• Nghien ciru - Ky thuat
12. Vinnder S. Pamiar, Subhash C. Jain, Kirpal S.
Bisht et al (1996), "Phytochemistry of the genus Pipei^, Phytochemistry. vol. 46 (4), pp. 591 - 673.
13. Xiang Zhong Huang, Yan Yin, Jian Hui Dai et al (2010), "Two new ceramides from the stems of Piper betle L.", Chinese Chemical Letters, vol. 21, pp 433-436.
14. Yasuhiro Fujiwara, Kaname Naithou, Tomoko Miyazaki et al (2001), "Two new alkaloids, pipercyclobutanamides A and B, from Piper nigrum'.
Tetrahedron Letters, vol. 42, pp. 2497-2499.
15. Yu-Chang Chen, Chang-Hui Liao, Ih-Sheng Chen et al (2007), "Lignans, an amide and anti-platelet activities from Piper philippinum", Phytochemistry. vol 68, pp 2101-2111
16. Zhi-Yong Jiang, Wen-Feng Liu, Chao-Guan Huang, Xiang-Zhong Huang (2013), "New amide alkaloids from Piper longum", Fitoterapia. vol. 84, pp 222-226.
Khao sat thyc trang sfr dung amikacin trong dieu tri cho tre em tai mot so benh vien
^ • • • • •
tren dia ban Ha Noi
Nguyen Tbi Kim Chi'*, Hoang Thi Kim Huyen^
Nguyen Thj Lien HuffngS Le Ba Hai', Hoang Ha Phuong^
' Trudng CD Y te Hd Noi, ' Trudng Dgi hoc Duac Ha Noi
* E-maiT [email protected]
Summary
The use of amikacin in 3 hospitals of Ha Noi (signed: I, It and III) was retrospectively investigated with 746 medical records to reveal the irrational use of amikacin there in the following aspects: dose, administration and therapeutic monitoring. For dosing regimen, amikacin was prescribed one daily dose (ODD) with the mean dose of 15 mg/kg/24 h to almost patients (>96%), but Indicated to use in bottles to nearly 30% of patients leading to irrational dosage for children. For drug administration, slow intravenous injection was indicated to 90% of cases, but lacked the time for bolus dose. For therapeutic monitoring, the renal function was monitored, but not on all the patients, with the percentage of 61.9%
and 71.7% for Hospital ll and III, respectively, and much less for Hospital I (39.7%) (p>0.05).
Keywords: Amikacin, drug use, hospitals of Hanoi.
Dat van de
Amikacin Id mgt khdng sinh thudc nhdm aminoglycosid, d u g c chf djnh cho cac trudng hgp nhiem k h u i n ngng, dgc bigt la nhidm vi k h u i n G(-) khi cdc khdng sinh cimg nhdm da bj khdng '''^i. Khdng sinh ndy cung cho phep si> dgng trdn tre em vd cd tre so sinh d l d i l u trj viem ph6i, n h i l m k h u i n huyet, nhidm khuan b^nh vi^n, nhi^m k h u i n trong 6 byng va d u g c Sli dyng d i l u trj theo kinh nghiem trong sot giam bgch c l u trung tinh i^^^'. Khdo sdt d u g c tien hanh trdn b$nh dn h6i ciru lay tip 3 bgnh vign tren dja
ban Ha Ndi n h l m tim hieu thuc trang sir dung de danh gia tinh hgp ly trong dieu trj, chuan hi cho vide xdy dung quy trinh giam sat dieu tn amikacin.
Doi tu'o'ng va phu'O'ng phap nghien CLPU
Doi tirgfRg nghien c i r u
Benh dn cua benh nhdn nhi tai 03 bgnh vign d u g c ma hod la: Benh vign I, Bgnh vign II va Bgnh vign 111, tir ngay 1/1/2009 den ngay 31/12/2011 thda man cac tieu c h u I n sau:
Tieu c h u a n lira c h g n
TAP CHi DUqC H p c - 10/2013 (S6450 NAM 53)
• Nghien CIFU - Ky thuat
Benh an cua benh nhan nhi d u g c chi dinh d i l u tri bang amikacin.
Tieu c h u a n loai trip
Benh nhan chuyen vien giQ'a chirng.
Benh nhan dang t i l n hanh Igc mdu hoac t h i m phdn phuc mac trong thdi gian sir dung khang sinh
PhiFo^ng phap n g h i e n c i r u
Co m l u vd each chgn m l u cu t h i nhu* sau:
+ VOT Benh vien I: Do so benh an trong 1 nam r i t Id'n nen chung tdi dp dung cdng thirc tinh c& m l u ^^. Ca mdu d u g c chgn phai 5 230.
