医院管理

处方前置审核现状及问题剖析

Pre-prescription audit status quo and problem analysis

:566-570
 
       处方前置审核工作是推动临床合理用药的重要措施,对转变医院药学服务模式具有重要意义。传统处方点评为回顾性的事后点评,存在滞后性和局限性,不能实时监控合理用药。相比而言,处方前置审核可以及时、有效地干预问题处方,简化不合格处方修改流程,提高就诊患者的取药效率,而人机结合更能发挥药学信息智能化等多重优势。前置审核工作在各医院开展形式及发展水平不一,探讨新型模式,建立自主维护知识库,制定基本化原则,完善个性化原则,对前置审核系统进行全面人工筛查,可从源头上拦截或干预医生的不合理处方,促进用药规范性,提高处方或医嘱合理率,实现药学智慧信息化,辅助临床合理用药。
       Pre-prescription audit is an important measure to promote clinical rational use of drugs,which is of great significance to the transformation of hospital pharmaceutical care mode.Traditional prescription review for retrospective review has lag and limitations,can not real-time monitoring rational drug use.By contrast,pre-prescription audit can timely and effective intervene problem prescription,simplify the unqualified prescription modification process,improve the efficiency of patients take medicine,and man-machine combination can make more pharmaceutical information intelligent multiple advantages.Advanced audit work in various hospitals presents different forms and development level,exploring the new mode,establishing independent maintenance knowledge base,developing basic principles,perfecting personalized principle,comprehensive check of advanted audit system,can intercept or intervene doctors unreasonable prescription from the source,contribute to normative,improve the prescription or advice reasonable rate,realize pharmaceutical wisdom informatization,auxiliary clinical rational use of drugs.
论著

复方黄芪颗粒对小鼠抗疲劳的作用及其机制研究

Study on the anti-fatigue effect of compound Huangqi granules on mice and its mechanism

:509-515
 
       目的   探讨复方黄芪颗粒(CHG)的抗疲劳作用及其机制。方法  48只雄性BALB/C小鼠随机分为空白对照组、低剂量(9.1 g/kg)、中剂量(18.2 g/kg)、高剂量(27.3 g/kg)CHG 3个试验组,每组12只。试验组给予不同剂量的复方黄芪颗粒溶液灌胃,空白对照组小鼠给予等体积生理盐水。给药30 d后,检测小鼠体内相关指标变化,观察其抗疲劳作用并分析相关机制。结果   与空白对照组相比,试验组小鼠体质量差异无统计学意义(P>0.05),小鼠力竭游泳时间及转棒耐力时间均明显延长(P<0.01),血尿素氮(BUN)、乳酸脱氢酶(LDH)、丙二醛(MDA)水平明显降低P<0.01),肝糖原和肌糖原水平升高(P<0.05),超氧化物歧化酶(SOD)活性升高(P<0.01)。体外抗氧化试验表明CHG以剂量依赖性方式清除2,2-联氮-二(3-乙基-苯并噻唑-6-磺酸)二铵盐(ABTS)和1,1-二苯基-2-三硝基苯肼(DPPH)自由基。当CHG质量浓度为100.000 0 mg/mL时,CHG对DPPH自由基清除能力可达85.030 3%。当CHG质量浓度为25.000 0 mg/mL时,CHG对ABTS自由基清除能力可达96.357 2%。结论  CHG具有抗疲劳的作用,其作用机制可能与抗氧化作用相关。
      Objective  To investigate the anti-fatigue effects of compound Huangqi granules(CHG)and its mechanism.Methods  Forty-eight male BALB/C mice were randomly divided into blank control group,9.1,18.2,27.3 g/kg CHG group(test groups).The test groups received different concentrations of CHG solution by gavage,and the blank control group mice were given equal volume saline.After 30 days of administration,the mice were tested,meanwhile the anti-fatigue effect and mechanism were investigated.Results  Compared with blank control group,there was no significant difference in body weight(P>0.05).The exhaustive swimming time and rod turning endurance time of mice were significantly prolonged(P<0.01).The serum levels of blood urea nitrogen,lactate dehydrogenase and malondialdehyde were significantly decreased(P<0.01),while the liver and muscle glycogen levels(P<0.05)and superoxide dismutase activity were increased(P<0.01).In vitro antioxidant tests showed that CHG can remove (1,1-Diphenyl-2-picrylhydrazyl,ABTS) and (2,2’-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid,DPPH) free radicals in a dose-dependent manner.When the CHG concentration is 100 mg/mL,the DPPH free  radical scavenging ability of CHG can reach 85.030 3%.When the CHG concentration was 25 mg/mL,the scavenging ability of CHG to ABTS free radicals reached 96.357 2%.Conclusions  CHG has anti-fatigue effect,and its mechanism may be related to anti-oxidation effect.
论著

