ABSTRACT
OBJECTIVE To investigate the eff ects of hypoalbuminemia and human albumin supplementation on patients with acute kidney injury （AKI）after off-pump coronary artery bypass grafting （OPCABG）. METHODS From December 2018 to January 2020，clinical information of 484 patients with coronary atherosclerotic heart disease who underwent selective OPCABG in Tianjin Chest Hospital were analyzed retrospectively. The basic data ，American Society of Anesthesiologists （ASA）grading，the number of coronary artery bypass grafting ，amount of intraoperative bleeding ，use of artificial colloid ，minimum value of hemoglobin within 7 days after operation ，hypoalbuminemia occurred after operation ，monitoring time in postoperative intensive care unit ，drainage volume of thoracic catheterization ，perioperative blood transfusion ，amount of human albumin after operation were summarized. All patients were divided into non-AKI group （414 cases）and AKI group （70 cases）according to the occurrence of AKI. The differences of the above indexes between the two groups were compared. Multiple Logistic regression analysis was performed to analyze the risk factor of AKI when selecting the indexes with P＜0.1. According to whether hypoalbuminemia occurred after operation ，all patients were divided into normal protein group （347 cases）and hypoalbuminemia group （137 cases）. Hierarchical analysis was carried out to explore the correlation between human albumin supplementation and AKI. RESULTS The results of multiple Logistic regression analysis showed that there was no significant effect on AKI in postoperative hypoalbuminemia （P＞0.05），but there were significant effect in body mass index and the dosage of postoperative human serum albumin （P＜0.05）. The risk of AKI would increase by 12.7％ every time the body mass index increases by 1 unit；the risk of AKI increased by 17.3％ for every 10 g increase in the dosage of human albumin. Stratified analysis showed that the risk of AKI would increased by 26.9％ for every 10 g increase in postoperative human albumin supplementation in normal protein group and 14.0％ for every 10 g increase in postoperative human albumin supplementation in hypoalbuminemia group. CONCLUSIONS Hypoalbuminemia is not a risk factor fo r the development of AKI after OPCABG ，but human albumin supplementation is a risk factor for AKI after OPCABG.
ABSTRACT
OBJECTIVE:To investigate the role of clinical pharmacists in the identification and treatment of serious drug erup-tion due to allopurinol. METHODS:Clinical pharmacists participated in the drug treatment for a patient with hyperuricemia. Through scanning the drugs used before and after hospitalization,suggesting to detect human leukocyte antigen(HLA)-B*5801 re-lated genes,and ultimately the cause of severe drug eruption was determined according to the detection result,i.e. allopurinol. At the same time,according to clinical symptom,genotype,lab detection indexes and results of drug sensitivity test,etc.,clinical pharmacists suggested to additionally use Ebastine tablets,Compound indometacin tincture,Triamcinolone acetonide and econazole nitrate cream and other symptomatic treatment;hormone+immunoglobulin shock therapy(Methylprednisolone sodium succinate for injection 80 mg,ivgtt,qd+Human immunoglobulin for intravenous injection 20 g,ivgtt,qd)replaced Allopurinol tablets to control allergic symptom;Bailing capsules and Compound α-ketoacid tablets were additionally used to improve renal function;Meropenem for injection and Voriconazole tablets were used to controll infection. Clinical pharmacists also provided pharmaceutical monitoring as therapeutic efficacy evaluation,electrolyte level monitoring,medication education and transferred-out follow-up,etc. RE-SULTS:Physicians adopted the suggestions of clinical pharmacists. The drug eruption of the patient gradually reduced,and pulmo-nary infection was improved. CONCLUSIONS:Severe drug eruption due to allopurinol has serious symptoms and long course of disease,and even endangers the lives of patients. It is suggested to screen HLA-B*5801 related genes before the use of allopurinol, and strengthen medical education to ensure the safety and effectiveness of drug use.
ABSTRACT
OBJECTIVE:To investigate the role of clinical pharmacists in the identification and treatment of serious drug erup-tion due to allopurinol. METHODS:Clinical pharmacists participated in the drug treatment for a patient with hyperuricemia. Through scanning the drugs used before and after hospitalization,suggesting to detect human leukocyte antigen(HLA)-B*5801 re-lated genes,and ultimately the cause of severe drug eruption was determined according to the detection result,i.e. allopurinol. At the same time,according to clinical symptom,genotype,lab detection indexes and results of drug sensitivity test,etc.,clinical pharmacists suggested to additionally use Ebastine tablets,Compound indometacin tincture,Triamcinolone acetonide and econazole nitrate cream and other symptomatic treatment;hormone+immunoglobulin shock therapy(Methylprednisolone sodium succinate for injection 80 mg,ivgtt,qd+Human immunoglobulin for intravenous injection 20 g,ivgtt,qd)replaced Allopurinol tablets to control allergic symptom;Bailing capsules and Compound α-ketoacid tablets were additionally used to improve renal function;Meropenem for injection and Voriconazole tablets were used to controll infection. Clinical pharmacists also provided pharmaceutical monitoring as therapeutic efficacy evaluation,electrolyte level monitoring,medication education and transferred-out follow-up,etc. RE-SULTS:Physicians adopted the suggestions of clinical pharmacists. The drug eruption of the patient gradually reduced,and pulmo-nary infection was improved. CONCLUSIONS:Severe drug eruption due to allopurinol has serious symptoms and long course of disease,and even endangers the lives of patients. It is suggested to screen HLA-B*5801 related genes before the use of allopurinol, and strengthen medical education to ensure the safety and effectiveness of drug use.