Ttr danh sach benh nhan s i i dung amikacin nam 2009 d u g c luu trtr tai phdng k l hoach tong h g p cua Benh vien, Igc ra tat ca cac benh dn sir dung amikacin. Dimg phucng phap chgn m i u ngdu
nhien b l n g phdn mem SPSS 17.0 chiing tdi lua chgn d u g c 296 benh an dat tieu chuan nghign CLFU.
+ VOT Khoa nhi 2 Benh vien II va III: si> dung ky thugt chon mau toan bg vi trong ca nam 2009 so ddi tu-gng nghidn ciru theo tieu chuan tren khdng nhieu. K i t qud s6 l u g n g bgnh an l l y dugc tir Benh vien 11 Id 252 va Benh vien III la 198.
Tong m l u thu d u g c tai 3 bdnh vidn la 746 benh an dat tieu c h u I n nghien CCFU.
XLF ly s o lieu
S u dung test t d l so sanh hai gid trj trung binfi va test %^ de so sdnh 2 ti le. S g khac bigt dugc coi Id cd y nghTa thong ke v a i p<0,05. SCF dung phan mdm Excel, SPSS 17.0 de nhdp va xi> ly du' lieu.
Ket qua nghien ciru
Dgc diem ve t u o i va can nang cua benh nhan du'O'c c h i d j n h amikacin Bang 1 : D$c diim benh nhan
B$nh vifn N(%)
Tuoi Can nang
N(%) II Tuoi
Can nang N(%) III TUOI
Can nang
Saslnh 174(58,8) 4,5 (3-6) ngay 2,75 ± 0,87 (kg)
143 (56,7%) 11 (7-16) ngay 3,2 ± 0,8 (kg) 28(14,1%) 1 (1-4,5) ngay
3,0 + 0,8(kg)
1 thang -1 tuoi 64(21,6) 5 (2-6) thang
6,5±2.2 (kg) 72 (28,6%) 3 (1,7-5,7) thang
5,7±2,1(kg) 35 (17,7%) 4 (2-8) thang 6,3±2,1(kg)
> 1 tuoi 58(19,6) 2 (1,5^1) tuoi 13,0±5,5(kg) 37 (14,7%) 2 (1,8-3,3) tuoi
12 (10-13,5) kg 135(68,2%) 8 (5-10) tuoi 20 ( 1 6 - 2 8 ) kg Nhdn xet:
- Cf 2 Benh vien I va II, p h i n ldn sd benh nhan (>50%) la tre s o smh Trong dd do tuoi cua benh nhdn s o smh cua Benh vien I tgp trung trong khoang tuan dau sau de (3-6 ngdy) cdn a Benh vien II tap trung a t u i n Id t h u 2 sau de (7-16
ngay). Tai 2 benh vien ndy, ldp tu6l tren 1 tuoi tap trung trong khoang 1 den 4 t u l i .
- & Benh vien III, phan bo benh nhdn a dp tu6i tren 1 tuoi chiem 2/3 tong sd bgnh nhan, chu ydu la cac tre cd tuoi trong khoang tip 5 -
Cach thiPc su* d u n g amikacin t r o n g mau nghien c i r u Bang 2 : Cach thdc SCH dung amikacin
Dac diem
Khoang each ^'' 9 ' "
du^thu6c , 2 g j j ,
/
351 (96,4%) 12(3,6%)
Benh vien II 289 (100%)
0 (0%)
III 218(97,8%)
5 (2,2%)
TAPCHl DirgtC HQC -10/2013 (SO 450NAM53)
Nghien ciru • Ky thuat
Theo Ig Theo mg Tiem bSp Tiim tinh Du-ima diina "'^ch ch$m Tmyen, tiem may
Ti^m tinh mach Thai gian dung amikacin
Trong ktii sCr dyng amikacin chdc ning Sau khi sd dung amikacin
th^n Khoang c^ch giira cac liin xet nghiem
ODD:
14,6 ± 2,0 MDD;
19,9 ±5,1 97 (26,7%) 266 (73,3%) 33(9,1%) 246 (67,8%)
74 (20,4%) 10(2,8%) 6,2 ± 2,8 ngay
116(39,7%) 58(19,9%) 2 ( 1 - 5 ) ngay
ODD:
14,8 ± 2,5 MDD:
Khong cd 0 (0%) 289(100%)
18(6,2%) 270 (93,4%)
1 (0.3%) 0 (0%) 6,2 ±1,8 ngay
156(61,9%) 36 (14,3%) 6 (3- 7) ngay
ODD:
15,0 ±1,6 MDD:
14,6 ±0,3 69 (30,9%) 154(69,1%) 1 (0,4%) 204(91,6%)
12 (5,4%) 6 (2,7%) 5,4±2,5 ngay 142(71,7%) 97 (49,0%) 5 (4-7) ngay _ - Do ndng d^ amikacin
tfOCp , ^ . J khi sw dung Nh$n xet:
G i n nhu toan bd s6 benh nhdn (>96%) d u g c dung amikacin vdi c h l dd l i l u 1 lln/ngay (one daily dose = ODD) d ca 3 bgnh vign vdl lieu dung trung binh Id ~15 mg/kg/ngay. Tgi Benh vien II, 100% cdc trudng hgp ke don amikacin deu d u g c tinh lieu theo mg. Tuy nhien tgi 2 Bgnh vien I va III, cd khoang gan 1/3 trudng hgp amikacin d u g c tinh lieu theo don vi Ig.
