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多非利特——特異性抗心律失常藥

醫(yi)案日記 2023-05-17 19:15:23

多非利特——特異(yi)性抗心律失常藥(yao)

Kalus等(deng)從MEDLINE上檢索(suo)1966年1月至1999年6月發表的多非利(li)特(dofetilide)治(zhi)療心律失(shi)常的英(ying)文文章(zhang),從藥理學和臨床(chuang)應用兩個(ge)方面進行了綜述(shu)。

多非利特是一種(zhong)比(bi)較(jiao)特異的(de)(de)(de)第Ⅲ類抗心律(lv)(lv)失常藥,它延長(chang)動(dong)作電位的(de)(de)(de)時(shi)間及有(you)效不(bu)應期,但不(bu)影響心臟傳導速(su)度。這些作用(yong)的(de)(de)(de)機制(zhi)為,它能抑制(zhi)滯后的(de)(de)(de)外向鉀(jia)電流(liu)中的(de)(de)(de)快速(su)部分,因而在復極化(hua)期阻斷(duan)鉀(jia)離子的(de)(de)(de)外流(liu)。有(you)關研究顯示,該(gai)藥可(ke)治療和預(yu)防房(fang)性(xing)(xing)心律(lv)(lv)失常,如房(fang)顫、心房(fang)撲動(dong)和陣發(fa)(fa)性(xing)(xing)室上性(xing)(xing)心動(dong)過(guo)速(su),也可(ke)預(yu)防室性(xing)(xing)心動(dong)過(guo)速(su)的(de)(de)(de)發(fa)(fa)生。有(you)資料(liao)表明,該(gai)藥可(ke)降低心衰患者的(de)(de)(de)并發(fa)(fa)癥發(fa)(fa)生率。多非利特最嚴重(zhong)的(de)(de)(de)不(bu)良反應是可(ke)誘(you)發(fa)(fa)室性(xing)(xing)心律(lv)(lv)失常(特別是尖端扭轉(zhuan)型室性(xing)(xing)心動(dong)過(guo)速(su))。

目前已有(you)的(de)資料顯示,多非利(li)特(te)在(zai)治療心(xin)律(lv)失常方面(mian)有(you)作(zuo)用,特(te)別(bie)是房性心(xin)律(lv)失常。但(dan)還需更多有(you)關其療效和耐受性的(de)資料,才能完全確定(ding)該藥在(zai)抗心(xin)律(lv)失常藥物(wu)中的(de)地(di)位(wei)和作(zuo)用。

冬眠靈簡(jian)介

目(mu)錄1拼音(yin)2英(ying)(ying)文(wen)參考(kao)3概述(shu)4氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)說明書(shu) 4.1藥品名稱4.2英(ying)(ying)文(wen)名稱4.3冬(dong)(dong)眠(mian)(mian)靈(ling)(ling)的(de)別名4.4分類4.5劑型4.6氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)藥理(li)作用(yong)4.7氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)藥代動(dong)力學4.8氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)適應證4.9氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)禁忌證4.10注意事項4.11氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)不(bu)良(liang)反應4.12氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)用(yong)法用(yong)量(liang)4.13冬(dong)(dong)眠(mian)(mian)靈(ling)(ling)與其它(ta)藥物(wu)的(de)相互作用(yong)4.14專家點(dian)評 5氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)中毒 5.1臨床(chuang)表現5.2診斷(duan)5.3治療 6參考(kao)資料這是(shi)一個(ge)重(zhong)定向條目(mu),共享了氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin)的(de)內容。為(wei)方便閱讀(du),下文(wen)中的(de)氯(lv)(lv)(lv)丙(bing)(bing)嗪(qin)(qin)(qin) 已經自動(dong)替換(huan)為(wei)冬(dong)(dong)眠(mian)(mian)靈(ling)(ling) ,可點(dian)此恢復原貌 ,或使用(yong)備注方式展現 1拼音(yin) dōng mián líng

2英文參考(kao) chlorpromazin

wintermin

3概述 冬眠靈廣泛抑(yi)制(zhi)中(zhong)樞(shu)神(shen)經(jing)系(xi)統,出現安(an)定、鎮靜(jing)、抗精(jing)神(shen)病作(zuo)(zuo)用(yong)。本品具有中(zhong)樞(shu)多巴胺(an)受體的阻滯作(zuo)(zuo)用(yong)和抗膽堿(jian)能作(zuo)(zuo)用(yong)。口服吸收好,可(ke)透過血(xue)(xue)腦脊液屏障,腦內濃度高于(yu)血(xue)(xue)濃度。主要用(yong)于(yu)治療(liao)急性(xing)(xing)(xing)或(huo)慢性(xing)(xing)(xing)精(jing)神(shen)分(fen)裂癥(zheng)、躁(zao)狂癥(zheng)、躁(zao)狂抑(yi)郁癥(zheng)、沖動暴力行(xing)為和重癥(zheng)焦慮(lv)不安(an)的短程治療(liao)。也可(ke)用(yong)于(yu)止吐,消除(chu)破傷風性(xing)(xing)(xing)痙(jing)攣(luan)、原(yuan)發性(xing)(xing)(xing)肌力障礙等病癥(zheng)。可(ke)發生(sheng)急性(xing)(xing)(xing)中(zhong)毒(du)(du)反應,主要毒(du)(du)性(xing)(xing)(xing)在心血(xue)(xue)管系(xi)統和中(zhong)樞(shu)神(shen)經(jing)系(xi)統。

4冬眠靈說明書

4.1藥品名稱

冬眠靈

4.2英文名稱

Chlorpromazine

4.3冬眠靈的別名

氯普馬嗪;氯丙(bing)嗪;可樂(le)靜;可平靜;氯硫(liu)二苯胺(an);Chlorpromazium;Wintermin;Aminazine

4.4分類

神經系統藥物 > 抗精神、抗抑郁、抗焦慮癥藥物 > 吩噻嗪類藥

4.5劑型

1.12.5mg,25mg,50mg;

2.注射劑(粉):10mg,25mg,50mg;

3.復(fu)方制劑:復(fu)方冬(dong)眠靈(ling)片:每片含(han)鹽(yan)酸冬(dong)眠靈(ling)及(ji)鹽(yan)酸異(yi)丙嗪各12.5mg;復(fu)方注(zhu)射(she)劑:每2ml含(han)鹽(yan)酸冬(dong)眠靈(ling)及(ji)鹽(yan)酸異(yi)丙嗪各25mg;

4.冬眠(mian)(mian)合劑:鹽酸冬眠(mian)(mian)靈(ling)、鹽酸異丙嗪(qin)各50mg,哌替啶100mg,加入5%葡萄糖注射劑中(zhong),靜脈(mo)輸注,用于冬眠(mian)(mian)療法(fa)。

4.6冬眠靈的藥理作用

1.抗精神(shen)病作用(yong):目前(qian)認(ren)為,冬眠靈(ling)通過(guo)阻斷(duan)與情緒和思(si)維(wei)有關的(de)(de)邊(bian)緣系統(tong)的(de)(de)多巴(ba)胺(an)受體(ti)而起抗精神(shen)病作用(yong)。而阻斷(duan)網狀(zhuang)結構上(shang)行激活(huo)系統(tong)的(de)(de)α腎上(shang)腺素受體(ti),則與鎮(zhen)靜(jing)安定的(de)(de)作用(yong)有關。正常人服用(yong)治療量后,出現安靜(jing)、活(huo)動(dong)減少、感情淡(dan)漠、注意(yi)力降低、對周圍事物不(bu)感興趣等反應。安靜(jing)時可誘導(dao)入睡,但易(yi)被喚(huan)醒。精神(shen)患者服用(yong)后,在不(bu)過(guo)分(fen)抑制的(de)(de)情況下(xia),可迅速控制精神(shen)分(fen)裂癥(zheng)患者的(de)(de)躁(zao)狂癥(zheng)狀(zhuang),減少或消除幻覺(jue)、妄(wang)想等癥(zheng)狀(zhuang),使思(si)維(wei)活(huo)動(dong)及行為趨于(yu)正常。

2.鎮吐(tu)作(zuo)用:小劑量(liang)可抑制(zhi)延腦催(cui)吐(tu)化學(xue)敏(min)感區(qu)的(de)(de)多巴胺受體,大劑量(liang)時又可直接抑制(zhi)嘔吐(tu)中樞(shu),產(chan)生強(qiang)大的(de)(de)鎮吐(tu)作(zuo)用。但(dan)對(dui) *** 前庭所致的(de)(de)嘔吐(tu)無效。

3.降(jiang)(jiang)溫(wen)(wen)作(zuo)(zuo)(zuo)用(yong)(yong):冬(dong)眠靈對下(xia)丘腦體(ti)(ti)溫(wen)(wen)調節中樞有很強的(de)抑制(zhi)作(zuo)(zuo)(zuo)用(yong)(yong),不但降(jiang)(jiang)低(di)發熱(re)(re)患者的(de)體(ti)(ti)溫(wen)(wen),還能降(jiang)(jiang)低(di)正(zheng)常(chang)體(ti)(ti)溫(wen)(wen),這(zhe)與解熱(re)(re)鎮痛藥不同,后者只(zhi)降(jiang)(jiang)低(di)發熱(re)(re)體(ti)(ti)溫(wen)(wen)而(er)不降(jiang)(jiang)低(di)正(zheng)常(chang)體(ti)(ti)溫(wen)(wen)。冬(dong)眠靈的(de)降(jiang)(jiang)溫(wen)(wen)作(zuo)(zuo)(zuo)用(yong)(yong)隨外(wai)界環境溫(wen)(wen)度而(er)變化,環境溫(wen)(wen)度愈低(di)其降(jiang)(jiang)溫(wen)(wen)作(zuo)(zuo)(zuo)用(yong)(yong)愈明顯,與物理(li)降(jiang)(jiang)溫(wen)(wen)同時運(yun)用(yong)(yong)具有協同作(zuo)(zuo)(zuo)用(yong)(yong),在(zai)炎熱(re)(re)的(de)天氣(qi),冬(dong)眠靈反可(ke)使體(ti)(ti)溫(wen)(wen)升高(gao),這(zhe)是(shi)干(gan)擾了機體(ti)(ti)正(zheng)常(chang)散熱(re)(re)的(de)結果(guo)。

