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《广州医药》编辑部

广州医药杂志服务号
中医研究

中药自制剂解郁化痰安神颗粒致失眠类瞑眩反应的讨论

Discussion on the insomnia like dizziness reaction caused by self-made traditional Chinese medicine Jieyu Huatan Anshen Granules

:268-272
 
       目的   提示临床在使用解郁化痰安神颗粒过程中,予以关注其发生的药物不良反应,同时进一步重视中成药及中药制剂带来的药物不良反应,并与中医药当中的瞑眩反应予以区分。方法   通过分析1例解郁化痰安神颗粒致失眠不良反应,基于中国知网、万方数据知识服务平台等国内数据库,对不良反应发生机制予以分析、讨论。结果   本次解郁化痰安神颗粒致失眠不良反应1例,不良反应相关性评价为“可能”,根据临床观察,可能为中药中典型的“瞑眩反应”。论   临床当发现基于中成药的不良反应,应予以分析辨别,及时处置药物不良反应,进一步观察研究瞑眩反应。
       Objective  To suggest that during the clinical use of Jieyu Huatan Anshen Granules,attention should be paid to its adverse drug reactions,and further attention should be paid to the adverse drug reactions caused by traditional Chinese patent medicines and simple preparations and traditional Chinese medicine preparations,and it should be distinguished from the insomnia and dizziness reactions in traditional Chinese medicine.Methods  A case of insomnia adverse  reaction caused by Jieyu Huatan Anshen Granules was analyzed based on domestic databases such as CNKI and Wanfang data to investigate and discuss the mechanism of adverse reactions.Results  One case of insomnia adverse reaction caused by Jieyu Huatan Anshen Granules was reported,and the correlation evaluation of the adverse reaction was “possible”.According to clinical observations,it may be a typical “dizziness reaction” in traditional Chinese medicine.Conclusions  When adverse reactions based on traditional Chinese medicine decoction,traditional Chinese patent medicines and simple preparations and other traditional Chinese medicine preparations are found in clinical practice,they should be analyzed and identified,and the adverse reactions should be handled in time and be further observed and studied.
医院管理

广州市越秀区 3 所综合医院 93 例医疗损害责任纠纷案件法院审理浅析

Analysis of the court trial of 93 cases of medical damage liability disputes in three general hospitals in Yuexiu District,Guangzhou

:131-138
 
       目的   对医疗损害责任纠纷案的法庭审理进行分析,探究医疗损害责任纠纷案件的处理现状,对此过程中医疗机构应当关注的问题进行分析总结,以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法   对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果  93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中,71例鉴定结论被法院采信,采信率达90%。有29例案件鉴定人出庭(占比36.7%),其中有25例鉴定意见被法院采信,采信率为86.2%,仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任占比为73.4%。鉴定结论为责任范围的,法院最后判决偏向于取最高值和中间值(43例出具责任范围的案例中,14例为最高值,13例为中间值)。结论   医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识,高度重视医疗损害鉴定工作,尤其加强尸体解剖告知及病历书写管理,充分利用好鉴定人和专家辅助证人出庭两种手段。
      Objective  To analyze the court trial of medical damage liability disputes,to explore the current situation of medical damage liability disputes,to analyze and summarize the problems encountered in dealing with medical damage disputes,so as to provide some references for hospitals to deal with medical damage disputes.Methods  Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District,Guangzhou from 2015 to 2021.Results  In 93 cases,79 cases had expertise of medical malpractice.In 79 expertise,71 of them were adopted,and the acceptance rate was 90%.Among the 29 cases in which the appraisers appeared in court,25 expert opinions were accepted by the court,the acceptance rate was 86.2%.In only 7 cases,the parties applied for expert witnesses to appear in court.In most cases,hospitals ultimately took secondary and lower responsibilities,accounting for 73.4%.If the appraisal conclusion falls within the scope of responsibility,the court’s final judgment tends to take the highest and middle values.Conclusions  Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification.Attach great importance to the identification of medical malpractice,especially strengthen the management of autopsy notification and medical record writing,make full use of two methods:appraisers and experts witnesses appearing in court.
论著

基于 Python 语言探析《圣济总录》中腰痛病用药规律研究

Study on medication rule of low back pain in Shengji Zonglu based on Python language