预防性风险管理对肌层浸润性膀胱癌根治术后的应用效果及术后生活质量影响

Effect of preventive risk management after surgery and quality of life of myometrial invasive bladder cancer patients

:494-499
 
       目的   探讨预防性风险管理在肌层浸润性膀胱癌根治术后的应用效果及对术后生活质量影响。方法   选取2020年6月—2023年10月安阳市肿瘤医院收治的66例肌层浸润性膀胱癌患者,应用抽签法分为观察组(n=33)与对照组n=33)。所有患者均采取根治性全膀胱切除术与淋巴清扫术治疗,对照组患者术后实施常规护理,观察组在对照组基础上增加预防性风险管理。对比两组术后尿量、胃肠功能恢复时间、术后住院时间,干预前后病耻感及负面情绪、术后并发症发生率,最后对比两组干预前后生活质量变化。结果   两组患者术后尿量对比差异无统计学意义(P>0.05),观察组术后胃肠功能恢复时间为(5.27±0.82)d,术后住院时间为(18.31±3.27)d,短于对照组的(7.25±1.12)(23.27±4.18)d,对比差异有统计学意义(t分别为8.194、5.369,P<0.05);干预后两组患者病耻感量表(SSCI)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分均降低,观察组分别为(35.67±7.45)(40.02±2.43)(45.36±4.17)分,低于对照组的(48.27±10.69)(54.54±3.54)(51.37±4.38)分,对比差异有统计学意义(t分别为5.555、19.426、5.709,P<0.05);观察组术后并发症发生率为9.09%,低于对照组的30.30%(χ 2 =4.690,P=0.030);干预后两组膀胱癌特异性模块、功能状况、精神状况、家庭/社会状况及躯体状况相关维度膀胱癌患者生活质量量表(FACT-BL)评分均升高,观察组分别为(34.27±3.26)(25.11±4.23)(21.51±4.23)(25.02±4.43)(20.56±3.11)分,高于对照组的(27.00±4.34)(21.11±3.24)(16.12±2.12)(21.54±5.54)(15.87±4.13)分,对比差异有统计学意义(t分别为7.694、4.313、6.544、2.818、5.211,P<0.05)。结论   预防性风险管理在肌层浸润性膀胱癌根治术后的应用效果显著,可缩短患者术后胃肠功能恢复时间及住院时间,改善患者负面情绪,有助减少术后并发症,提升患者生活质量。
       Objective  To explore the effect of preventive risk management on postoperative application and quality of life of myometrial invasive bladder cancer patients after radical surgery.Methods  A total of 66 patients with myometrial invasive bladder cancer admitted to Anyang Cancer Hospital from June 2020 to October 2023 were selected as research objects,and were divided into observation group(n=33)and control group(n=33)by lot drawing.All patients were treated with  radical total cystectomy and lymph node dissection.The control group received routine nursing care after surgery,while the observation group received preventive risk management in addition to the control group.The postoperative urine output,recovery time of gastrointestinal function,and hospitalization time between two groups were compared,as well as the shame and negative emotions before and after intervention,the incidence of postoperative complications,and the changes in quality of life between the two groups before and after intervention.Results  There was no significant difference in postoperative urine volume between the two groups of patients(P>0.05),and the postoperative gastrointestinal function recovery time(5.27±0.82)d,postoperative hospitalization time(18.31±3.27)d were shorter than the control group[(7.25±1.12)d,(23.27±4.18)d],with statistical significantce(t=8.194,5.369,P<0.05).After intervention,the Stigma Scale of Chronic Illness(SSCI),Self Rating Depression Scale(SDS),and Self-Rating Anxiety Scale(SAS)in both groups of patients decreased,and the observation group[(35.67±7.45),(40.02±2.43),(45.36±4.17)]scored lower than the control group[(48.27±10.69),(54.54±3.54),(51.37±4.38)],statistically significantt=5.555,19.426,5.709,P<0.05).The incidence of postoperative complications in the observation group was significantly lower at 9.09% compared to the control group at 30.30%(χ 2 =4.690,P=0.030,P<0.05).After intervention,the scores of bladder cancer specific module,functional status,mental status,family/social status and physical status  related dimensions of bladder cancer patients’ quality of life scale for bladder cancer patients(FACT-BL)in both groups increased,and the observation group[(34.27±3.26),(25.11±4.23),(21.51±4.23),(25.02±4.43),(20.56±3.11)] scored higher than the control group[(27.00±4.34),(21.11±3.24),(16.12±2.12),(21.54±5.54),(15.87±4.13)],the comparison was statistically significant(t=7.694,4.313,6.544,2.818,5.211,P<0.05).Conclusions  Preventive  risk management has a significant effect on the application of myometrial invasive bladder cancer after radical surgery,which can shorten the recovery time of gastrointestinal function and hospital stay,improve patients’ negative emotions,assist in preventing postoperative complications,and improve patients’ quality of life.
综述

