2014 Volume 16 Issue 2 Published: 28 April 2014
  

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    论著

  • 论著
    Yan Yan;Wang Yuqin;Shen Qian;Liu Chen;Tang Jing
    2014, 16(2): 74-5.
    Abstract ( ) PDF ( )

    ObjectiveCompare criteria of eight countries such as United States for potentially inappropriate medications (PIM) in elderly, to provide a reference for formulating China′s PIM criteria. MethodsUsing the database and network, the authors collect the PIM criteria in elderly that has been released from the inception to December 2012. Eight countries PIM criteria were selected and their development method, expert panel′s composition and contents were compared.ResultsPIM criteria from a total of eight countries including the United States, Canada, Japan, France, Norway, Germany, South Korea and Austria were selected for the analysis. Except the United States PIM criteria has been updated to version 4 (2012), the other countries have just published their first edition. The applicable age of respective country about PIM criteria is slightly different (≥ 65 ~ ≥ 75 years). Seven countries except Japan were using the Delphi method as a research methodology. The composition of the expert panel has pharmacist, geriatrician, psychiatrist, general and family practitioner, and so on. Eight countries′ PIM criteria were not completely consistent in the content and the form, but mainly contain three parts: independent risk factors, drug-disease interactions, and drug-drug interactions. Drugs were included in PIM criteria with the following features: the elderly are proneto poisoning and adverse reactions; the benefits of treatment outweigh its potential risks for the elderly; poor efficacy or uncertain efficacy for the elderly; drugs can be replaced with similar products. ConclusionReference and learning from foreign method and experience of PIM criteria in elderly can help us to formulate a PIM criteria for China′s situation as early as possible and promote rational use of drugs.

  • 论著
    Zhang Xiaolan;Wang Yuqin;Yan Yan;Shen Qian;Li Xiaoling;Liu Chen;Li Xingwei;Xie Hongjuan
    2014, 16(2): 79-7.
    Abstract ( ) PDF ( )

    ObjectiveTo develop primary standard of potentially inappropriate medication (PIM) in Chinese aged people under morbid state and provide the basis and guide for clinical rational drug use in aged people.MethodsStandards of PIM in aged people under morbid state of the United States, Canada, Thailand, South Korea, and the Taiwan area of China were collected and, after summarizing, removing duplication, and integrating, the first round questionnaire was designed according to Delphi method to ask for the experts′ opinions. The experts′ feedback and suggestions were organized and the second round questionnaire was designed to ask for opinions again. Authoritative coefficient, positive coefficient, coordinate coefficient, mean score, and full mark rate were calculated. The selected drugs were respectively divided into grade A (frequency ≥ 3 000) and B (frequency < 3 000) standard according to medication frequency.ResultsThirty nine and 38 experts respectively took part in the 2 rounds of Delphi method investigations, who were selected from 23 grade Ⅲa hospitals in 11 provinces and 3 municipalities directly under the central government. These experts′ specialties involved 11 clinical medical specialties including neurology, psychiatry, cardiology, gastroenterology, endocrinology, urogenital epidemiology, gerontology, general medicine, pain medicine, dermatology, and respiratory medicine and 3 pharmacy specialties including clinical pharmacy, clinical pharmacology, and hospital pharmacy. After the 2 rounds of investigations, all of the authoritative coefficients of the experts were above 0.7, all of positive coefficients were 100%, and the first coordination coefficient were 0.17 and 0.21, respectively. Meanwhile, the mean scores were 3.65 and 3.94 and the means of full mark rates were 0.15 and 0.32, respectively. The first round investigation contained 188 points of drug-induced risks of 89 species (categories) of drugs under 31 kinds of morbid states and the second round investigation contained 74 points of drug-induced risks of 44 species (categories) of drugs kinds of morbid states. These indexes listed in the second round investigation were all enrolled the primary standard of PIM in Chinese aged people under morbid state. Grade A standard contained 62 points of drug-induced risks of 35 species (categories) of drugs under 25 kinds of morbid states, and grade B standard contained 12 points of drug-induced risks of 9 species (categories) of drugs under 9 kinds of morbid states.ConclusionsThe development of primary standard of PIM in Chinese aged people under morbid state has completed preliminarily. However, the standard still needs to be improved by clinical application to be used as a powerful tool for promoting rational drug use and lowering drug-induced risks of aged people.