:99-105
 
      目的   应用 Python语言对《圣济总录》中腰痛病篇中的中药进行用药规律分析,提取腰痛病治疗方法及用药特色指导临床腰痛病治疗思路。方法   运用 Python语言中的语言提取对《圣济总录》中腰痛篇章中的所有中药方剂识别,提取方剂组成,统计并分析方剂中中药的规律并将其结果可视化呈现。结果   最终共纳入62首方剂,包含药物86味。其中使用频次≥7次、频率≥1.6%的药物共20味,频次频率最高的为桂枝;所用中药四气以温性为主,占56.74%;五味以辛、甘、苦为主,共约占90%,归经以肝肾经为主;药物功效以补虚类为主,占27.13%;关联规则分析显示提升度最高的组合为麻黄-独活,置信度最高的组合为巴戟天-牛膝、牵牛子-牛膝,支持度最高的组合为川芎-当归、川芎-杜仲;通过聚类分析得到3个聚类结果。结论   《圣济总录》治疗腰痛病方面善用通法和补法,强调活血通络,补益肝肾,尤擅长治疗肝肾亏虚或风寒所客等腰痛病证。
       Objective Python language was used to analyze the rules of traditional Chinese medicine in the chapter of low back pain in Shengji Zonglu,and to extract the treatment methods and medication characteristics of low back pain to guide the clinical treatment of low back pain.Methods The language extraction in Python language was used to identify all the Chinese medicine prescriptions in the chapter of low back pain in Shengji Zonglu,extract the composition of the prescription,and analyze the rules of Chinese medicine in the prescription to visually present the results.Results A total of 62 prescriptions were included,including 86 drugs.Among them,with there were 20 kinds of drugs,the frequency of use ≥7 times,the frequency ≥1.6%,and cmnamomi Mmulus highest frequency.Four gas used in traditional Chinese medicine is given priority to with warm,accounted for 56.74%.The five flavors were mainly pungent,sweet and bitter,accounting for about 90%,and the liver and kidney meridians were the main meridians.The drug efficacy was mainly deficiency tonic,accounting for 27.13%.The association  rule analysis showed that the combination with the highest improvement was Ephedrae Herba- Angelicae Pubescentis Radix,the combination with the highest confidence was Morindae Officinalis Radix- Achyranthis Bidentatae Radix,Pharbitidis Semen- Achyranthis Bidentatae Radix.and the combination with the highest support was Chuanxiong Rhizoma- Angelicae Sinensis Radix,Chuanxiong Rhizoma- Eucommiae Cortex.Three clustering result is obtained by cluster analysis.Conclusions In the treatment of low back pain,Shengji Zonglu is good at using both blocking methods and reinforcing methods,emphasizing circulating blood and unblocking meridians supplementing liver and kidney,especially in the treatment of low back pain syndrome caused by liver and kidney deficiency or wind and cold.
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.
综述

评价药源性心脏毒性生物标志物的研究进展

Research progress in evaluating biomarkers of pharmacogenic cardiotoxicity

:48-55
 
       药源性心脏毒性是临床常见的药物不良反应,是药物研发和临床治疗需面临的严峻考验。对药源性心脏毒性的评价是目前研究的重点,基于其机制复杂多样、临床表现不一、影响因素多,早期评价具有困难。生物标志物是评价心脏毒性的重要指标之一,文章总结了目前已经报道的多种心脏毒性标志物及其潜在的生物标志物,希望能从中找到特异性强、敏感性高的标志物,以贡献于药物心脏安全性评价工作。
    As a common clinical adverse reaction,pharmacogenic cardiotoxicity is a severe challenge for drug development and clinical treatment.The evaluation of pharmacogenic cardiotoxicity is the focus of current research,and early evaluation is difficult with its complex and diverse mechanisms,varying clinical manifestations,and numerous influencing factors.Biomarker is an important index to evaluate cardiotoxicity.This article summarizes a variety of cardiotoxicity biomarkers and other potential biomarkers that have been reported so far,hoping to find  biomarkers with strong specificity and high sensitivity,so as tocontribute to the evaluation on cardiac safety of drugs.
眼科专题:近视防控

广州荔湾区 398 例儿童 FTD 和 PPA 与眼轴长相关性研究

Study on the correlation between FTD and PPA with axial length in 398 children from Liwan district,Guangzhou