4.阻(zu)斷外(wai)周腎上腺素受體,直接擴張血管,引起血壓下降。大劑量時可(ke)引起直立性(xing)低血壓。還可(ke)解除(chu)小動脈(mo)、小靜脈(mo)痙攣,改善(shan)微循環,從而(er)起抗休克的(de)作(zuo)用。同時由于(yu)擴張大靜脈(mo)的(de)作(zuo)用大于(yu)擴張動脈(mo)的(de)作(zuo)用,故可(ke)降低心臟(zang)(zang)前負荷,從而(er)改善(shan)心臟(zang)(zang)功能(尤其是左心功能衰竭)。

5.內分(fen)泌系(xi)(xi)統:可阻斷(duan)結節漏斗(dou)系(xi)(xi)統中(zhong)的D2亞型受(shou)體,從(cong)而使血中(zhong)催乳(ru)素(su)濃度增高,出現 *** 腫大、乳(ru)溢。抑制(zhi)促(cu)性腺激素(su)釋(shi)放、促(cu)皮質素(su)及促(cu)生長激素(su)分(fen)泌,延遲(chi)排卵。由于(yu)冬眠靈也抑制(zhi)垂體生長激素(su)的分(fen)泌,故可試用于(yu)巨人癥(zheng)的治(zhi)療(liao)。

6.對M膽堿受體的阻斷(duan)作用較弱,可引(yin)起口干、便秘和視力(li)模糊等不良反應。

4.7冬眠靈的藥代動力學

口(kou)服(fu)吸(xi)(xi)收慢而不(bu)規則,肌(ji)內(nei)注(zhu)射吸(xi)(xi)收迅速(su)。治療精(jing)神分(fen)裂癥時的(de)(de)(de)(de)(de)有(you)效藥(yao)(yao)(yao)物濃度(du)(du)為(wei)(wei)100~300ng/ml。肌(ji)內(nei)注(zhu)射后的(de)(de)(de)(de)(de)血藥(yao)(yao)(yao)濃度(du)(du)是口(kou)服(fu)的(de)(de)(de)(de)(de)4~10倍。不(bu)同患者之間(jian)的(de)(de)(de)(de)(de)血藥(yao)(yao)(yao)濃度(du)(du)、臨床(chuang)效應(ying)存在(zai)(zai)較(jiao)大個體差(cha)異。達峰時間(jian)口(kou)服(fu)為(wei)(wei)2.8h,肌(ji)內(nei)注(zhu)射為(wei)(wei)1~4h,靜脈給藥(yao)(yao)(yao)為(wei)(wei)2~4h。單(dan)次口(kou)服(fu)藥(yao)(yao)(yao)效持續時間(jian)為(wei)(wei)6h左(zuo)右(you)。口(kou)服(fu)的(de)(de)(de)(de)(de)生(sheng)物利(li)用度(du)(du)為(wei)(wei)32%,蛋白(bai)結合率為(wei)(wei)90%~99%,分(fen)布(bu)(bu)容積為(wei)(wei)8~160L/kg。冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)分(fen)布(bu)(bu)于(yu)(yu)全身,在(zai)(zai)腦、肺、肝、脾、腎中(zhong)(zhong)(zhong)(zhong)較(jiao)多,其中(zhong)(zhong)(zhong)(zhong)腦脊液(CSF)中(zhong)(zhong)(zhong)(zhong)的(de)(de)(de)(de)(de)濃度(du)(du)是血漿(jiang)濃度(du)(du)的(de)(de)(de)(de)(de)5倍。腦脊液中(zhong)(zhong)(zhong)(zhong)冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)的(de)(de)(de)(de)(de)蛋白(bai)結合率在(zai)(zai)19%~72%之間(jian)。可通過胎(tai)盤屏障進入胎(tai)兒體內(nei)。冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)脂(zhi)溶性(xing)高,易蓄(xu)積于(yu)(yu)脂(zhi)肪組織中(zhong)(zhong)(zhong)(zhong)。冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)有(you)首過代謝效應(ying)。大部(bu)分(fen)在(zai)(zai)肝臟中(zhong)(zhong)(zhong)(zhong)以氧化或與葡(pu)萄(tao)糖醛酸(suan)結合的(de)(de)(de)(de)(de)方式(shi)代謝,在(zai)(zai)小(xiao)腸壁也有(you)不(bu)同程(cheng)度(du)(du)的(de)(de)(de)(de)(de)代謝。冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)的(de)(de)(de)(de)(de)生(sheng)物轉化在(zai)(zai)兒童(0.3~17歲)體內(nei)比在(zai)(zai)成人體內(nei)快。23%的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)物從(cong)腎臟排泄。可經(jing)母(mu)乳分(fen)泌。母(mu)體藥(yao)(yao)(yao)物的(de)(de)(de)(de)(de)清除(chu)半(ban)(ban)衰(shuai)期為(wei)(wei)6h,但(dan)停藥(yao)(yao)(yao)6個月后,仍可從(cong)尿(niao)中(zhong)(zhong)(zhong)(zhong)檢出冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)代謝物。肝臟疾(ji)病并不(bu)明顯(xian)影響半(ban)(ban)衰(shuai)期。冬(dong)眠(mian)(mian)(mian)(mian)靈(ling)不(bu)能經(jing)血液誘析、腹(fu)膜透(tou)析清除(chu)。

4.8冬眠靈的適應證

1.用(yong)于控制精(jing)(jing)神(shen)分(fen)裂(lie)癥(zheng),主要用(yong)于Ⅰ型(xing)精(jing)(jing)神(shen)分(fen)裂(lie)癥(zheng)(以精(jing)(jing)神(shen)運動性興(xing)奮(fen)和幻(huan)覺妄(wang)(wang)想(xiang)為(wei)主),尤其(qi)對(dui)(dui)急性患(huan)者效(xiao)果顯(xian)著,但不能根治(zhi)。對(dui)(dui)慢性精(jing)(jing)神(shen)分(fen)裂(lie)癥(zheng)患(huan)者療效(xiao)較差(cha),對(dui)(dui)Ⅱ型(xing)精(jing)(jing)神(shen)分(fen)裂(lie)癥(zheng)患(huan)者無效(xiao),甚(shen)至加(jia)重病情(qing)。還可用(yong)于治(zhi)療其(qi)他精(jing)(jing)神(shen)病的興(xing)奮(fen)躁(zao)動、緊張不安、幻(huan)覺、妄(wang)(wang)想(xiang)等癥(zheng)狀,對(dui)(dui)憂郁癥(zheng)狀及(ji)木僵癥(zheng)狀的療效(xiao)較差(cha)。

2.鎮吐:幾乎對(dui)各種原(yuan)因引(yin)起的嘔(ou)吐有(you)效(xiao),如(ru)尿(niao)毒癥、胃腸炎、癌癥、妊娠(shen)及藥物引(yin)起的嘔(ou)吐。也可治療(liao)頑固性呃(e)逆。但(dan)對(dui)暈(yun)動病的嘔(ou)吐無效(xiao)。

3.低溫(wen)麻(ma)醉(zui)及人工冬(dong)(dong)眠:用于低溫(wen)麻(ma)醉(zui)時(shi)(shi)可防止休(xiu)(xiu)克發(fa)生(sheng)。人工冬(dong)(dong)眠時(shi)(shi),與哌替啶、異(yi)丙嗪配成冬(dong)(dong)眠合(he)劑用于創傷(shang)性休(xiu)(xiu)克、中毒(du)性休(xiu)(xiu)克、燒(shao)傷(shang)、高燒(shao)及甲狀腺危(wei)象的輔助治療(liao)。

4.可與鎮(zhen)痛藥(yao)合用,治(zhi)療癌癥晚期患者的劇痛。

5.治療心力衰竭。

6.試用(yong)于治(zhi)療肢(zhi)端肥大(da)癥(zheng)(巨人癥(zheng))。

4.9冬眠靈的禁忌證

1.有吩噻(sai)嗪(qin)類過敏史和骨髓抑制患者禁(jin)用。

2.閉角型青光眼(yan)、前(qian)列(lie)腺增生及昏迷(mi)患者(zhe)禁用。

3.尿(niao)毒(du)癥、嚴重心(xin)血管疾病及肝損(sun)害的(de)患者禁用。

4.有癲癇(xian)史或(huo)有腦器(qi)質(zhi)性病(bing)變的患者慎用或(huo)禁用。

5.糖尿(niao)病、甲狀腺(xian)功能低下者慎用(yong)和(he)禁用(yong)。

4.10注意事項

1.(1)肝功(gong)能(neng)不良(liang)者;(2)尿毒(du)癥(zheng)患(huan)者;(3)嚴重心血(xue)(xue)管疾病(bing)患(huan)者(如(ru)高血(xue)(xue)壓和(he)冠(guan)心病(bing)患(huan)者);(4)青光眼者;(5)前列腺(xian)肥大、尿潴留者;(6)嚴重呼(hu)吸(xi)系統疾病(bing)患(huan)者(尤其是兒童患(huan)者);(7)震顫麻痹癥(zheng)患(huan)者;(8)孕婦、哺(bu)乳(ru)婦女;(9)暴露于高熱(re)環境、有機磷殺蟲劑及接(jie)受阿托品(pin)或相關(guan)藥物治療的(de)患(huan)者;(10)有神經阻滯劑所致(zhi)惡性綜合(he)征病(bing)史者;(11)有瑞氏綜合(he)征征象和(he)癥(zheng)狀者;(12)乳(ru)癌患(huan)者。

