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OBJECTIVE：To evaluate the benefit and risk of tirofiban in the treatment of acute coronary syndrome （ACS），and to provide evidence-based reference for clinical drug selection and decision. METHODS ：Retrieved from domestic and foreign database as PubMed ，the Cochrane Library ，CNKI and Wanfang database ，during the establishment of database to Apr. 2020，two researcher independently screened the literature based on inclusion and exclusion criteria and extracted the data. After the quality evaluation of the included literatures ，based on rapid health technology assessment ，the extracted results were classifiedly evaluated and comprehensively analyzed. RESULTS ：A total of 13 researches of systematic review/Meta-analysis and 1 research of pharmacoeconomics were included. Compared with placebo ，tirofiban could significantly reduce all-cause mortality [OR ＝0.68， 95％CI（0.54，0.86），P＝0.000 1] and the incidence of major adverse cardiac events （MACE）in patients with ACS [RR ＝0.24， 95％CI（0.14，0.40），P＜0.01]，and increased the incidence of TIMI 3 [OR＝5.73，95％CI（2.99.10.97），P＜0.01]. Tirofiban and eptifibatide had similar therapeutic efficacy in the treatment of ACS ，but tirofiban significantly increased the risk of TIMI small bleeding in patients with ACS [RR ＝0.61，95％CI（0.38，0.98），P＝0.04]. For ACS patients with non-ST elevation （NSTE-ACS）， compared with placbo ，tirofiban significantly reduced the incidence of MACE [RR ＝0.76，95％ CI（0.61，0.96），P＝0.018]，but significantly increased the risk of bleeding [OR ＝1.49，95％CI（1.12，1.98），P＝0.006]，while there was no significant difference in its effects on the all-cause mortality of NSTE-ACS patients （P＞0.05）. For STEMI patients ，compared with placebo ，tirofiban significantly reduced the all-cause mortality [RR＝0.61，95％CI（0.35，1.05），P＝0.007] and the incidence of MACE [RR ＝0.63，95％ CI（0.44，0.90），P＝0.007]. When combined with liposuction ，tirofiban also significantly reduced the incidence of MACE [RR ＝ 2.05，95％CI（1.71，2.46），P＜0.01]，and significantly increased the incidence of TIMI 3 [OR＝3.18，95％ CI（2.4，4.22），P＜ 0.01]，but there was no significant difference in its effects on bleeding risk （P＞0.05）. The included pharmacoeconomic study showed that patients treated with bivalutine could get 10.07 QALYs，patients treated with heparin combined with tirofiban could get 9.98 QALYs，and the incremental cost-effectiveness ratio bivalutine compared to the latter one was 28 575.77 yuan/QALYs，which was lower than 3 times of the per capita GDP of some cities. CONCLUSIONS ：Tirofiban has good efficacy in the treatment of ACS，but it can increase the risk of bleeding than eptifibatide and placebo. Domestic bivalirudin treating for ACS has a cost-effectiveness advantage over tirofiban combined with heparin.
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OBJECTIVE:To investigate the thoughts and ways of clinical pharmacist in nephrology department to review medi-cal orders,and to provide reference for rational drug use in nephrology department. METHODS:Based on specific cases of nephrolo-gy department,the thoughts and ways of clinical pharmacist in nephrology department to review medical orders were investigated from several aspects,including whether the therapeutic drugs had covered all the problems,drug duplication,drug selection,usage and dosage and course of treatments,drug interaction and compatibility. RESULTS & CONCLUSIONS:By establishing rigorous and systematic review thinking mode,based on their professional specialty,clinical pharmacists of nephrology department can sort the reviewing thought,fill in the gaps of medical orders reviewing and enhance the ability of participating in the clinical practice.