Tgi 2 Bgnh vign II va III, tiem tTnh mgeh cham Id dudng dua thuoc d u g c sir dyng trong hau nhu todn bO so lan sir dyng amikacin (>90%), mgt so it cdn lgi (<6%) la dudng dimg tiem bdp hoac truyen tinh mgeh. Tgt Benh vien I, dudng dimg tiem tmh mgeh chgm chiem 2/3 so trudng hgp, dud'ng ddng khdc ehu yeu Id tiem mdy (20,4%). Tuy nhien cd khodng <3% benh nhan duge dua thudc theo dudng tTnh mgeh tare tiep tai B#nh vign I va III.
Thdi gian si> dyng amikacin trung binh tai ed 3 b^nh vidn la ~6 ngay.
S l b$nh nhan d u g c giam sat chirc nang than trong khi sCe dgng amikacin a 2 Bgnh vign II va III chilm ti 1$ cao han so vdi Bgnh vign I (p>0,05). (3 B0nh vl§n !, ti 1$ bgnh nhan d u g c giam sat chire ndng th$n sau khi SCF dyng amikacin cao han vd khodng cdch giira cdc l l n xet nghi#m ngan han so vdi 2 B$nh vign II vd III (p<0,05).
Khdng cd benh vien nao giam sat nong dd thuoe trong mau khi dieu trj.
Ban luan
- Ve dg tuoi: Hai bgnh vign I va il cd sd benh nhdn sa sinh chiem ti le cao, trong dd tre mdi sinh non yeu tgp trung chu y i u trong khoang tuan dau sau de (3-6 ngay). 0 Benh vign III, benh nhan chu y i u Id eae tre Idn, do tuoi trong khoang tip 5 - 10 tuoi. Bay la dae diem can can n h l e khi nghien CLPU cac thdng so duoc ddng hge ciJa amikacin tiep theo va trong viec lua chgn md hinh giam sat dieu trj (TDM) phil hgp'"^i.
- Ve che do lieu: Trong nghien ciru cua chiing ldi, gan nhu toan bg so benh nhan d ca 3 benh vien (>96%) d u g c dimg amikacin vdi ehe do lieu 1 lan/ngay (ODD) vdi lieu dung trung binh la - 1 5 mg/kg/ngay. Day la mgt yeu to quan trgng trong vigc xay dung qui trinh TDM amikacin sau nay'^'.
Cdch tinh l i l u cho tre em d u a c qui djnh trong cac khuyen cao la tinh theo mg/kg trgng lu-gng ca the. Dgc biet doi vdi tre so smh va tre nhd, each tinh chinh xac han Id tinh theo dign tich be mat ca the. WHO da edng bo bdng tham ehieu vigc qui doi giifa tuoi, can nang va c h i l u cac sang di^n tich be mat ca the cho doi tugng nayi^' Rieng vdi amikacin, mgt thuoc cd khoang dieu tn hgp
TAPCHi DUgfC Hpc - 10/2013 (SO 450 NAM S3)
Nghien CIFU - Ky thuat
va ddc tinh cao, viec tuan thu chinh xac lieu dung lgi cang c i n thiet. Tren thuc t l si> dung thudc tgi cac benh vien cd t i l n hdnh giam sat thuoc d i l u trj (TDM), l i l u dting amikacin cho tre sa sinh vd tre nhd thudng d u g e tinh theo can ndng '''•^•^i.