2.藥物對(dui)老(lao)人的(de)影(ying)響:老(lao)年人對(dui)本類藥物的(de)耐受降(jiang)低(di),且易產生低(di)血壓(ya)、過(guo)度鎮靜及不(bu)易消除的(de)遲(chi)發性運動障礙(ai)等。

3.藥物(wu)對檢驗值或(huo)診斷的影響:治療時(shi)(shi)可出(chu)現心電圖(tu)異常,如(ru)Q波(bo)或(huo)T波(bo)改變等;有時(shi)(shi)會影響免疫妊娠(shen)試驗,出(chu)現假陽性反應;尿膽(dan)紅(hong)素(su)測定(ding)時(shi)(shi)也(ye)可出(chu)現假陽性。

4.用(yong)藥前后(hou)及用(yong)藥時(shi)應(ying)當檢(jian)(jian)查或監測(ce):(1)長(chang)期(qi)治療或用(yong)量大時(shi)應(ying)定時(shi)檢(jian)(jian)查白細胞計數與分類(lei);(2)肝功能;(3)尿膽紅(hong)素;(4)長(chang)期(qi)大量應(ying)用(yong)時(shi)應(ying)注意進行眼科檢(jian)(jian)查。常規半年檢(jian)(jian)查一(yi)次。

5.注射(she)給藥只限(xian)用于(yu)急(ji)性(xing)興奮躁(zao)動的患者(zhe),并需密切觀(guan)察與監測(ce),防止發生低血壓。

6.服藥大約2周(zhou)后才(cai)能充分顯效。

7.肌內(nei)注射時應緩(huan)慢深部(bu)注射。為(wei)防(fang)止直立(li)性(xing)低(di)血(xue)壓,用藥后應靜臥1~2h,血(xue)壓過(guo)低(di)時可靜脈(mo)滴注去甲腎(shen)(shen)上(shang)(shang)腺(xian)(xian)上(shang)(shang)腺(xian)(xian)上(shang)(shang)腺(xian)(xian)素或麻(ma)黃(huang)堿升壓。但不可用腎(shen)(shen)上(shang)(shang)腺(xian)(xian)素,以(yi)防(fang)血(xue)壓降得更低(di)。

8.不要突(tu)然(ran)停藥,否則可(ke)導(dao)致惡心、嘔吐、胃部 *** 、頭(tou)痛、心跳(tiao)加快、失眠或病情惡化(hua)。經長(chang)期(qi)治療需停藥時,應在幾周之內逐漸減少用量。

9.出現粒(li)細(xi)胞減少時應立(li)即停藥;在脊髓X線攝影(ying)之(zhi)前至少停藥48h。

10.用量(liang)須從小劑(ji)量(liang)開始(shi),按照個體化(hua)的(de)原則調整增加量(liang)。經數(shu)日(ri)或(huo)數(shu)周,精神狀態明顯(xian)好(hao)轉后,還須鞏固治(zhi)療至少(shao)兩周,然(ran)后逐漸(jian)減至最小有(you)效維持量(liang)。維持量(liang)使用的(de)期限須根據臨床需要(yao)而定。

11.肌(ji)內注射局部(bu)疼痛較重時,可加(jia)1%普魯(lu)卡因。

12.如只存在角(jiao)膜和晶體混濁而無視(shi)力障礙(ai)時(shi),可在觀察(cha)下使用冬眠(mian)靈;如有皮膚或視(shi)網(wang)膜色(se)素沉著或不明原因的視(shi)力障礙(ai)時(shi),則應減少劑量(liang)到每(mei)天40mg以下或用其他抗精(jing)神(shen)病藥代替。大劑量(liang)應用冬眠(mian)靈時(shi),夏季應注意防(fang)曬,最好戴太陽鏡以保護(hu)角(jiao)膜和晶體。

13.過量癥狀有中樞神經系統的(de)抑制,包括昏迷、低血壓和運動(dong)障礙。

14.過量處(chu)理(li)主要是對癥(zheng)治(zhi)療(liao)和支持治(zhi)療(liao)。必要時采取以(yi)(yi)下措施:盡早洗胃和(或)給予(yu)藥(yao)用炭懸液及鹽類瀉劑(ji)。不得誘嘔。監測(ce)體(ti)溫(wen)和心(xin)血(xue)管功能(neng),至少5天。靜(jing)脈注射(she)苯(ben)妥英(ying)鈉(na)9~11mg/kg,以(yi)(yi)控(kong)制心(xin)率失(shi)常(chang)。用洋地(di)黃治(zhi)療(liao)心(xin)功能(neng)衰竭。給予(yu)去甲腎(shen)上(shang)(shang)腺上(shang)(shang)腺上(shang)(shang)腺素或去氧腎(shen)上(shang)(shang)腺腎(shen)上(shang)(shang)腺腎(shen)上(shang)(shang)腺素治(zhi)療(liao)低(di)血(xue)壓。進(jin)行心(xin)電圖監測(ce);給予(yu)地(di)西泮(pan),隨后給予(yu)苯(ben)妥英(ying)鈉(na)15mg/kg,以(yi)(yi)控(kong)制驚厥。給予(yu)苯(ben)扎托品(pin)或苯(ben)海拉明處(chu)理(li)可能(neng)出現的帕金(jin)森(sen)樣癥(zheng)狀(zhuang)。

4.11冬眠靈的不良反應

1.大(da)劑(ji)量給藥時,由于α腎上腺(xian)素(su)能(neng)受體阻(zu)斷作用(yong),可出現直立(li)性低血(xue)壓。

2.錐體(ti)外系反(fan)應(ying):長期大劑(ji)量(liang)應(ying)用(yong)(yong)可致錐體(ti)外系癥(zheng)狀,發(fa)生率(lv)約30%。除遲發(fa)性運動障礙(ai)外,應(ying)用(yong)(yong)抗(kang)膽堿藥如苯海索(安坦)、苯扎托品、東莨菪堿;或適當減少(shao)用(yong)(yong)量(liang),可使癥(zheng)狀緩解。

3.變態反應:可出現蕁(qian)麻(ma)疹、接觸性(xing)皮(pi)炎。偶見剝脫性(xing)皮(pi)炎、紅(hong)斑狼瘡樣(yang)癥(zheng)狀(zhuang)、急性(xing)肝(gan)(gan)(gan)炎樣(yang)癥(zheng)狀(zhuang),并伴有肝(gan)(gan)(gan)實質細胞損害、肝(gan)(gan)(gan)功能(neng)異(yi)常(chang)及阻塞性(xing)黃疸(dan)。也可發生皮(pi)膚及眼(yan)部(bu)色(se)素沉著,角膜(mo)和晶體混濁。

4.內(nei)分(fen)泌(mi)(mi)系統(tong):長期(qi)應(ying)用可致內(nei)分(fen)泌(mi)(mi)紊亂,表現為男性乳(ru)腺(xian)增(zeng)生、泌(mi)(mi)乳(ru)、閉經、體重增(zeng)加、兒童抑郁等(deng)。

5.血液系統(tong)可發生(sheng)(sheng)粒(li)細胞(bao)減(jian)少(shao)、溶血性貧血、再生(sheng)(sheng)不良性貧血、血小板(ban)減(jian)少(shao)性紫(zi)癜、白細胞(bao)減(jian)少(shao),甚(shen)至粒(li)細胞(bao)減(jian)少(shao)致死的(de)報(bao)道多與過(guo)敏有關,常發生(sheng)(sheng)在治療開始的(de)4~10周。

6.急性中(zhong)毒反應:表現為昏迷、呼吸抑制、血壓下降、休(xiu)克、心肌損害(hai)和心臟驟(zou)停等癥(zheng)狀。

7.停(ting)藥反應:長期大(da)劑量應用,突然停(ting)藥可出現惡心、嘔(ou)吐、胃炎和震(zhen)顫。

8.偶可誘發癲癇。

9.抗精神病(bing)藥(yao)惡性(xing)(xing)綜合(he)征(zheng)(zheng)(neuroleptic malignant syndrome,NMS)是一(yi)種抗精神病(bing)藥(yao)(還(huan)包括(kuo)(kuo)多巴胺(an)拮(jie)抗藥(yao)如甲氧氯普氯普胺(an))引起的最嚴(yan)重(zhong)的致死性(xing)(xing)不(bu)良反(fan)應。臨床表現有高熱、嚴(yan)重(zhong)的錐體外系統反(fan)應包括(kuo)(kuo)肌肉僵(jiang)直、自主神經功能障礙、意識(shi)不(bu)清;骨骼肌損害可能發生(sheng),并引起肌紅蛋白(bai)尿,繼而(er)導致腎(shen)衰。然而(er),對這(zhe)一(yi)綜合(he)征(zheng)(zheng)尚(shang)無(wu)一(yi)個統一(yi)的標(biao)準,當疑及此綜合(he)征(zheng)(zheng)時,應立即停藥(yao),采取積極的對癥治療(liao),以制止(zhi)病(bing)情(qing)惡化。

4.12冬眠靈的用法用量

1.(1)口服25~75mg,每(mei)(mei)天(tian)2~3次(ci),1~2周內逐(zhu)漸增至每(mei)(mei)天(tian)400~600mg,2~3次(ci)分服。維持量每(mei)(mei)天(tian)100~300mg,2~3次(ci)分服。(2)肌內注射(she):可(ke)用(yong)(yong)于控(kong)制嚴(yan)重癥狀,一般每(mei)(mei)次(ci)25~50mg,深部肌內注射(she)。(3)靜脈注射(she):偶可(ke)用(yong)(yong)于極度躁動(dong)患(huan)者,每(mei)(mei)次(ci)不超過50mg,用(yong)(yong)0.9%氯化鈉注射(she)劑20ml稀釋,緩慢推注。