  • 论著
    Zou Deling;Liu Xingli;Fang Yue;Chen Yanli;Geng Ning;Pang Wenyue
    2014, 16(2): 86-5.
    Abstract ( ) PDF ( )

    ObjectiveTo compare the efficacy and safety of intravenous application of amiodarone or esmolol in elderly patients with ventricular arrhythmia following acute myocardial infarction (AMI) within 48 hours, and provide reference for safeuse of medication in clinical practice.MethodsElderly hospitalized patients with severe ventricular arrhythmia following AMI in department of Cardiology in Shengjing Hospital of China Medical University from January 2009 to June 2013 were enrolled into the study. The patients were divided into amiodarone group and esmolol group. The patients in amiodarone group received intravenous injection of amiodarone 150 mg in 5% glucose solution 20 ml within 10 minutes, then an IV infusion of amiodarone 1 mg/min was given by syringe pump for 6 hours, then an IV infusion of amiodarone 0.5 mg/min was given for 24-48 hours. After finishing the intravenous application, the patients were given amiodarone orally 0.2 g thrice daily for 7 days. The patients in esmolol group received intravenous infusion of esmolol 0.5 mg/kg within 1 minute, then a venoclysis of esmolol 0.1 mg/(kg·min) was given by syringe pump for 6 hours, then a venoclysis of esmolol 0.05 mg/(kg·min) was given for 24-48 hours. After finishing the intravenous application, the patients were given metoprolol orally 25 mg, twice daily for 7 days. The patient who still had ventricular tachycardia after intravenous application of amiodarone or esmolol for 6 hours in amiodarone group or esmolol group should receive the above-mentioned esmolol or amiodarone treatment, respectively. The efficacy and safety within 48 hours between the 2 groups were compared. ResultsThe effective rate in amiodarone group and esmolol group within 48 hours were 92.1% (35/38) and 75.0 (27/36), respectively (P=0.046). The incidence of adverse reactions in the 2 groups were 39.5% (15/38) and 19.4% (7/36), respectively (P=0.060). Two patients who had accompanied heart failure in the amiodarone group developed acute liver injury 24 hours after intravenous application. Two weeks later, their liver function returned to normal after drug withdrawal and symptomatic treatment.ConclusionsThe effective rate of intravenous application of amiodarone was higher than that of esmolol in treatment for elderly patients with ventricular arrhythmia following AMI. Amiodarone and esmolol are relatively safe. The liver function should be monitored in the elderly AMI patients when intravenous application of amiodarone were given. Once liver injury occurs, the drug should be discontinued immediately and the symptomatic treatment should be given.