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Objective@#To evaluate the effects of application of vancomycin in the early stage of patients with extremely severe burn, in order to provide reference to drug for anti-infection treatment in the early stage of patients with extremely severe burn.@*Methods@#Data of 15 patients of Kunshan explosion on August 2nd, 2014, admitted to the Department of Intensive Care in our hospital were retrospectively analyzed. The clinical efficacy of continuously intravenous dripping of vancomycin (combined with imipenem) in the early stage of burns (before and on post burn day 14) was analyzed. (1) The steady state plasma concentration of vancomycin was monitored respectively 30 min before the third, sixth, and tenth medication with direct chemiluminescent imaging method. (2) The distribution of Gram-positive bacteria of patients during hospitalization and their drug resistance to 14 antibiotics commonly used in clinic were analyzed. (3) Serum level of procalcitonin (PCT), white blood cell count, percentage of neutrophils before and after treatment, and efficacy grade of anti-infection treatment in the early stage of burns were analyzed. (4) Serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine before and after treatment, and the adverse effects during medication were analyzed. The WHONET 5.5 statistical software was used to analyze the distribution of Gram-positive bacteria in all the pathogens, and the status of drug resistance of Gram-positive bacteria to 14 antibiotics. Data were processed with Wilcoxon rank sum test.@*Results@#(1) Twenty-nine times of steady state plasma concentration monitoring were performed in the patients in total, with the steady state plasma concentration of vancomycin from 4.3 to 42.1 μg/mL. In the monitoring before third, sixth, and tenth medication, the percentages of result reaching the standard were respectively 1, 3/14, and 2/7. (2) A total of 79 Gram-positive bacteria were isolated, including 49 (62.03%) strains of Staphylococcus aureus, 9 (11.39%) strains of Staphylococcus haemolyticus, 7 (8.86%) strains of Staphylococcus epidermidis, 12 (15.19%) strains of Enterococcus faecium, and 2 (2.53%) strains of Enterococcus faecalis. The above-mentioned Staphylococcus strains were with high drug resistance to antibiotics including penicillins, erythromycin, ciprofloxacin, and low drug resistance to linezolid, teicoplanin, and nitrofurantoin. The above-mentioned Enterococcus strains were with high drug resistance to antibiotics including erythromycin, ciprofloxacin, gentamicin, and low drug resistance to linezolid and teicoplanin. The above-mentioned Staphylococcus strains were all sensitive to vancomycin. Two strains of vancomycin-resistant Enterococcus were detected in the above-mentioned Enterococcus strains. (3) Serum level of PCT, white blood cell count, percentage of neutrophils of patients were (8.1±7.5) ng/mL, (24±10)×109/L, and 0.898±0.029 before treatment, which were significantly higher than (3.0±2.8) ng/mL, (12±5)×109/L, and 0.867±0.016 after treatment (with Z values respectively -2.103, -3.237, and -3.068, P<0.05 or P<0.01). After the early treatment, excellence, progess, and invalid results were achieved in 7, 5, and 3 patients, with the effective percentage of 4/5 in clinic. (4) There were no statistically significant differences in serum levels of AST, ALT, and creatinine of patients between before and after treatment (with Z values respectively-0.057, -1.508, and -1.363, P values above 0.05). Only one patient had liver and renal dysfunction during treatment.@*Conclusions@#The positive and reasonable use of vancomycin can remove most of the Gram-positive bacteria, and control the development of sepsis combined with imipenem in the early stage of patients with extremely severe burn. However, the dose of vancomycin should be individualized and the steady state plasma concentration should be monitored to maintain the blood concentration within the safe and effective range, so as to improve the rational use of vancomycin.
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AIM:To optimize the formulation of Fuyankang Dispersible Tablets and study the in vitro release characteristics of them. METHODS: The orthogonal design was used to obtain the optimal formulation with the disintegration,hardness and weight of tablets as markers,and then dispersible uniform and the in vitro release characteristics of the optimal formulation were studied with dispersed experiment and PR-HPLC,respectively.(RESULTS:)The proportion of each adjuvant in the optimal formulation consisted of 10% MCC,4% L-HPC,12% PVPP.The optimized dispersible tablets disintegrated in 1 min,the hardness was 5.24 kg,the average weight was 0.407 g;the dispersible uniform was excellent,and the settling velocity equation was logF=-0.028-1.001?10~(-3)t;The released rate parameters of Fuyankang Dispersible Tablets were T_(50)=3.0 min and T_d=4.0 min,which were remarkly less than that of the control group,T_(50)=14.28 min and T_d=16.62 min(P
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OBJECTIVE:To optimize the preparation technique of norcantharidin liposome(NL) and study its pharmaceutical properties. METHODS: With envelopment efficiency(EE), mean particle size and span of the liposome as indexes, the effects of thin-film dispersion method, injection method, reverse phase evaporation and reverse phase film-evaporation method on the EE and particle size of the NL were evaluated. And the uniform design was used to optimize the reverse phase film-evaporation preparation technique of NL with the amount of phospholipid (X1), the mass ratio of phospholipid/ cholesterol (X2), the sonde-type ultrasounding times (X3), the dilution times of buffer phosphate (X4), the volume ratio of oil/water phase (X5) and the mass ratio of lipoids/ drug (X6) as integrated indexes. A verification test was performed on the optimal technique. RESULTS: The formulation prepared by reverse phase film-evaporation technique exhibited the best EE. The preparation conditions of the optimized NL were as follows: X1=200 mg; X2=7∶1; X3=20 times; X4=50 times; X5=1∶4; X6=30∶1. The verification test showed that the EE, the mean particle size and the span of the liposome were (42.5?1.3)%, (210.9?2.1) nm and (0.61?0.12), respectively. CONCLUSION: NL was prepared successfully.