2.止吐(tu)或止呃逆:(1)成人(ren)口服:12.5~50mg,每(mei)天3~4次;肌內注射每(mei)次可(ke)用(yong)25~50mg。如癥(zheng)狀持(chi)續,可(ke)用(yong)冬眠靈25~50mg加(jia)入(ru)0.9%氯化鈉注射劑(ji)500ml中緩(huan)慢輸(shu)注。(2)小兒:肌內注射或輸(shu)注劑(ji)量均為每(mei)次0.5~1mg/kg。(3)手(shou)術前給藥:25~50mg加(jia)哌(pai)替啶50~100mg,于全身(shen)麻醉前1次肌內注射。

4.13藥物相互作用

1.三環類抗(kang)(kang)抑郁藥(yao)(如阿(a)莫沙平(ping)、度硫平(ping)、多塞平(ping)、阿(a)米替(ti)林(lin)、氯丙米嗪、曲(qu)丙米嗪、洛非帕明、地(di)昔帕明、丙咪(mi)嗪、去甲替(ti)林(lin)、普羅替(ti)林(lin)等(deng))與冬(dong)眠靈合(he)用(yong)時,兩(liang)者(zhe)(zhe)可(ke)相互影響對(dui)方(fang)的代(dai)謝,導致藥(yao)物濃(nong)度均升(sheng)高,毒性(xing)(xing)增(zeng)強(qiang)(qiang)。另外(wai),兩(liang)者(zhe)(zhe)都(dou)有抗(kang)(kang)膽堿活性(xing)(xing),合(he)用(yong)則抗(kang)(kang)膽堿作(zuo)用(yong)增(zeng)強(qiang)(qiang)。故合(he)用(yong)時應謹慎。

2.與顛(dian)茄合用(yong),抗膽堿(jian)作用(yong)增強。

3.檳榔有(you)膽堿能(neng)效(xiao)應(ying),與冬(dong)眠(mian)靈合用,可(ke)增(zeng)加冬(dong)眠(mian)靈的錐體外系(xi)反應(ying)。

4.冬(dong)眠靈與卡托普利(li)、曲唑酮合用時,產生協同降壓作用,可能導致低血壓。

5.阿替洛(luo)爾(er)、美托洛(luo)爾(er)與(yu)冬眠(mian)(mian)靈合用時,兩者相(xiang)互抑制對方的代謝,使(shi)血藥濃度均升高,導致(zhi)低血壓和/或冬眠(mian)(mian)靈毒性增加(jia)。

6.西(xi)沙(sha)(sha)(sha)(sha)(sha)必(bi)利(li)、多(duo)非(fei)利(li)特(te)(te)、索(suo)他洛爾、匹莫齊特(te)(te)、斯帕(pa)沙(sha)(sha)(sha)(sha)(sha)星、加(jia)替沙(sha)(sha)(sha)(sha)(sha)星、莫西(xi)沙(sha)(sha)(sha)(sha)(sha)星、格雷(lei)沙(sha)(sha)(sha)(sha)(sha)星、左氟沙(sha)(sha)(sha)(sha)(sha)星、左美沙(sha)(sha)(sha)(sha)(sha)酮(tong)、鹵泛群等與冬眠靈合(he)用時(shi),對心臟的毒性增加(jia),故不宜(yi)合(he)用。

7.冬眠(mian)靈與二氮嗪(qin)合用,可能會引起(qi)高血糖癥。

8.冬眠靈可誘導(dao)或抑(yi)制(zhi)苯妥(tuo)(tuo)英(ying)鈉的(de)(de)(de)代謝,而(er)苯妥(tuo)(tuo)英(ying)鈉則誘導(dao)冬眠靈的(de)(de)(de)代謝,故合用時苯妥(tuo)(tuo)英(ying)鈉的(de)(de)(de)濃度(du)可能會升高或降低,而(er)冬眠靈的(de)(de)(de)濃度(du)則降低。

9.與腎(shen)上腺素合用(yong)時,可能(neng)導致低血壓(ya)和心動過速。

10.伊布(bu)利特與冬眠(mian)靈合用(yong),發(fa)生心律失(shi)常的危險性增加。

11.卡(ka)法根與冬眠靈合用時,對多巴胺的(de)拮抗作(zuo)(zuo)用增加,從而導致冬眠靈的(de)治療作(zuo)(zuo)用和/或不良反應都增加。

12.冬眠(mian)靈(ling)(ling)與鋰(li)劑合用(尤其是冬眠(mian)靈(ling)(ling)的用量較大(da)時),可能導致虛弱、運動(dong)障礙、錐(zhui)體外系反應加(jia)重、腦(nao)病及腦(nao)損傷等。

13.與哌替啶合用時,對中(zhong)樞神經系統(tong)和呼吸的抑制作用加強。

14.卟吩姆鈉與冬眠靈都(dou)有致光敏(min)(min)感的作用(yong),合用(yong)可加重(zhong)光敏(min)(min)感組織的細胞內損害。

15.普萘(nai)洛爾可降低冬眠(mian)靈的(de)代謝,使冬眠(mian)靈的(de)毒性增強。

16.氨(an)甲環酸與冬眠靈(ling)合用治療(liao)蛛網膜下(xia)腔(qiang)出血(xue)(xue)時,有導致腦血(xue)(xue)管(guan)痙攣及腦缺血(xue)(xue)的報道,可(ke)能是兩者都有擬(ni)交(jiao)感神經(jing)的作用所致。

17.安非他明(ming)與冬眠靈合(he)用時(shi)兩者效力均降低(di)(di),且使驚厥發生的危(wei)險性增加,而冬眠靈的抗精神病作(zuo)用降低(di)(di),故不(bu)推薦合(he)用。

18.制(zhi)酸(suan)劑對冬(dong)眠(mian)(mian)靈(ling)的吸附作用(yong)(yong)可降低冬(dong)眠(mian)(mian)靈(ling)的吸收(shou),故合(he)用(yong)(yong)時冬(dong)眠(mian)(mian)靈(ling)療效降低。應在(zai)冬(dong)眠(mian)(mian)靈(ling)用(yong)(yong)藥前至少(shao)1h或用(yong)(yong)藥后(hou)2h服(fu)用(yong)(yong)制(zhi)酸(suan)劑。

19.苯扎(zha)托品、奧芬那君、丙環定、安坦可延遲胃排(pai)空(kong),增加冬(dong)眠(mian)靈(ling)的腸壁代謝(xie),并降(jiang)低(di)吸收(shou),導(dao)致(zhi)冬(dong)眠(mian)靈(ling)的血(xue)藥濃度(du)降(jiang)低(di),藥效減弱,而抗膽堿作用則加強。

20.卡(ka)麥角林為多巴胺(an)D2受體激動劑,不應與多巴胺(an)D2拮(jie)抗(kang)劑如(ru)冬眠靈同時(shi)使(shi)用。兩者(zhe)如(ru)合(he)用,治(zhi)療學(xue)效(xiao)應均降低。

21.西咪替丁可降低冬眠靈的療效,作用機制(尚不(bu)明確)。

22.普拉睪酮可降低冬(dong)眠靈的藥效。

23.冬(dong)眠(mian)(mian)靈(ling)可拮抗右苯(ben)丙(bing)胺的(de)作(zuo)用,還(huan)能抑制其畏食作(zuo)用。故冬(dong)眠(mian)(mian)靈(ling)常(chang)用于(yu)逆(ni)轉(zhuan)苯(ben)丙(bing)胺過量時的(de)中(zhong)樞神經系統不良反應。

24.冬(dong)眠(mian)靈可降低(di)胍乙啶、去甲腎上(shang)腺上(shang)腺上(shang)腺素、芬(fen)美曲秦(qin)的藥效。還可使左旋多(duo)巴失效。

25.苯巴比妥可誘導肝臟的微粒體酶,使冬眠(mian)靈的藥效降低。

26.冬眠靈(ling)可降低苯丙(bing)香豆素、華法(fa)林的藥效,機(ji)制不(bu)清。

27.長期(qi)使用冬(dong)眠靈可能會顯著降低促甲狀腺激素(TSH)對(dui)普羅(luo)瑞(rui)林(lin)的(de)反應。

28.在一項實驗中,西酞普(pu)蘭與(yu)冬眠靈合用,未(wei)觀察到兩(liang)者的藥動學受到影(ying)響。但還需要進一步研究來證(zheng)實。

29.冬眠(mian)靈(ling)可能會抑制胍那決(jue)爾的降壓作用。

30.與月見草油、甲泛(fan)葡胺、曲馬朵、佐(zuo)替平合(he)用時,發生驚(jing)厥的危險性(xing)增加。

31.冬(dong)眠(mian)靈(ling)可使同用(yong)的丙(bing)戊酸的血(xue)藥濃度增加,但沒有臨床意(yi)義。

32.唑吡坦與冬(dong)眠(mian)靈合用不會(hui)引起(qi)藥動學的變(bian)化。

33.吸煙(yan)者的藥物峰濃度及曲線(xian)下面積(ji)比不吸煙(yan)者略低;吸煙(yan)者在服用冬眠靈時(shi)其嗜睡作用會(hui)減(jian)少。

34.與酒精合用時,對中樞的抑制作(zuo)用增強。

35.胃內有(you)食(shi)物時,冬眠靈的(de)吸收(shou)將(jiang)受(shou)影響。

4.14專家點評

冬眠靈(ling)治療(liao)(liao)急、慢性的各(ge)種精神分裂癥、躁(zao)狂癥或其他具(ju)有(you)興奮、幻覺(jue)、妄想(xiang)等陽性癥狀的精神病效(xiao)果較(jiao)好。但對陰(yin)性癥狀如淡漠、孤僻、少(shao)語療(liao)(liao)效(xiao)差。可出(chu)現不良(liang)反應。總之此藥是治療(liao)(liao)精神病老一代藥物,已長久應用(yong)臨(lin)床,也是最常用(yong)的抗(kang)精神病藥物,療(liao)(liao)效(xiao)肯定、價(jia)格比較(jiao)低,但是容(rong)易出(chu)現不良(liang)反應,臨(lin)床上有(you)被新(xin)一代抗(kang)精神病藥取代的趨勢。