  • 论著
    Long Liang;Li Lulu;Yan Min;Yin Tao
    2014, 16(2): 91-4.
    Abstract ( ) PDF ( )
    ObjectiveTo explore the occurrence and related factors of kidney injury induced by tacrolimus in elderly patients.MethodsThe clinical data of patients who were hospitalized in Xiangya Hospital during December 2011 to October 2013 and had complete medical records, aged≥60 years, and received tacrolimus treatments were collected and analyzed retrospectively. The main analytic indicators included the change of serum creatinine before and after tacrolimus treatment, the blood trough concentration of tacrolimus, and the drug combinations. The tacrolimus trough concentration >15.0 μg/L was considered as a positive result and the positive rates after tacrolimus treatment in patients in the renal damage and the no renal damage groups were compared.ResultsA total of 127 patients were enrolled in this study. There were 11(8.7%)patients in the renal damage group and 116 patients in the no renal damage group. It comprised 6 men with age of 61 to 80 (69±11) years, and 5 women with age of 60 to 85 (69±11) years in the renal damage group; while it comprised 64 men with age of 60 to 89 (74±9) years, and 52 women with age of 60 to 85 (70±6) years in the no renal damage group. There were no statistical significance in gender and age distribution in patients between the 2 groups (P>0.05). The serum creatinine levels before tacrolimus treatment were 57-363 (179±90) μmol/L in patients in the renal damage group and 42-350 (150±65) μmol/L in patients in the no renal damage group. The difference was no statistical significance between the 2 groups (P>0.05). The serum creatinine levels increased to 176-639 (358±183) μmol/L after 5 to 20 (11±6) days receiving tacrolimus treatments in patients in the renal damage group. The difference before and after treatment was statistically significant (P<0.05). The blood trough concentration of tacrolimus was 5.9-15.1 μg/L in 11 patients in the renal damage group and >15.0 μg/L (81.8%) in 9 of them; the tacrolimus trough concentration was 4.7-16.9 μg/L in 116 patients in the no renal damage group and >15.0 μg/L (36.2%) in 42 of them. The difference between the 2 groups was statistically significant (P=0.00). Eleven patients with renal damage were treated with cytochrome P450 3A inducers/inhibitors combined with glucocorticoid; 3 of them combined with nephrotoxic drug at the same time. When the kidney injury appeared in the 11 patients, tacrolimus was stopped immediately and changed to other immunosuppressants in 9 patients and the drug dosages were adjusted in 2 patients. No irreversible kidney injury occurred in any of the patients.ConclusionTacrolimus may induce renal damage in elderly patients, which may be related to the blood trough concentration of tacrolimus as well as potential interactions among combined drugs.
  • 论著
    Chen Qian;Liang Beibei;Li Yue;Niu Hui;Di Xiuzhen;Chu Xiaomeng;Bai Yan;Wen Ke;Liu Xu;Wang Jin;Wang Rui
    2014, 16(2): 95-5.
    Abstract ( ) PDF ( )

    ObjectiveTo investigate the research progress in nephrotoxicity due to polymyxin and provide a reference for clinical safe use of polymyxin.Methods“Polymyxin”, “colistin”, “colistimethate”,“nephrotoxicity”, and “renal toxicity” were selected as the keywords and PubMed, Embase, Web of Science, Chinese Medical Citation Index, and Chinese BioMedical Disc were searched. All literature about nephrotoxicity due to polymyxin were enrolled. The evaluated databases of literature accepted for bibliometric study were establish by Microsoft Excel. The parameters of bibliometrics such as literature′s language, literature′s type, publication date, the countries and institutes ranking in the top 5 in publishing, top 5 journals in publishing number, and top 10 most frequently cited articles. The main content and hotspot of literature were analyzed. The clinical manifestations, mechanism, and prophylactico-therapeutic measures of nephrotoxicity due to polymyxin were summarized.ResultsA total of 95 articles (90 in English, 3 in Chinese, 1 in French and 1 in Portuguese) were enrolled in the study, of which 82 were original articles and 13 were reviews. The published time of first original publication of nephrotoxicity due to polymyxin was in 1952. The countries ranking in the top 5 in publishing were United States (29 pieces), Greece (12 pieces), Turkey (8 pieces), Australia (6 pieces), and Korea (5 pieces), respectively. The highest citation rate of article was 156 times. The mode of administration of polymyxin were intravenous infusion and nebulized inhalation. Kidney injury due to polymyxin usually occurred in 4-10 days after administration. The main clinical manifestations were myodynia, weakness, dark urine, hematuria, and proteinuria. Laboratory examination showed elevated serum creatinine and depressed creatinine clearance rate. After the drug withdrawal and supportive treatments, some patients′ renal functions returned to the levels before administration. The incidence of nephrotoxicity due to polymyxin elevated following the increase of dosage and decreased following the lengthening of dosing interval. The mechanism of nephrotoxicity due to polymyxin was unknown, it may be related to the increase of membrane permeability and the change of transmembrane potential of ureteric epithelial cells.ConclusionsGreece is ranked at the leading position in the research of nephrotoxicity due to polymyxin. The researchers pay more attention to the high-qulity articles. The degree of nephrotoxicity due to polymyxin can be alleviated by decreasing dose, extending the dosing interval, and combined use of kidney-protective drugs. Once kidney injury due to polymyxin occurred, the drug withdrawal and supportive treatments should be given immediately.

