背景与目的 对卫生保健干预措施进行决策权衡需要有不良和有益的可靠证据,然而绝大多数系统评价针对的是研究方法非常成熟的随机对照试验及其有效性评价,系统地评价不良反应的方法尚未完善,对研究者而言,能作为相关指南的资源很少.为此,作者在文中报告了对不良反应进行系统评价的新近体会,同时提出进一步实践和研究的建议.方法 描述并比较3个包含不良反应评价的药物干预的系统评价的方法学,重点评价其研究问题、研究设计和质量评价.结果 1个研究关注于如何根据提供的特殊不良反应数据建立卫生经济学模式,而其它两个研究涉及更广泛的问题.尽管每个评价对纳入标准的定义不同,但它们均纳入了随机和观察性数据.对研究质量的评价采用了标准方法.由于研究设计不良、报告不充分和现有研究工具有限,在运用纳入标准和评估研究质量时,研究者遇到了各种问题.最终发现,3个评价都做了大量的工作,但对卫生保健决策者有用的资料不多.研究者确认,改善的关键在于如何提出系统评价的问题和发展不良反应研究的质量评价方法学.结论 若不良反应的系统评价只专注于一个中心问题,那么它会提供与临床决策更相关的资料,也有利于明确纳入系统评价研究的类型.系统评价中不良反应的质量评估的方法学需要进一步完善.
目的 分析都江堰市人民医院药品不良反应（ADR）的发生情况及引发ADR的相关因素，为临床合理用药及正确评价ADR的发生提供参考。 方法 对医院2009年1月－2011年12月收集上报至全国ADR监测网络的168例ADR报告，进行回顾性分类与统计分析。 结果 ADR报告例数最多的为临床科室，男女病例数比为0.87∶1，静脉给药途径引发的ADR最多（占77.98%）；抗感染药物的ADR发生率最高（占61.90%）；皮肤及其附件损害最常见占（27.98%）。 结论 抗感染药物和中药注射剂是ADR监测的重点药物，应加强ADR监测及相关知识的宣传，提高合理用药水平，减少药源性疾病的发生。
Most immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICIs) resulted from excessive immune response against normal organs. The severity, timing, and organs affected by these events were often unpredictable. Adverse reactions could cause treatment delays or interruptions, in rare cases, pose a life-threatening risk. The mechanisms underlying irAE involved immune cell dysregulation, imbalances in inflammatory factor expression, alterations in autoantibodies and complement activation, even dysbiosis of intestinal microorganisms. However, the mechanisms of irAE occurrence might differ slightly among organs due to variations in their structures and the functions of resident immune cells. Future research should focus on the development of targeted drugs for the prevention or treatment of irAE based on the mechanisms by which irAE occurs in different organs. A deeper understanding of the mechanisms underlying irAE occurrence would aid clinicians in effectively utilizing ICIs and provide valuable guidance for their clinical application.
Valproic acid can reduce the frequency of seizures through various mechanisms and is widely used in clinical practice as a monotherapy or adjunctive treatment for various types of epilepsy and epileptic syndromes. In addition, valproic acid has significant therapeutic effects on comorbidities associated with epilepsy, such as migraines and psychiatric disorders. It can also be effective in terminating status epilepticus and is commonly used as a broad-spectrum antieseizure medication in clinical settings. However, valproic acid has side effects such as teratogenicity, infertility, and menstrual disorders. Additionally, when used in combination with other drugs, the interactions between medications should be carefully considered. Therefore, in clinical practice, it is necessary to strictly adhere to the indications and dosage regimens for the use of valproic acid. This article provides a comprehensive review of the use of valproic acid in different types of seizures, epileptic syndromes, comorbidities associated with epilepsy, post-craniotomy cases, status epilepticus, and special populations. It also summarizes the combination therapy of valproic acid with other drugs, providing a basis for the rational use of valproic acid and individualized drug treatment selection for epilepsy patients.
【摘要】 目的 探讨研究静脉滴注丹参注射液发生不良反应的类型及因素，为临床用药提供依据。 方法 对2007年1月-2010年12月82例因静脉滴注丹参注射液发生不良反应的患者资料进行回顾分析，并对其相关因素进行分析。 结果 男性的不良发生率高于女性，不良反应发生年龄多为中、老年患者，并且不良反应多发生在输液30 min内，多为Ⅰ型过敏反应。 结论 对丹参注射液应严格控制生产工艺流程，临床用药要掌握适应证，以避免不良反应的发生。【Abstract】 Objective To investigate the types and factors of adverse reactions caused by intravenous infusion of Danshen injection, in order to provide basis for clinical drug application. Methods We retrospectively analyzed the clinical records of 82 patients with adverse reaction to intravenous infusion of Danshen injection from January 2007 to December 2010. Results Adverse reaction incidence was higher in males than females, and it mainly occurred in patients of middle or old ages. Most of the adverse reactions happened within 30 minutes of the infusion. Type-I allergic reaction was more commonly observed. Conclusion In order to avoid the occurrence of adverse reactions, Danshen injection production process should be strictly controlled, and indications should be considered carefully in clinical medication.
【摘要】 目的 探讨抗菌药物诱导尖端扭转型室速（torsade de pointes，TDP）的规律及特点，为临床合理用药提供参考。 方法 检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库建库至2011年7月有关抗菌药物致TDP的病例报道，共16例，并进行分析。 结果 16例患者中男3例，女13例；年龄17～88岁，平均54岁。6例患者存在心脏疾病；诱导TDP的抗菌药物包括常用的莫西沙星、司帕沙星、头孢拉定、头孢哌酮、磷霉素、克林霉素、两性霉素B、氟康唑、伊曲康唑以及不常用的红霉素、酮康唑；TDP发生时间为用药后（5.1±6.6） d，多数患者先出现心悸、心电图提示QTc间期延长，进而出现TDP。 结论 临床医师、药师应重视抗菌药物诱导TDP的不良反应。【Abstract】 Objective To investigate the regularity and characteristics of antimicrobial agents-induced torsade de pointes(TDP),and to provide reference for rational use of drugs. Methods A total of 16 reported cases of antimicrobial agents-induced TDP were analyzed. Results The 16 cases including 3 males and 13 females at the age of 17-88 years with the mean age of 54. Six patients suffered from heart disease. The antimicrobial agents included moxifloxacin, sparfloxacin, cefradine, cefoperazone, fosfomycin, clindamycin, amphoterincin B, fluconazole, and itraconazole; which were used frequently, as well as some less frequently-used ones liked erythromycin, ketoconazole. The mean time from medication to onset of TDP was (5.1±6.6) days. Patients usually presented with palpitations at first following by prolonged QTc intervals, and then TDP appeared. Conclusion Clinical physicians and pharmacists should pay attention to antimicrobial agents-induced TDP.