5冬眠靈中毒 冬眠靈(氯(lv)(lv)丙嗪(qin),氯(lv)(lv)普(pu)馬嗪(qin),可樂靜(jing))廣泛抑制中樞神(shen)經系統,出現(xian)安(an)定、鎮(zhen)靜(jing)、抗(kang)精神(shen)病作用(yong)(yong)。本品具有中樞多巴胺受(shou)體的阻(zu)滯(zhi)作用(yong)(yong)和(he)抗(kang)膽堿能作用(yong)(yong)。口服吸收好(hao),血漿(jiang)蛋白結合率(lv)>95%,分布容積7L/kg,血漿(jiang)半衰期(qi)16~30h。本品可透過(guo)血腦脊液屏障,腦內濃(nong)(nong)度高于血濃(nong)(nong)度。主要用(yong)(yong)于治療(liao)急性或慢(man)性精神(shen)分裂癥(zheng)(zheng)、躁狂癥(zheng)(zheng)、躁狂抑郁癥(zheng)(zheng)、沖動暴力行為和(he)重癥(zheng)(zheng)焦(jiao)慮不安(an)的短程治療(liao)。也(ye)可用(yong)(yong)于止吐,消除破傷(shang)風性痙攣、原發(fa)性肌力障礙(ai)等病癥(zheng)(zheng)。治療(liao)血濃(nong)(nong)度為0.5mg/L。成人每天(tian)常(chang)用(yong)(yong)量50~800mg,分次服用(yong)(yong)。1次劑量達2~4g,可發(fa)生急性中毒反應,主要毒性在(zai)心血管系統和(he)中樞神(shen)經系統。[1]

5.1臨床表現

[2]

1.治(zhi)療應用時,患者初起有嗜睡、乏力, *** 性(xing)低血(xue)壓;大(da)劑量服用出現口干、便秘、鼻塞、視力模糊、眼壓升高或心動過速及QT間期(qi)延長,后者是產生(sheng)致死性(xing)心律失常的先(xian)兆。

2.急性中毒主要表(biao)現為昏迷、血壓(ya)下降甚至休克。心電(dian)圖異常的發生率達(da)70%~80%,以QT間期(qi)延長最(zui)為多見(jian),偶見(jian)QRS增寬(kuan)。可出現低體溫。

3.個別患者(zhe)在(zai)服(fu)藥過程中突然(ran)因心臟意(yi)外(wai)、低血壓、休克或(huo)肺栓塞而死亡。錐體(ti)外(wai)系反應(震顫麻痹(bi)綜合征表現(xian)):靜坐(zuo)不(bu)能、運動不(bu)能、語言(yan)不(bu)清(qing)、吞(tun)咽困(kun)難、扭轉性(xing)痙攣、流涎等表現(xian)。本藥可引起抑郁狀態、意(yi)識障礙、興(xing)奮躁動和(he)幻覺妄想等藥源(yuan)性(xing)精神異常。

4.眼部的并(bing)發癥有眼壓升高、角膜和晶狀體(ti)混濁。服用冬眠(mian)靈偶有引起兒童發育遲(chi)緩(huan),女(nv)性 *** 增(zeng)大、溢乳和停經。

5.過(guo)敏反應:常在(zai)用藥后6~12周出現(xian)白(bai)細胞減(jian)少(shao),少(shao)數發生(sheng)再障(zhang)性(xing)貧血(xue)、溶血(xue)性(xing)貧血(xue)、血(xue)小板減(jian)少(shao)。出現(xian)發熱、皮疹、哮喘、紫癜(dian)、中毒性(xing)肝炎,黃疸等。

6.慢性精(jing)神病用冬眠靈治療者(zhe)可能(neng)發展到(dao)高熱、強直、昏迷等表現(xian),往(wang)(wang)往(wang)(wang)是致死性的。

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5.2診斷

冬眠靈中毒的診斷(duan)要點為[3]:

1.有(you)服用或(huo)誤服冬眠靈史,出現(xian)上述(shu)臨床表現(xian)。

2.排除其(qi)他藥物中毒可能(neng)性。

5.3治療

冬(dong)眠靈中毒的(de)治療要點為[3]:

1.過量服(fu)用時(shi),立即給予(yu)吞服(fu)藥用炭,不(bu)宜引吐(tu)。

2.冬眠靈中毒(du)無特效解(jie)毒(du)藥,以對(dui)癥支持治(zhi)療為主。

鹽酸(suan)齊拉西酮片的禁(jin)忌

1.QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)延(yan)(yan)(yan)長(chang)(chang)齊(qi)(qi)(qi)拉西酮劑量(liang)依賴性(xing)延(yan)(yan)(yan)長(chang)(chang)QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi),并且已(yi)經證實一些延(yan)(yan)(yan)長(chang)(chang)QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)的藥(yao)(yao)物(wu)與致死性(xing)心(xin)律不齊(qi)(qi)(qi)有(you)關。具有(you)QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)延(yan)(yan)(yan)長(chang)(chang)病(bing)史的患者(zhe)(包括先(xian)天性(xing)長(chang)(chang)QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)綜合征)、近期(qi)(qi)(qi)出現(xian)急性(xing)心(xin)肌(ji)梗塞的患者(zhe)和非代(dai)償性(xing)心(xin)衰(shuai)的患者(zhe)禁(jin)用(yong)(yong)(yong)(yong)齊(qi)(qi)(qi)拉西酮。齊(qi)(qi)(qi)拉西酮禁(jin)忌與在藥(yao)(yao)效(xiao)學方(fang)面能夠延(yan)(yan)(yan)長(chang)(chang)QT間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)的藥(yao)(yao)物(wu)、或者(zhe)在處(chu)方(fang)信息中禁(jin)忌用(yong)(yong)(yong)(yong)于QTc間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)延(yan)(yan)(yan)長(chang)(chang)患者(zhe)的藥(yao)(yao)物(wu)、以(yi)及有(you)黑框警(jing)告慎重用(yong)(yong)(yong)(yong)于QTc間(jian)(jian)(jian)(jian)期(qi)(qi)(qi)延(yan)(yan)(yan)長(chang)(chang)患者(zhe)的藥(yao)(yao)物(wu)合用(yong)(yong)(yong)(yong)。齊(qi)(qi)(qi)拉西酮不應與多(duo)非利(li)特(te)、索(suo)他洛爾(er)、奎尼丁、其他Ia 和 III 類抗心(xin)律失常(chang)藥(yao)(yao)、美索(suo)達嗪、硫(liu)利(li)達嗪、氯丙嗪、氟派利(li)多(duo)、匹莫(mo)齊(qi)(qi)(qi)特(te)、司帕沙星(xing)、加替沙星(xing)、莫(mo)西沙星(xing)、鹵泛(fan)群、甲(jia)氟喹、噴(pen)他脒、三氧化砷、左醋美沙朵(duo)(levomethadyl acetate)、甲(jia)磺酸多(duo)拉司瓊、丙丁酚(fen)和他克莫(mo)司等合用(yong)(yong)(yong)(yong)。2.對本品過敏的患者(zhe)禁(jin)用(yong)(yong)(yong)(yong)。

房顫詳細資(zi)料大全

心(xin)房(fang)顫(zhan)動(簡稱房(fang)顫(zhan))是最常(chang)見(jian)的持續性(xing)心(xin)律(lv)失常(chang)。隨(sui)著(zhu)年齡增長房(fang)顫(zhan)的發生率(lv)(lv)不(bu)斷增加,75歲(sui)以上人(ren)(ren)群可達10%。房(fang)顫(zhan)時心(xin)房(fang)激動的頻率(lv)(lv)達300~600次(ci)/分(fen),心(xin)跳頻率(lv)(lv)往往快而且(qie)(qie)不(bu)規(gui)則,有時候可達100~160次(ci)/分(fen),不(bu)僅(jin)比正常(chang)人(ren)(ren)心(xin)跳快得多,而且(qie)(qie)絕對(dui)不(bu)整齊,心(xin)房(fang)失去有效(xiao)的收縮功能。房(fang)顫(zhan)患病(bing)率(lv)(lv)還(huan)與(yu)冠(guan)心(xin)病(bing)、高血壓病(bing)和心(xin)力衰(shuai)竭等疾病(bing)有密切關(guan)系。