Trong nghien ciru ciia chung tdi, tai Benh vien II, 100% sd trudng hap ke dan amikacin deu d u g c tinh l i l u theo mg. Tuy nhien, tai 2 Bdnh vien I va III, gan 1/3 trudng hgp amikacin d u g e tinh l i l u theo dan vi Ig. Viee tinh lieu theo tg lai Idm cho lieu dimg cang khdng ehinh xdc han, dac biet Id nhCrng trudng hgp tinh l i l u md each chia khdng tron sd (1/3; 1/6; 1/7,1/9 Ig) thi viec hut chinh xac mgt t h i tich pha loang Id khdng the. Ro rang viec khuyin cao ve edeh tinh l i l u diing chinh xac la rat c i n t h i l t trong viec xay dgng qui trinh TDM t i l p theo cung nhu trong cdng tac giam sat s u dung t h u l e sau nay.
- Ve each tiem: Trong khao sdt cua ehung tdi, tiem tTnh mach cham la dud'ng dua thuoc du'gc SU" dung pho b i l n d ea 3 benh vien, dac biet d nhii'ng nai ma ti le tre s c sinh cao ( Benh vien i va II). Bam tiem dien (tiem may) hien nay d u g c SLP dyng rgng rai trong khoa nhi tai n h i l u ca s d d i l u trj va Id mdt d i l m manh eua Benh vien I. Ky thuat nay eho phep k i l m soat ehinh xac tdc do dua thuoe dong thai t i l t kiem thai gian cham sdc benh nhdn. Song qua khao sat benh an chi cd 20,4%
benh nhan cua Benh vien I d u g c dung amikacin b l n g bam tiem dien vd ti le nay d benh vien M vd III Id hau nhu khdng ed. D i l u nay e i n d u g c xem xet ky trong viec lya chgn dudng du'a thuoc trong xay dung qui trinh TDM amikacin sau nay.
SLP dyng amikacin theo dudng tiem tTnh maeh chami^i rd rang tiem tang mdt nguy ca cho benh nhan do kha nang bao dam thdi gian tiem 3-5 phdt eho tre nhd, dae biet la tre so sinh rat khd, dan den kha nang dua thudc nhanh, tao ndng do qua cao d i n tdi nguy ca ngat do Net ca hd hap'^i.
Vi vay d u d n g tiem mdy hogc t r u y i n tTnh mgeh va dung bam tiem dien la nhung d u d n g diing an toan nen d u g c trien khai rgng, dac biet cho tre s a sinh.
- Ve giam sat chirc nang than qua do thanh thai creatinin (CIcr): Doi vdi cae thuoc thai trir qua than ed ddc tinh cao nhu amikacin, vtec sir dyng thuoc tren tre sa sinh, dgc biet la tre dang a trong tuan l l dau ddi, khi ma ehue nang than dang trong giai doan trudng Ihanh rat
quan trgng'*'. Tuy nhien, qud nua s6 bgnh nhan (59,5%) khdng d u g e xet nghiem creatinin mau trong thai gian sCr dung amikacin tai Benh vidn I va ti le benh nhan d u g c kiem tra chirc nang thgn sau khi s u dung amikacin lai edng rat thap d ca 3 benh vien. Mat khde, khdng cd benh dn nao ghi chieu cao benh nhdn, nhtp vgy vigc tinh do thanh thai creatinin (CIcr) qua creatinin huyet thanh la khdng the t h y c hign d u g c .
- Ve giam sat sd dung thuoc qua do nong do thuoc trong mau: cho d i n nay ehua dirge t h y c hien tai ca 3 Benh vign nghien ciru.
Viec sir dung thuoc an toan vd hgp ly cdng doi hdi s y ehuan m y e trong cac b u d c si> dyng thuoc va cdng tac giam sat dieu trj cdng trd nen d p thiet han bao gid h i t . NhO'ng b i t cdp tren cung la nhirng diem cdn d u g c lu'u y trong viec xdy dung qui trinh TDM sau nay.
K e t l u a n v a d l x u a t Ket ludn
Ve thux: trang su" dung amikacin trong dieu tri
+ V4 dd tudi dirge ke don: benh nhan sa sinh cua Benh vien I tap trung trong khoang tuan dau sau de (3-6 ngdy) cdn d Benh vien II d tuan le thir 2 sau de (7-16 ngay). Tgi 2 benh vign nay, ldp tuoi tren 1 tuoi tap trung trong khoang 1 den 4 tuoi cdn d benh vien III: benh nhan cd dp tuoi tren 1.
+ Ve dSc diim sd diing amikacin t^l 3 b$nh vien khao sat:
- C h l do lieu: G i n nhu toan bg so b^nh nhan (>96%) d u g c dting amikacin vdi c h l dg lilu 1 l l n / 2 4 h (ODD) d ca 3 bgnh vign vai lieu diing trung binh Id - 1 5 mg/kg/ngay. Tai benh vien II, 100% cdc trud'ng hgp ke dan amikacin deu dugc tinh h l u theo mg cdn tai 2 Benh vign I va III, c6 khoang g i n 1/3 tru'dng h g p amikacin duge tinh l i l u theo dan vi ig.
