00%），重度1例（1.00%）；观察组与对照组性别、年龄、体质指数（BMI）、高血压史、糖尿病史、心功能不全史、甲状腺功能亢进史、冠状动脉粥样硬化性心脏病史、碘对比剂使用史、食物过敏史对比差异无统计学意义（P＞0.05），观察组与对照组哮喘史（9.00% vs 2.00%）、肾功能不全史（13.00% vs 3.00%）、碘对比剂不良反应发生史（21.00% vs  2.00%）、花粉过敏史（12.00% vs 4.00%）、药物过敏史（26.00% vs 7.00%）及其他过敏史（10.00% vs 2.00%），对比差异有统计学意义（χ ² =4.710，P=0.030；χ  ² =6.790，P=0.009；χ ² =17.740，P＜0.001；χ ² =4.350，P=0.037；χ ² =13.100，P＜0.001；χ ² =5.670，P=0.017）；观察组与对照组碘对比剂剂量对比差异无统计学意义（P＞0.05），观察组与对照组碘对比剂注射速度（＜3 mL/min为55.00% vs 69.00%；≥3 mL/min为45.00% vs 31.00%）、碘对比剂类型（碘克沙醇为34.00% vs 34.00%，碘佛醇为47.00% vs 30.00%，碘海醇为19.00% vs  36.00%）对比差异有统计学意义（χ ² =4.160，P=0.041；χ ² =9.010，P=0.011）；肾功能不全史、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度为发生碘对比剂急性不良反应的影响因素（P＜0.05）。结论  CT增强碘对比剂急性不良反应多以轻度为主，且以往合并肾功能不全、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度过高可能为碘对比剂不良反应发生的影响因素。

       Objective  To explore the occurrence and influencing factors of acute adverse reactions of iodine contrast agents in enhanced computed tomography（CT）．Methods  A retrospective analysis was conducted on 100 patients admitted to our hospital from October 2020 to October 2023 who experienced acute adverse reactions to iodine contrast agents during CT enhancement．They were divided into an observation group and another 100 patients who underwent CT enhancement examination in our hospital during the same period without any adverse reactions were selected as the control group．The acute adverse  reactions of iodine contrast agent in the observation group of patients were analyzed，the clinical data and injection of iodine contrast agent between the two groups of patients were compared，and include acute adverse reactions as the dependent variable（occurrence of acute adverse reactions=1，absence of acute adverse reactions=0）was used in the Logistic regression model to analyze the independent influencing factors of acute adverse reactions of CT enhanced iodine contrast agent．Results  Among the 100 patients who experienced acute adverse reactions to iodine contrast agents，65 were mild reactions，accounting for 65.00%，34 cases had were moderate reactions，accounting for 34.00%，and one cases had severe reactions，accounting for 1.00%．There was no significant difference between the observation group and the control group in gender，age，body mass index（BMI），history of hypertension，diabetes，heart dysfunction，hyperthyroidism，coronary heart disease，use of iodine contrast agent，and food allergy（P＞0.05）．The history of asthma（9.00% vs 2.00%），renal insufficiency（13.00% vs 3.00%），adverse reactions of iodine contrast（21.00 % vs 2.00%），pollen allergy（12.00% vs  4.00%），drug allerg（26.00% vs  7.00%）and other allergies（10.00 % vs  2.00%）were significantly different（χ ² =4.710，P=0.030；χ ² =6.790，P=0.009；χ ² =17.740，P＜0.001；χ ² =4.350，P=0.037；χ ² =13.100，P＜0.001；χ ² =5.670，P=0.017）．There was no significant difference in the dosage of iodine contrast agent between the observation group and the control group（P＞0.05）．The injection rate of iodine contrast agent between the observation group and the control group（＜ 3 mL/min was 55.00% vs  69.00%；≥3 mL/min was 45.00% vs 31.00%），and the types of iodoxanol （iodoxanol［34.00% vs 34.00%］，iodoxanol［47.00% vs 30.00%］，iodohexanol［19.00% vs 36.00%］） were significantly different（χ ² =4.160，P=0.041；χ ²  =9.010，P=0.011）．History of renal insufficiency，adverse reactions to iodine contrast agents，drug allergies，other allergies，and injection speed of iodine contrast agents were independent risk factors for the occurrence of acute adverse reactions to iodine contrast agents（P＜0.05）．Conclusions  Acute adverse reactions to iodinated contrast agents in CT enhancement are mostly mild．Previous history of  renal insufficiency，history of adverse reactions to iodinated contrast agents，history of drug allergies，other allergic histories，and high injection speed of iodinated contrast agents may be influencing factors for the occurrence of adverse  reactions to iodinated contrast agents．