:18-25
 
       目的   探讨眼底豹纹斑密度(FTD)及视盘旁萎缩弧(PPA)与眼轴长(AL)的相关性,为眼底定量化在儿童近视防控的应用提供科学依据。方法   本研究随机抽取广州市荔湾区两所小学三年级学生作为研究对象,在校园视力筛查的过程中同时采集AL、CR和眼底彩照。使用AI软件对眼底彩照进行量化分析,量化指标包括不同区域和范围的FTD及PPA面积大小,根据眼轴长度分为三组:A组(AL<23 mm);B组(23 mm≤AL<24 mm);C组(24 mm≤AL)。结果   共有398例右眼被纳入统计分析,年龄范围8~11岁,中位数是9岁,男性人数占55.1%。三组组间AL、AL/CR和SE比较均有统计学差异(P<0.05)。A组与B组相比,FTD在后极部整体范围、黄斑中心3 mm区域、黄斑中心3 mm区域上方区域具有统计学差异(P<0.05),C组与B组相比,PPA面积及FTD在后极部整体范围、视盘为中心4.5 mm范围、黄斑为中心直径3 mm和6 mm范围均具有统计学差异(P<0.05),Spearman相关性分析表明,AL与PPA(r=0.443)和FTD(r=0.322)呈正相关(P<0.001)。亚组相关性分析表明,A组仅黄斑为中心直径3 mm上方范围FTD与AL呈正相关(P=0.028),B组PPA、黄斑中心直径3 mm及其上方范围FTD与AL呈正相关(P<0.05),C组仅PPA与AL呈正相关(P=0.005)。结论底定量对于儿童近视防控具有潜在价值,PPA和FTD与AL呈正相关性,不同区域和范围FTD与AL相关性具有一定差异性,黄斑中心直径3 mm范围及其上方范围与眼轴相关性最强。FTD在短眼轴阶段就可以作为生物标记物预测近视严重程度,而PPA主要在长眼轴阶段体现生物标记物的作用。
       Objective  To investigate the correlation between fundus tessellated density(FTD)and peripapillary atrophy(PPA)with axial length(AL), providing a scientific basis for the application of fundus quantification in the prevention and control of myopia in children. Methods  This study randomly selected third-grade students from two primary schools in Liwan District, Guangzhou City, as research subjects. Axial length(AL), corneal radius(CR), and fundus color photographs were collected simultaneously during the school vision screening process. AI software was utilized to perform quantitative analysis on the fundus color photographs, with quantification indicators including the area size of PPA and FTD in different regions and ranges. Subjects were divided into three groups based on axial length:Group A(AL<23 mm); Group B(23 mm≤AL<24 mm); Group C(AL≥24 mm). Results  A total of 398 right eyes were included in the statistical analysis, with an age range of 8 to 11, a median age of 9, and 55.1% were male. There were significant statistical differences in AL, AL/CR, and spherical equivalent(SE)among the three groups(P<0.05). Compared with Group B, Group A showed significant statistical differences in FTD in the overall posterior pole, the 3 mm diameter area centered on the fovea, and the superior area of the 3 mm foveal center(P<0.05). Compared with Group B, Group C showed significant differences in PPA area and FTD in the overall posterior pole, the 4.5 mm diameter area centered on the optic disc, and the 3 mm and 6 mm diameter areas centered on the fovea(P<0.05). Spearman correlation analysis indicated that AL was significantly positively correlated with PPA(r=0.443)and FTD(r=0.322)(P<0.001). Subgroup correlation analysis showed that in Group A, only the FTD in the superior area of the 3 mm diameter centered on the fovea was significantly positively correlated with AL(P=0.028). In Group B, PPA and FTD in the 3 mm diameter and superior area centered on the fovea were significantly positively correlated with AL(P<0.05). In Group C, only PPA was significantly positively correlated with AL(P=0.005). Conclusions  Fundus quantification holds potential value for the prevention and control of myopia in children. PPA and FTD show significant positive correlations with AL, with varying degrees of correlation in different regions and ranges of FTD with AL. The 3 mm diameter area centered on the fovea and its superior area have the strongest correlation with the eye axis. FTD can serve as a biomarker to predict the severity of myopia in the early stages of eye axis elongation, while PPA primarily manifests as a biomarker in the later stages of elongation. 
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