  • 论著
    Zhan Hanqiu;Liu Hui;Sun Na
    2014, 16(2): 100-7.
    Abstract ( ) PDF ( )

    ObjectiveTo evaluate the efficacy and safety of human serum albumin in treatment of patients with ascites due to cirrhosis.MethodsCochrane Library, PubMed, EMBase, Web of Science, CBM, CNKI, VIP, Wanfang Database were searched by using keywords “ascites”, “albumin”, “cirrhosis” and “randomized controlled trials”. The full text papers of randomized controlled trials (RCT) about human albumin treatment in patients with ascites due to cirrhosis were collected. The articles were selected and evaluated according to the inclusion criteria. The related information was statistically analyzed with RevMan 5.2 software, the relative risk (RR) and 95% confidence intervals (CI) were calculated. The patients in experimental group received IV infusion of human serum albumin. The patients in control group received isotonic 0.9% sodium chloride injection or artificial colloid (such as hetastarch, dextran, polygeline etc.) or no drugs. The efficacy and safety were compared between the 2 groups.ResultsA total of 688 related articles were searched and 13 RCT were enrolled into the study finally. There were 11 articles in English and 2 in Chinese. A total of 1 152 patients were entered in the study. The results of Meta-analysis showed that the incidence of hyponatremia in the experimental group (7.67%) was lower than that in the control group (14.66%), the difference was statistically significant(RR=0.60,95%CI:0.41~0.88, P=0.008). The differences of the ascites regression rates (91.67% vs. 88.44%), the incidences of renal injury (5.12% vs. 6.93%), the incidences of infection (5.04% vs. 4.93%), the incidences of hepatic encephalopathy (5.90% vs. 5.00%), the incidences of hemorrhage of digestive tract (2.57% vs. 2.73%), the incidences of hyperpotassemia (1.09% vs. 6.45%), the rehospitalization rates (52.15% vs.61.82%), the rehospitalization rates due to ascites (38.68% vs. 41.85%), the hospital mortality (3.80% vs. 4.54%), and the total mortality rates (21.40% vs. 24.83%) between the experimental group and the control group were not statistically significant ( all P >0.05). The difference of incidence of adverse reactions between the experimental group and the control group (3.13% vs. 3.05%) was not statistically significant (P=097).ConclusionThe present study can not demonstrate the obvious differences in curative effect and safety between the therapies of IV infusion of human serum albumin and artifical colloid or chloride in treatment of patients with ascites due to cirrhosis.

  • 综述

  • 综述
    Dai Ning;Ma Qing;Chen Haiping
    2014, 16(2): 107-4.
    Abstract ( ) PDF ( )

    Wide use of loop diuretics in patients with cardio-renal syndrome may cause loop diuretic resistance, that means the patients′reactions to loop diuretics decline. The mechanisms of loop diuretic resistance are the decrease of renal perfusion, the changes of kidney structure, the excessive activation of neurohormones, the abnormal reaction of tubule-glomerular feedback, sodium retention after diuretic therapy, and hypoproteinemia. Treatment principles for loop diuretic resistance are avoidance of excessive diuretic therapy, continuous and constant infusion of loop diuretics, combined use of drugs to increase renal blood flow, angiotensin converting enzyme inhibitors or angiotensin receptor blockers, positive correction for hypoproteinemia, combined use of different diuretics, application of new diuretics, and blood purification, etc.

  • 综述
    Yu Nan;Gao Ying;Li Xuesong;Guo Xiaohui
    2014, 16(2): 111-3.
    Abstract ( ) PDF ( )

    Sunitinib, an oral multi-targeted tyrosine kinase inhibitor, is approved for the treatment of metastatic renal cell carcinoma and gastrointestinal stromal tumor after imatinib treatment failure or intolerance. Hypothyroidism induced by sunitinib has a high incidence and symptoms are not typical. The symptoms include fatigue, palpitation, chills, and somnolence, and they are difficult to be distinguished from the tumor-associated symptoms and other common adverse reactions of sunitinib. The possible mechanisms of hypothyroidism induced by sunitinib include destruction of thyroid tissue, inhibition of thyroid peroxidase, and vascular injuries. The patients′ thyroid functions should be monitored regularly during the sunitinib treatment, and thyroid hormone replacement therapy should be given in some severe cases.