基本介紹別稱 :心房顫動 英文別名 :atrial fibrillation,AF 就診科室 :心內科 多發群體 :老年人 常見病因 :風濕性心臟病、冠心病、甲亢等 常見癥狀 :心悸,乏力、勞累;眩暈;胸部不適;氣短等 病因,分類,臨床表現,檢查,治療,預后,預防,病因房顫常見的病因包括高血壓病、冠心病、心臟外科手術、瓣膜病、心力衰竭、心肌病、先天性心臟病、肺動脈栓塞、甲狀腺功能亢進癥等,與飲酒、精神緊張、水電解質紊亂、嚴重感染等有關;此外還可以合并有其他類型心律失常。分類房顫分類沒有統一,按持續時間可以分為陣發性房顫、持續性房顫和永久性房顫。通常認為陣發性房顫指能在7天內自行轉復為竇性心律者,一般持續時間小于48小時;持續性房顫指持續7天以上,需要藥物或電擊才能轉復為竇性心律者;永久性房顫指不能轉復為竇性心律或在轉復后24小時內復發者。 按有無基礎心臟疾病分為病理性房顫和特發性房顫(臨床檢查無基礎心臟疾病)。特發性房顫往往發生在年齡較輕者,多數小于50歲,特發性房顫有時也稱孤立性房顫。臨床表現 1. 心悸感到心跳加快,伴有乏力或感勞累; 2. 眩暈頭暈眼花甚至昏倒; 3. 胸部不適心前區疼痛、壓迫感或者不舒服; 4. 氣短在輕度體力活動或者休息時感覺呼吸困難,有些病人可能沒有任何癥狀。 房顫時心房喪失收縮功能,血液容易在心房內淤滯而形成血栓,血栓脫落后可隨著血液至全身各處,導致腦栓塞(腦卒中)、肢體動脈栓塞(嚴重者甚至需要截肢)等。房顫患者腦卒中的高危因素包括以前有栓塞病史、高血壓病、糖尿病、冠心病、心衰、左心房擴大等。檢查根據臨床癥狀和體征可初步診斷房顫,但確診需要心電圖檢查;對于房顫短暫發作難以捕捉到的患者,需要進行動態心電圖等檢查。治療 1.治療原則 (1)恢復竇性心律只有恢復竇性心律(正常心律),才能達到完全治療房顫的目的,所以對于任何房顫病人均應該嘗試恢復竇性心律的治療方法。 (2)控制快速心室率對于不能恢復竇性心律的房顫病人,可以套用藥物減慢較快的心室率。 (3)防止血栓形成和腦卒中房顫時如果不能恢復竇性心律,可以套用抗凝藥物預防血栓形成和腦卒中的發生。 對于某些疾病如甲亢、急性酒精中毒、藥物所致的房顫,在祛除病因之后,房顫可能自行消失。 2.藥物治療目前藥物治療依然是治療房顫的重要方法,藥物能恢復和維持竇性心律,控制心室率以及預防血栓栓塞并發癥。 轉復竇性心律(正常節律)藥物:對于新發房顫因其在48小時內的自行復竇的比例很高(24小時內約60%),可先觀察,也可采用普羅帕酮或氟卡胺頓服的方法。房顫已經持續大于48小時而小于7天者,能用靜脈藥物轉律的有氟卡胺、多非利特、普羅帕酮、伊布利特和胺碘酮等,成功率可達50%。房顫發作持續時間超過一周(持續性房顫)藥物轉律的效果大大降低,常用和證實有效的藥物有胺碘酮、伊布利特、多非利特等。 控制心室率(頻率控制)的藥物:控制心室率可以保證心臟基本功能,盡可能降低房顫引起的心臟功能紊亂。常用藥物包括: (1)β受體阻滯劑 最有效、最常用和常常單獨套用的藥物; (2)鈣通道拮抗劑如維拉帕米和地爾硫卓也可有效用于房顫時的心室率控制,尤其對于運動狀態下的心室率的控制優于地高辛,和地高辛合用的效果也優于單獨使用。尤其多用于無器質性心臟病或左室收縮功能正常以及伴有慢性阻塞性肺疾病的患者; (3)洋地黃在緊急情況下控制房顫心室率的一線用藥,目前臨床上多用于伴有左心衰時的心室率控制; (4)胺碘酮可降低房顫時的心室率,不建議用于慢性房顫時的長期心室率控制,只是在其他藥物控制無效或禁忌時、在房顫合并心力衰竭需緊急控制心室率時可首選胺碘酮與洋地黃合用。 (5)抗凝治療 是預防房顫病人血栓形成和栓塞的必要手段,房顫病人如果有下列情況,應當進行抗凝治療:年齡≥65歲;以前有過腦卒中病史或者短暫腦缺血發作;充血性心力衰竭;高血壓;糖尿病;冠心病;左心房擴大;超聲心動圖發現左心房血栓。抗凝治療一定要有專科醫生指導,抗凝過度可能導致出血,抗凝強度不夠則沒有預防作用。 3.非藥物治療房顫的非藥物治療包括電轉復(轉復竇性心律)、射頻消融治療和外科迷宮手術治療(徹底根治房顫)。 (1 )電復律是指用兩個電極片放置在病人胸部的適當部位,通過除顫儀發放電流,重新恢復竇性心律的方法。電復律適用于:緊急情況的房顫(如心肌梗死、心率極快、低血壓、心絞痛、心衰等),房顫癥狀嚴重,病人難以耐受,上次電復律成功,未用藥物維持而又復發的房顫。電復律不是根治房顫的方法,病人的房顫往往會復發,而且部分病人還需要繼續服用抗心律失常藥物維持竇性心律。 (2 )導管消融治療適用于絕大多數房顫患者,創傷小,病人易于接受。 (3 )外科迷宮手術目前主要用于因其(qi)他心(xin)臟(zang)疾病(bing)需(xu)要行心(xin)臟(zang)手(shou)(shou)術治療的(de)(de)房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)病(bing)人(ren)(ren),手(shou)(shou)術效果好,但(dan)是(shi)(shi)創(chuang)傷(shang)大。預(yu)后(hou)腦(nao)卒(zu)(zu)中是(shi)(shi)房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)最大的(de)(de)危害之一,非瓣膜病(bing)性房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)病(bing)人(ren)(ren)腦(nao)卒(zu)(zu)中發生率是(shi)(shi)正(zheng)常(chang)人(ren)(ren)的(de)(de)5.6倍(bei)(bei),瓣膜病(bing)房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)腦(nao)卒(zu)(zu)中發生率是(shi)(shi)正(zheng)常(chang)人(ren)(ren)的(de)(de)17.6倍(bei)(bei);而且房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)引起的(de)(de)腦(nao)卒(zu)(zu)中后(hou)果更為嚴(yan)重。預(yu)防房(fang)(fang)(fang)(fang)(fang)顫(zhan)(zhan)病(bing)人(ren)(ren)生活中的(de)(de)注(zhu)意事(shi)項包括:戒菸(yan),限(xian)制(zhi)飲酒,一些病(bing)人(ren)(ren)可能需(xu)要避免含有咖啡(fei)因的(de)(de)物(wu)質諸如茶、咖啡(fei)、可樂以及(ji)一些非處方用藥。謹慎套(tao)用某些治療咳嗽或(huo)者感(gan)冒藥物(wu)。

心血管系(xi)統合(he)理用藥詳細資料大全

《心(xin)血管系統合理用藥(yao)》是(shi)2009年中(zhong)國醫(yi)藥(yao)科技出(chu)版社出(chu)版的圖書,作(zuo)者是(shi)王成章。