- Gaeh tiem: Tiem tTnh mgeh cham Id dudng du'a thuoe d u g e SLP dung chu yeu (>90%) tai 2 Benh vign II va III, con tai Benh vien I, dudng dung tiem tTnh mach chgm chiem 2/3 so trudng hgp, d u d n g dung khac chii yeu la tiem b l n g bam tiem dien (20,4%).
- Ve gidm sdt chiPc nang than trong d i l u trj: (J Benh vien I, ti Ig benh nhan d u g c giam sdt chuc
10 TAPCHI DlTgfC HQC - 10/2013 (SO 450 NAM 53)
• Nghien ci>u - Ky thuat
ndng thdn cao han vd khodng edeh giipa cdc l l n xet nghigm ngdn hon so v6i 2 Benh vidn II va III (P<0,a5).
- Ve gidm sdt d i l u trj qua n i n g do thudc trong mau: chu-a cd bdnh vidn nao thuc hien.
D l xuat
- C i n quy dinh bat huge khi s u dung khdng sinh nhdm aminoglycosid Id phai tinh l i l u theo cdn ndng va l l y thuoe theo dung tich pha loang tuong irng ma khdng d u g c tinh theo 6ng/lg de bdo dam d u g c do chfnh xac khi si> dung, dac biet eho I6p tre sa sinh vd tre nhd.
- Vide gidm sat ehire nang than c i n d u g c lam tren t i t cd cdc benh nhan d u g c chi djnh amikacin nham bdo ddm tinh an todn eho d i l u trj, dac biet khi chua cd bidn phdp giam sat nong do thudc trong mau.
- Can sdm trien khai vigc do nong do thuoc trong mau, dac bigt khi dting khang sinh nhdm aminoglycosid nhu amikacin de bao dam tinh hi$u qua vd an todn t i t han.
T a i l i e u t h a m k h a o 1 B(> Y t4 - Ban BiSn sogn Dugc thu qudc gia (2002), "Amikacin ", Dupc thu qu6c gia Vi$t Nam. Nha xuit bdn Y hgc. Ha NOi, tr 130-132.
2 Nguyin Van Tuan (2007), "Lam sang thong ke". Retrieved, 2009, from http7/www.ykhoanet-Com/
baiqiang/lamsangthongke/index.htm.
3. Arshad Anila, et al (2011), "Rational Use of Amikacin in Children", J. Pharm. Sci. & Res., 3(1), pp.
995-1001.
4 Karel Allegaert, et al. (2006), "Limited predict- ability of amikacin clearance in extreme premature neonates at birth", Br J. Clin. Pharmacol. . 61(1), pp.
39-48.
5 LabauneJ.M., et al. (2001), "Once-a-day individualized amikacin dosing for suspected infection at birth based on population pharmacokinetic models", Biol Neonate. 80(2), pp. 142-7.
6. Martindale (2009), The Complete Drug Reference, Thirty-sixth edition, Pharmaceutical Press, (158-1)
7 McEvoy Gerald K. (2011), "Aminoglycosides General Statement", AHFS Drug Information®, American Society of Health-System Pharmacists, Bethesda, Maryland 814.
a. World Health Organization (WHO) (2010), "Ami- kacin", WHO model formulary for children 2010. World Health Organization, Geneva, pp. 130 -131.
9. Paediatnc Formulary Committee (2010),
"Amikacin", Bntish national formulary for children (BNFC). Truy cap, tir: http7/bnfc.orq/
b n f c / b n f c / 2 0 1 0 / 3 8 3 7 h t m ' ? q ^ a m i k a c i n % 2 0
&t=search&ss=text&p=1# hit
Nghien cihi bao che va danh gia vien pseudoephedrin giai phong keo dai bang
phvong phap bao mang zein
Dinh Thj Hai Binh', Hoang Thi Thuy Hong^
Nguyin Thach T\in%\ Nguyen Thanh Hai', Pham Thi Minh Hue^' ' Tnrang Cao ddng Duae Hdi Duang
'Truang Dgi hoc Duae Hd Noi^Khoa Y- Duac, Dai hoc Quae Gia Hd Noi
* E-mail: [email protected]
Summary
A novel sustained release system for pseudoephedrin (PSE) was developed with zein-coating on tablet matrix. The effect of the input variables (zein, and plasticizers) on PSE release profile was evaluated through experiment design using factorial design. PSE release rate was inversely proportional