  • 综述
    Jiang Luxi;Chen Yu;Zhao Li
    2014, 16(2): 114-5.
    Abstract ( ) PDF ( )

    Medications in pregnancy can be divided into five categories (A, B, C, D, X). Bronchial asthma medications involve controller medication and relief medication. Inhaled corticosteroids are recommended as first-line controller medications for pregnant women with asthma. Low to medium dose of these drugs is generally safe and budesonide (category B) is considered to be the first choice. Short-acting β2 -agonists are recommended as first-line relief medications for pregnant women with asthma and albuterol (category C) is the first choice. Systemic corticosteroids during pregnancy could cause elevated incidence of hypertension in pregnancy and preeclampsia. Besides, systemic corticosteroids in first trimester of pregnancy could induce occurrence of fetal cleft lip and cleft palate. Leukotriene modifier, cromolyn, and nedocromil have generally been established as safe to mothers and infants, but none of them is the first choice. Low dose theophylline for mild persistent asthma during pregnancy can be chosen, but serum concentrations must be monitored, and theophylline is not the first choice either. The use of long-acting β2 -agonists during pregnancy alone has no marked effect on fetal growth and development while the safety to mothers remains to be further investigated. Poor asthma control can lead to hypoxia in pregnant women and it can cause much harm to the mothers and infants. It appears that the risk of consequences of poorly controlled asthma is higher than the adverse effects of asthma medications. In a word, asthma therapy in pregnancy should firstly weight the advantages and disadvantages. Choice of appropriate medication is critical for ensuring maternal and infant health.

  • 中毒救治

  • 中毒救治
    Zhao Ruizhan;Li Shuanlu;An Guohui
    2014, 16(2): 119-2.
    Abstract ( ) PDF ( )

    A 30-year-old male patient took about 300 pills of salbutamol (2 mg/pill ) by himself after a quarrel with his family and was hospitalized in emergency department. The patient had dizziness, headache, giddiness, palpitation and dry mouth, etc. and was treated with emetic and cathartic treatments, oral medicinal charcoal tablets for poison adsorption, correction of electrolyte imbalance, maintaining acid-base balance, and hemoperfusion combined with hemodialysis. Clinical symptoms improved 3 days later and he was discharged. And the patient had no uncomfortable feelings during follow-up visit 7 d later.

  • 病例报告

  • 病例报告
    Wei Yanhong;Zhang Yatong;Wu Suowei
    2014, 16(2): 120-1.
    Abstract ( ) PDF ( )

    A 75-year-old male patient received regularly fluvastatin sodium 80 mg once daily after intracoronary stent implantation. The medication was changed to atorvastatin calcium 10 mg every night because his lipid levels could not reach the standard. On day 4, the patient′s insomnia became worse than before, he was awake all night. Atorvastatin calcium was stopped and rosuvastatin calcium 10 mg every night was given. Three days later, his insomnia was relieved.

  • 病例报告
    Qi Hongliang;Zhou Hui;Li Li
    2014, 16(2): 121-2.
    Abstract ( ) PDF ( )

    A 71-year-old male patient received intravenous amiodarone 150 mg followed by amiodarone 600 mg with continuous microdose venous pump after pacemaker implantation. Liver function was normal before the operation. On day 3 of drug use, the patient presented with nausea, vomiting, and yellowish skin with a alanine aminotransferase (ALT) value of 2 954 U/L, a aspartate aminotransferase (AST) value of 156 U/L, a total bilirubin (TBil) value of 56.4 μmol/L, a direct bilirubin (DBil) value of 37.4 μmol/L, and an indirect bilirubin (IBil) value of 19.0 μmol/L. Amiodarone was withdrawn and protective liver therapy was given. On day 5 of amiodarone withdrawn, tests revealed the following values: ALT 965 U/L, AST 296 U/L, TBil 35.6 μmol/L, DBil 21.3 μmol/L, and IBil 14.3 μmol/L, and on day 15, ALT 37 U/L, AST 27 U/L, TBil 14.0 μmol/L, DBil 6.7 μmol/L, and IBil 7.3 μmol/L.