基本(ben)介紹(shao)(shao)書名 :心(xin)(xin)(xin)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)系(xi)統(tong)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 作者(zhe) :王成(cheng)(cheng)章(zhang)(zhang)(zhang) 出(chu)(chu)(chu)版(ban)(ban)(ban)社(she)(she)(she) :中(zhong)(zhong)國(guo)(guo)(guo)(guo)醫(yi)(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)科(ke)技出(chu)(chu)(chu)版(ban)(ban)(ban)社(she)(she)(she) 出(chu)(chu)(chu)版(ban)(ban)(ban)時(shi)(shi)(shi)間(jian)(jian) : 2009 版(ban)(ban)(ban)權(quan)資訊(xun)(xun),內(nei)(nei)容(rong)簡介,編(bian)(bian)輯(ji)推薦,目錄(lu)(lu),序言(yan),版(ban)(ban)(ban)權(quan)資訊(xun)(xun)書 名: 心(xin)(xin)(xin)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)系(xi)統(tong)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 作 者(zhe):王成(cheng)(cheng)章(zhang)(zhang)(zhang) 出(chu)(chu)(chu)版(ban)(ban)(ban)社(she)(she)(she): 中(zhong)(zhong)國(guo)(guo)(guo)(guo)醫(yi)(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)科(ke)技出(chu)(chu)(chu)版(ban)(ban)(ban)社(she)(she)(she) 出(chu)(chu)(chu)版(ban)(ban)(ban)時(shi)(shi)(shi)間(jian)(jian): 2009 ISBN: 9787506739849 開本(ben): 16 定(ding)價: 49.00 元內(nei)(nei)容(rong)簡介《心(xin)(xin)(xin)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)系(xi)統(tong)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)》分為(wei)2篇(pian)13章(zhang)(zhang)(zhang),主要介紹(shao)(shao)了(le)(le)(le)目前臨(lin)(lin)床(chuang)中(zhong)(zhong)心(xin)(xin)(xin)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)系(xi)統(tong)常用(yong)(yong)(yong)的(de)(de)(de)(de)(de)西藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、中(zhong)(zhong)成(cheng)(cheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)。西藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)篇(pian)對(dui)每(mei)個藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)都詳細介紹(shao)(shao)了(le)(le)(le)其藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)名稱、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)概述(shu)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)動學(xue)、用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)指(zhi)征、用(yong)(yong)(yong)法(fa)(fa)用(yong)(yong)(yong)量、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)相互(hu)作用(yong)(yong)(yong)、禁忌證、規格劑型、不(bu)良反(fan)應、用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)指(zhi)導(dao)等(deng)(deng)內(nei)(nei)容(rong);中(zhong)(zhong)成(cheng)(cheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)篇(pian)對(dui)常用(yong)(yong)(yong)的(de)(de)(de)(de)(de)心(xin)(xin)(xin)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)系(xi)統(tong)中(zhong)(zhong)成(cheng)(cheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)進(jin)(jin)行(xing)了(le)(le)(le)全(quan)面的(de)(de)(de)(de)(de)介紹(shao)(shao),適(shi)合(he)心(xin)(xin)(xin)內(nei)(nei)科(ke)等(deng)(deng)內(nei)(nei)科(ke)系(xi)統(tong)醫(yi)(yi)生(sheng)參(can)考(kao)使用(yong)(yong)(yong)。編(bian)(bian)輯(ji)推薦臨(lin)(lin)床(chuang)醫(yi)(yi)學(xue)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學(xue)專家(jia)共(gong)同打造(zao),破解臨(lin)(lin)床(chuang)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)難點,著(zhu)重于(yu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)相互(hu)作用(yong)(yong)(yong)、不(bu)良反(fan)應及(ji)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)指(zhi)導(dao)。目錄(lu)(lu)西藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)篇(pian) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)章(zhang)(zhang)(zhang)鈣通(tong)(tong)道阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 硝(xiao)(xiao)(xiao)苯地(di)(di)(di)(di)(di)(di)平(ping) 戈洛(luo)(luo)(luo)帕米(mi)(mi)(mi) 維(wei)拉帕米(mi)(mi)(mi) 地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er)硫(艸卓(zhuo)) 尼(ni)(ni)群(qun)地(di)(di)(di)(di)(di)(di)平(ping) 尼(ni)(ni)索地(di)(di)(di)(di)(di)(di)平(ping) 非洛(luo)(luo)(luo)地(di)(di)(di)(di)(di)(di)平(ping) 伊拉地(di)(di)(di)(di)(di)(di)平(ping) 氨(an)(an)氯(lv)地(di)(di)(di)(di)(di)(di)平(ping) 左旋氨(an)(an)氯(lv)地(di)(di)(di)(di)(di)(di)平(ping) 尼(ni)(ni)伐(fa)地(di)(di)(di)(di)(di)(di)平(ping) 樂卡(ka)地(di)(di)(di)(di)(di)(di)平(ping) 拉西地(di)(di)(di)(di)(di)(di)平(ping) 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)章(zhang)(zhang)(zhang)腎上腺(xian)素(su)受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)節(jie)(jie)(jie)(jie)(jie)僅受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 哌唑嗪(qin)(qin)(qin) 多(duo)沙(sha)(sha)唑嗪(qin)(qin)(qin) 特(te)拉唑嗪(qin)(qin)(qin) 阿(a)(a)夫唑嗪(qin)(qin)(qin) 烏拉地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)節(jie)(jie)(jie)(jie)(jie)B受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 醋丁洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 阿(a)(a)替洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 倍(bei)他(ta)(ta)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 比(bi)索洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 卡(ka)替洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 左布(bu)諾(nuo)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 美(mei)(mei)(mei)托(tuo)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 納(na)多(duo)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 吲(yin)哚洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 普(pu)(pu)(pu)(pu)萘洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 索他(ta)(ta)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 噻(sai)嗎(ma)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 卡(ka)維(wei)地(di)(di)(di)(di)(di)(di)洛(luo)(luo)(luo) 貝(bei)(bei)凡(fan)洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 奈必洛(luo)(luo)(luo)爾(er)(er)(er)(er)(er)(er)(er)(er) 第(di)(di)(di)(di)(di)(di)(di)三章(zhang)(zhang)(zhang)抗(kang)心(xin)(xin)(xin)律失常藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)節(jie)(jie)(jie)(jie)(jie)I類(lei)(lei)(lei)——鈉(na)通(tong)(tong)道阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 一(yi)(yi)(yi)、IA類(lei)(lei)(lei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu) 雙(shuang)(shuang)氫(qing)奎尼(ni)(ni)丁 普(pu)(pu)(pu)(pu)魯卡(ka)因胺(an) 丙吡胺(an) 二(er)(er)、IB類(lei)(lei)(lei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu) 利(li)(li)多(duo)卡(ka)因 美(mei)(mei)(mei)西律 妥(tuo)(tuo)卡(ka)尼(ni)(ni) 阿(a)(a)普(pu)(pu)(pu)(pu)林(lin)定(ding) 三、IC類(lei)(lei)(lei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu) 恩卡(ka)尼(ni)(ni) 氯(lv)卡(ka)尼(ni)(ni) 普(pu)(pu)(pu)(pu)羅帕酮(tong)(tong)(tong) 莫(mo)雷(lei)西嗪(qin)(qin)(qin) 常咯啉 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)節(jie)(jie)(jie)(jie)(jie)Ⅱ類(lei)(lei)(lei)——B受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)三節(jie)(jie)(jie)(jie)(jie)Ⅲ類(lei)(lei)(lei)——延長(chang)動作電位時(shi)(shi)(shi)程(cheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 胺(an)碘酮(tong)(tong)(tong) 溴芐(xia)胺(an) 多(duo)非利(li)(li)特(te) 第(di)(di)(di)(di)(di)(di)(di)四(si)節(jie)(jie)(jie)(jie)(jie)Ⅳ類(lei)(lei)(lei)——鈣通(tong)(tong)道阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)五(wu)節(jie)(jie)(jie)(jie)(jie)其他(ta)(ta)抗(kang)心(xin)(xin)(xin)律失常藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 苯妥(tuo)(tuo)英鈉(na) 門(men)冬氨(an)(an)酸鉀(jia)鎂 腺(xian)苷(gan) 依(yi)(yi)地(di)(di)(di)(di)(di)(di)酸二(er)(er)鈉(na) 卡(ka)馬西平(ping) 安他(ta)(ta)唑啉 第(di)(di)(di)(di)(di)(di)(di)四(si)章(zhang)(zhang)(zhang)抗(kang)心(xin)(xin)(xin)絞(jiao)痛(tong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)節(jie)(jie)(jie)(jie)(jie)有機硝(xiao)(xiao)(xiao)酸酯類(lei)(lei)(lei) 硝(xiao)(xiao)(xiao)酸甘(gan)油 硝(xiao)(xiao)(xiao)酸異(yi)山(shan)(shan)梨酯 單硝(xiao)(xiao)(xiao)酸異(yi)山(shan)(shan)梨酯 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)節(jie)(jie)(jie)(jie)(jie)B受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)三節(jie)(jie)(jie)(jie)(jie)鈣通(tong)(tong)道阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)四(si)節(jie)(jie)(jie)(jie)(jie)其他(ta)(ta)抗(kang)心(xin)(xin)(xin)絞(jiao)痛(tong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 曲匹地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 曲美(mei)(mei)(mei)他(ta)(ta)嗪(qin)(qin)(qin) 銀(yin)杏黃酮(tong)(tong)(tong)苷(gan) 川芎嗪(qin)(qin)(qin) 雙(shuang)(shuang)嘧達莫(mo) 二(er)(er)磷酸果糖 尼(ni)(ni)可(ke)地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 第(di)(di)(di)(di)(di)(di)(di)五(wu)章(zhang)(zhang)(zhang)治(zhi)療慢性心(xin)(xin)(xin)功能不(bu)全(quan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)節(jie)(jie)(jie)(jie)(jie)強心(xin)(xin)(xin)苷(gan)類(lei)(lei)(lei) 地(di)(di)(di)(di)(di)(di)高辛(xin) 洋(yang)地(di)(di)(di)(di)(di)(di)黃毒苷(gan) 去(qu)乙酰毛花苷(gan) 毒毛花苷(gan)K 甲地(di)(di)(di)(di)(di)(di)高辛(xin) 萬年(nian)(nian)青(qing)總苷(gan) 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)節(jie)(jie)(jie)(jie)(jie)非強心(xin)(xin)(xin)苷(gan)類(lei)(lei)(lei) 多(duo)巴(ba)(ba)酚丁胺(an) 異(yi)波(bo)帕胺(an) 米(mi)(mi)(mi)力農 依(yi)(yi)諾(nuo)昔(xi)酮(tong)(tong)(tong) 左西孟旦 奈西利(li)(li)肽 氨(an)(an)茶堿 第(di)(di)(di)(di)(di)(di)(di)六章(zhang)(zhang)(zhang)抗(kang)高血(xue)(xue)(xue)(xue)壓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)一(yi)(yi)(yi)節(jie)(jie)(jie)(jie)(jie)中(zhong)(zhong)樞性降壓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 