大柴胡汤合大承气汤在急性胰腺炎治疗中的研究进展

Research progress on Dachaihu Decoction combined with Dachengqi Decoction in the treatment of acute pancreatitis

:252-259
 
       急性胰腺炎(AP)是一种常见的消化系统急症。随着生活水平的提高,其重症发病率也逐年增加。中西医结合治疗急性胰腺炎在临床实践中展现出优势。近年来,大柴胡汤合大承气汤在治疗急性胰腺炎方面药理机制的研究不断延伸,同时对方药中的药理活性成分也在不断深入研究。该文旨在整理相关研究,综述大柴胡汤合大承气汤治疗急性胰腺炎的理论基础、临床应用、药物活性成分、药理机制等,以期为临床实践和进一步深入研究提供参考。
        Acute pancreatitis(AP)is a common gastrointestinal emergency.With the improvement of living standards,the incidence of severe AP has been increasing year by year.The combined treatment of traditional Chinese and Western medicine has shown advantages in the clinical practice of acute pancreatitis.In recent years,the pharmacological mechanism of Dachaihu Decoction combined with Dachengqi Decoction in the treatment of acute pancreatitis has been continuously studied,and the pharmacological active components in the prescription are also being explored.This article aims to summarize  relevant  research on the theoretical basis,clinical application,active ingredients and pharmacological mechanism of Dachaihu Decoction combined with Dachengqi Decoction in the treatment of acute pancreatitis,providing reference for clinical practice and further research.
论著

心房颤动患者射频消融术中清醒状态下电复律疗效观察

Efficacy of awake electrical cardioversion during radiofrequency ablation of atrial fibrillation