  • 病例报告
    Zhou Xuan;Lu Min
    2014, 16(2): 122-2.
    Abstract ( ) PDF ( )

    A 57-year-old woman with postoperative infection of rectal melanoma received an IV infusion of levofloxacin 0.2 g/100 ml twice daily. She developed weakness, hyperhidrosis, and palpitation 20 minutes after IV infusion. Laboratory examination showed that blood glucose was 2.7 mmol/L. Levofloxacin was discontinued immediately. She was given an IV infusion of 10% glucose 500 ml and candy. Her symptoms were mitigated. She was given an IV infusion of levofloxacin injection on the next day. The symptoms mentioned above recurred 10 minutes later. Laboratory examination showed blood glucose was 2.8 mmol/L. Levofloxacin was discontinued immediately and the symptomatic treatment was given again. Her hypoglycemia symptoms relieved. After switching to other antibiotics, her infection was under control and the hypoglycemic reaction did not occur again.

  • 病例报告
    Zhang Hanyu
    2014, 16(2): 123-2.
    Abstract ( ) PDF ( )

    A 37-year-old male received compound glycyrrhizin 25 mg three times daily for one month because of positive HBsAg, HBeAb, HBcAb and increased serum aminotransferase. He developed ache in both lower extremities and fatigue. Laboratory tests revealed the following results: serum potassium 1.8 mmol/L, creatine kinase 8378 U/L. The patient was considered to have compound glycyrrhizin-induced hypokalemia and rhabdomyolysis. Compound glycyrrhizin was stopped and the patient was treated with potassium supplement and fluid infusion for 10 days. His serum potassium increased to 5.1 mmol/L, creatine kinase decreased to 450 U/L. His ache in both lower extremities and fatigue symptoms disappeared.

  • 病例报告
    Gao Jie;Hang Yongfu;Xie Cheng;Zheng Xiaoxian
    2014, 16(2): 125-2.
    Abstract ( ) PDF ( )

    A 13-year-old boy (weighing 24 kg) after allogeneic transplantation due to acute lymphoblastic leukemia received an IV infusion of azithromycin at a dose of 20.8 mg/kg because of pneumonia. At the end of intravenous infusion of azithromycin for the first time, the boy developed palpitation and the heart rate was 225 beats/min, blood pressure 75/45 mmHg, and oxygen saturation 0.98. The ECG examination showed supraventricular tachycardia and narrow QRS complex. The bedside echocardiographic examination showed a small amount of pericardial effusion,slight decrease of the motion range of left ventricular posterior wall, and ejection fraction 0.58. Azithromycin was discontinued immediately and his carotid sinus and eyeball were pressed alternately. About 10 minutes later, his heart rate dropped to 120 beats/min, sinus rhythm recovered, and blood pressure was 92/62 mmHg. Two days later, his ECG examination showed normal and his heart rate was 87 beats/min.

  • 病例报告
    Yang Jingxiu;Ge Shengrong
    2014, 16(2): 126-3.
    Abstract ( ) PDF ( )

    Two male infants (aged 5 months and 19 days, and 3 months and 19 days, respectively) were given an intravenous infusion of ceftriaxone sodium 0.7 g in 0.9% sodium chloride 100 ml once daily and an intravenous infusion of ceftriaxone sodium 0.6 g in 0.9% sodium chloride 50 ml once daily for bronchitis and infectious diarrhea, respectively. On day 10 and 4, white granules were found on skin surface of the two infants′oschea. There were no inflamed urinary meatus and abnormal results of routine urine tests. The white granules gradually decreased and disappeared after ceftriaxone sodium was withdrawn.