可(ke)樂定(ding) 甲基多(duo)巴(ba)(ba) 胍那(nei)芐(xia) 胍法(fa)(fa)辛(xin) 莫(mo)索尼(ni)(ni)定(ding) 利(li)(li)美(mei)(mei)(mei)尼(ni)(ni)定(ding) 第(di)(di)(di)(di)(di)(di)(di)二(er)(er)節(jie)(jie)(jie)(jie)(jie)外周性降壓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 利(li)(li)血(xue)(xue)(xue)(xue)平(ping) 胍乙啶 胍那(nei)決爾(er)(er)(er)(er)(er)(er)(er)(er) 帕吉(ji)林(lin) 第(di)(di)(di)(di)(di)(di)(di)三節(jie)(jie)(jie)(jie)(jie)腎上腺(xian)素(su)受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)四(si)節(jie)(jie)(jie)(jie)(jie)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)擴張(zhang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 肼(jing)屈(qu)嗪(qin)(qin)(qin) 雙(shuang)(shuang)肼(jing)屈(qu)嗪(qin)(qin)(qin) 卡(ka)屈(qu)嗪(qin)(qin)(qin) 硝(xiao)(xiao)(xiao)普(pu)(pu)(pu)(pu)鈉(na) 二(er)(er)氮嗪(qin)(qin)(qin) 米(mi)(mi)(mi)諾(nuo)地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 第(di)(di)(di)(di)(di)(di)(di)五(wu)節(jie)(jie)(jie)(jie)(jie)鈣通(tong)(tong)道阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)六節(jie)(jie)(jie)(jie)(jie)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)緊(jin)張(zhang)素(su)轉換酶抑(yi)制藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(AcEI) 卡(ka)托(tuo)普(pu)(pu)(pu)(pu)利(li)(li) 依(yi)(yi)那(nei)普(pu)(pu)(pu)(pu)利(li)(li) 賴諾(nuo)普(pu)(pu)(pu)(pu)利(li)(li) 貝(bei)(bei)那(nei)普(pu)(pu)(pu)(pu)利(li)(li) 西拉普(pu)(pu)(pu)(pu)利(li)(li) 培哚普(pu)(pu)(pu)(pu)利(li)(li) 福辛(xin)普(pu)(pu)(pu)(pu)利(li)(li) 雷(lei)米(mi)(mi)(mi)普(pu)(pu)(pu)(pu)利(li)(li) 莫(mo)昔(xi)普(pu)(pu)(pu)(pu)利(li)(li) 佐(zuo)芬(fen)普(pu)(pu)(pu)(pu)利(li)(li) 第(di)(di)(di)(di)(di)(di)(di)七節(jie)(jie)(jie)(jie)(jie)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)緊(jin)張(zhang)素(su)Ⅱ受(shou)(shou)體(ti)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 氯(lv)沙(sha)(sha)坦(tan) 纈沙(sha)(sha)坦(tan) 厄貝(bei)(bei)沙(sha)(sha)坦(tan) 坎地(di)(di)(di)(di)(di)(di)沙(sha)(sha)坦(tan)西酯 替米(mi)(mi)(mi)沙(sha)(sha)坦(tan) 依(yi)(yi)普(pu)(pu)(pu)(pu)羅沙(sha)(sha)坦(tan) 第(di)(di)(di)(di)(di)(di)(di)八節(jie)(jie)(jie)(jie)(jie)神經節(jie)(jie)(jie)(jie)(jie)阻(zu)(zu)(zu)(zu)滯(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 樟磺咪芬(fen) 美(mei)(mei)(mei)卡(ka)拉明 第(di)(di)(di)(di)(di)(di)(di)九(jiu)節(jie)(jie)(jie)(jie)(jie)利(li)(li)尿藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 氫(qing)氯(lv)噻(sai)嗪(qin)(qin)(qin) 呋(fu)塞米(mi)(mi)(mi) 螺(luo)內(nei)(nei)酯 吲(yin)達帕胺(an) 第(di)(di)(di)(di)(di)(di)(di)十(shi)節(jie)(jie)(jie)(jie)(jie)其他(ta)(ta)抗(kang)高血(xue)(xue)(xue)(xue)壓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 酮(tong)(tong)(tong)色林(lin) 吡那(nei)地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 非諾(nuo)多(duo)泮 第(di)(di)(di)(di)(di)(di)(di)七章(zhang)(zhang)(zhang)周圍血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)擴張(zhang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 尼(ni)(ni)莫(mo)地(di)(di)(di)(di)(di)(di)平(ping) 倍(bei)他(ta)(ta)司汀 罌粟(su)堿 己酮(tong)(tong)(tong)可(ke)可(ke)堿 莫(mo)西賽利(li)(li) 丁咯地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 萘呋(fu)胺(an) 氟桂(gui)利(li)(li)嗪(qin)(qin)(qin) 桂(gui)利(li)(li)嗪(qin)(qin)(qin) 尼(ni)(ni)麥角林(lin) 雙(shuang)(shuang)氫(qing)麥角堿 前列(lie)地(di)(di)(di)(di)(di)(di)爾(er)(er)(er)(er)(er)(er)(er)(er) 阿(a)(a)米(mi)(mi)(mi)三嗪(qin)(qin)(qin)/蘿巴(ba)(ba)新 長(chang)春(chun)西汀 …… 第(di)(di)(di)(di)(di)(di)(di)八章(zhang)(zhang)(zhang)用(yong)(yong)(yong)于(yu)休(xiu)克的(de)(de)(de)(de)(de)血(xue)(xue)(xue)(xue)管(guan)(guan)(guan)(guan)活(huo)性藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)九(jiu)章(zhang)(zhang)(zhang)調血(xue)(xue)(xue)(xue)脂及(ji)減肥藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 中(zhong)(zhong)成(cheng)(cheng)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)篇(pian) 第(di)(di)(di)(di)(di)(di)(di)十(shi)章(zhang)(zhang)(zhang)心(xin)(xin)(xin)悸用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)十(shi)一(yi)(yi)(yi)章(zhang)(zhang)(zhang)高血(xue)(xue)(xue)(xue)壓病用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)十(shi)二(er)(er)章(zhang)(zhang)(zhang)冠心(xin)(xin)(xin)病、心(xin)(xin)(xin)絞(jiao)痛(tong)(胸痹心(xin)(xin)(xin)痛(tong))用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 第(di)(di)(di)(di)(di)(di)(di)十(shi)三章(zhang)(zhang)(zhang)降血(xue)(xue)(xue)(xue)脂藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao) 參(can)考(kao)文(wen)獻(xian)序言(yan)1985年(nian)(nian),在(zai)奈洛(luo)(luo)(luo)比(bi)國(guo)(guo)(guo)(guo)際合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)專家(jia)研(yan)討會(hui)上,提(ti)(ti)(ti)出(chu)(chu)(chu)了(le)(le)(le)“對(dui)癥(zheng)開藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、供藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)適(shi)時(shi)(shi)(shi)”等(deng)(deng)六項合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(rational drug use)內(nei)(nei)容(rong)。1987年(nian)(nian),世(shi)界衛(wei)(wei)生(sheng)組(zu)織(zhi)(WHO)又(you)提(ti)(ti)(ti)出(chu)(chu)(chu)了(le)(le)(le)“處方(fang)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)應為(wei)適(shi)宜的(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)”等(deng)(deng)五(wu)項關于(yu)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)具體(ti)要求。當(dang)(dang)(dang)前,就全(quan)球范(fan)圍來看,一(yi)(yi)(yi)般所指(zhi)的(de)(de)(de)(de)(de)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)包括(kuo)安全(quan)、有效、經濟(ji)、適(shi)當(dang)(dang)(dang)四(si)個基本(ben)要素(su)。 隨(sui)(sui)著(zhu)改革開放的(de)(de)(de)(de)(de)不(bu)斷(duan)深入(ru),中(zhong)(zhong)國(guo)(guo)(guo)(guo)醫(yi)(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)產業也(ye)在(zai)30年(nian)(nian)間(jian)(jian)得(de)到。了(le)(le)(le)巨大的(de)(de)(de)(de)(de)發展,藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)品(pin)種隨(sui)(sui)著(zhu)醫(yi)(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)科(ke)技的(de)(de)(de)(de)(de)發展在(zai),而(er)迅速(su)增加,現在(zai)國(guo)(guo)(guo)(guo)內(nei)(nei)常用(yong)(yong)(yong)的(de)(de)(de)(de)(de)處方(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)已達7000種之(zhi)多(duo),然而(er)在(zai)當(dang)(dang)(dang)前的(de)(de)(de)(de)(de)臨(lin)(lin)床(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)治(zhi)療過程(cheng)中(zhong)(zhong),藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)治(zhi)療水平(ping)并未伴隨(sui)(sui)著(zhu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)種類(lei)(lei)(lei)的(de)(de)(de)(de)(de)增加而(er)提(ti)(ti)(ti)高,藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)浪費、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)療事故、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)源(yuan)性疾(ji)病等(deng)(deng)不(bu)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)現象時(shi)(shi)(shi)有發生(sheng),這些藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)的(de)(de)(de)(de)(de)不(bu)合(he)理(li)(li)(li)使用(yong)(yong)(yong),在(zai)危及(ji)人類(lei)(lei)(lei)健(jian)康(kang)與(yu)生(sheng)命安全(quan)的(de)(de)(de)(de)(de)同時(shi)(shi)(shi),也(ye)增加了(le)(le)(le)社(she)(she)(she)會(hui)的(de)(de)(de)(de)(de)負擔(dan)和資源(yuan)的(de)(de)(de)(de)(de)消耗。 2008年(nian)(nian)8月,衛(wei)(wei)生(sheng)部副部長(chang)、國(guo)(guo)(guo)(guo)家(jia)食品(pin)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)監督管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)局(ju)長(chang)邵(shao)明立撰寫(xie)署名文(wen)章(zhang)(zhang)(zhang)《建(jian)立國(guo)(guo)(guo)(guo)家(jia)基本(ben)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)制度滿足民眾(zhong)基本(ben)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)需求》,指(zhi)出(chu)(chu)(chu):“健(jian)全(quan)和落(luo)實(shi)醫(yi)(yi)療衛(wei)(wei)生(sheng)機構(gou)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)制度與(yu)責任”是建(jian)立國(guo)(guo)(guo)(guo)家(jia)基本(ben)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)制度的(de)(de)(de)(de)(de)重要舉措(cuo)之(zhi)一(yi)(yi)(yi)。 中(zhong)(zhong)國(guo)(guo)(guo)(guo)是一(yi)(yi)(yi)個人口(kou)大國(guo)(guo)(guo)(guo),近(jin)年(nian)(nian)來,隨(sui)(sui)著(zhu)社(she)(she)(she)會(hui)經濟(ji)的(de)(de)(de)(de)(de)不(bu)斷(duan)發展和入(ru)口(kou)老齡化進(jin)(jin)程(cheng)的(de)(de)(de)(de)(de)加快,相對(dui)短(duan)缺(que)的(de)(de)(de)(de)(de)醫(yi)(yi)療資源(yuan)與(yu)廣(guang)大人民民眾(zhong)健(jian)康(kang)需求之(zhi)間(jian)(jian)的(de)(de)(de)(de)(de)矛(mao)盾日益(yi)突出(chu)(chu)(chu)。為(wei)了(le)(le)(le)進(jin)(jin)一(yi)(yi)(yi)步提(ti)(ti)(ti)高合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)水平(ping),落(luo)實(shi)邵(shao)明立局(ju)長(chang)的(de)(de)(de)(de)(de)講話精神,我們在(zai)國(guo)(guo)(guo)(guo)家(jia)食品(pin)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)監督管(guan)(guan)(guan)(guan)理(li)(li)(li)局(ju)的(de)(de)(de)(de)(de)指(zhi)導(dao)之(zhi)下,組(zu)織(zhi)全(quan)國(guo)(guo)(guo)(guo)醫(yi)(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)衛(wei)(wei)生(sheng)各領域的(de)(de)(de)(de)(de)專家(jia)教授編(bian)(bian)寫(xie)了(le)(le)(le)這套《臨(lin)(lin)床(chuang)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)叢書》。

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