:166-170
 
       目的 探讨术中未恢复窦性心律需要行电复律的心房颤动(房颤)患者在清醒和镇静两种状态下的安全性及有效性。方法 选择2022年1月—2023年12月100例接受射频消融术中行同步直流电复律的持续性房颤患者进行研究,采用随机数字表法将患者分为观察组(清醒状态)和对照组(镇静状态),其中观察组和对照组各为50例。观察两组患者接受电复律的成功率、复发率和不良事件发生率(呼吸抑制、低血压、谵妄、肺水肿、心律失常)等指标。结果 观察组和对照组首次电复律成功分别有48、49例,成功率分别为96%、98%,组间比较差异无统计学意义(P=0.558)。观察组术后30 min内有2例复发,对照组术后30 min内无复发,组间比较差异无统计学意义(P=0.153)。在不良反应方面,观察组共发生1例心律失常事件,1例低血压事件,不良反应的总发生率为4%。对照组共发生3例呼吸抑制事件、2例谵妄事件、1例心律失常事件、2例低血压事件,不良反应的总发生率为16%,组间比较差异有统计学意义(P=0.046)。结论 对持续性房颤患者在射频消融术中,处于清醒状态下行电复律也具有良好的临床疗效,可以减少不良事件的发生,安全性更高。
  Objective  To compare the safety and efficacy of awake state and sedation state in patients with atrial fibrillation(AF)who did not recover sinus rhythm and needed electrical cardioversion during operation.Methods  A total of 100 patients with persistent atrial fibrillation who underwent synchronous direct current cardioversion during radiofrequency ablation from January 2022 to December 2023 were selected and divided into the observation group(awake state)and the control group(sedation state)according to the random number table method,with 50 cases in each group.The success rate of electrical cardioversion,recurrence rate and incidence of adverse events(respiratory depression,hypotension,delirium,pulmonary edema,arrhythmia)were observed.Results  The first electrical cardioversion was successful in 48 and 49 patients in the observation group and the control group,and the success rates were 96% and 98%,respectively.There was no significant difference between the two groupsP=0.558).There were 2 cases of  recurrence in the observation group and no  recurrence in the control group within 30 minutes after operation,and there was no significant difference between the two groups(P=0.153).In terms of adverse reactions,there were 1 case of arrhythmia event and 1 case of hypotension event in the observation group,and the total incidence of adverse reactions was 4%.There were 3 cases of respiratory depression events,2 cases of delirium events,1 case of arrhythmia events,and 2 cases of hypotension events in the control group.The total incidence of adverse reactions was 16%,and the difference between the two groups was statistically significant(P=0.046).Conclusions  Electrical cardioversion in awake state during  radiofrequency ablation of persistent atrial fibrillation has a good clinical efficacy and safety,which can reduce the occurrence of adverse events.
论著

癌症患者生命质量测定量表体系之肾癌量表(QLICP-REV2.0)的条目筛选

Items selection on the Specific Module of Quality of Life Instruments for patients with renal cancer (QLICP-REV2.0)

:77-81
 
       目的   开发适合中国肾癌患者的生命质量测定量表的特异模块。   采用议题小组和核心小组的程序化决策方式,提出条目池,形成初步量表,采用医生及患者重要性评分法、相关系数法、变异度法、因子分析法和克朗巴赫系数α对20例肾癌患者和20名医护人员进行的数据进行统计分析。结果   经过上述方法进行筛检,结合专家小组的建议,最终得到含有11个条目的肾癌生命质量测定量表的特异模块。结论 肾癌的生命质量测定量表特异模块严格按照程序执行,具有较好的内容效度。
      Objective  To develop the specific module of the quality of life instruments for patients with renal cancer(QLICP-RE).Methods  With the structured group(nominal group and focus group)methods,the item pool was put forward and a preliminary instrument was formed.The data from 20 renal cancer patients and 20 doctors/nurses were analyzed by statistical procedures.Doctors and patients’ importance rating procedure,correlation analysis,method of coefficient of variation,factor analysis,and Cronbach’s α.Results  By above statistical procedures and advises of expert panel,11-items of the specific module were formed finally.Conclusions  The specific module of QLICP-RE developed on the strict procedures has good content validity and representativeness.
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