消化类药物常见用药误区

消化类药物常见用药误区 消化类药物常见用药误区分析(一) 用药剂量未据患者情况调整 ?王秋冬 消化类药物是临床上常用的药物种类之一，近年来随着消化系统疾病的增多，其药物使用的范围和频率也在增加。但是由于消化类药物种类繁多，在使用中也出现一些新的问题，不仅影响到药物的疗效，而且也增加了不良反应，给患者带来损害。尤其是在使用中，有的临床医生存在的一些误区，值得我们注意。文章作者归纳出5条临床上常见的消化类药物使用的误区，列举典型病例，并进行分析点评，可供大家参考借鉴。 临床上每一种药物，都是有其使用剂量的，超过其使用剂量。不仅不能够增加疗效，而且会导致对患者的损害，乃至引发新的疾病，所以必须注意使用剂量，做到个体化给药，使药物发挥最大的作用。 典型病例1:患者王某，女，43岁，一年前患胃溃疡，两个月前明显加重，上腹部疼痛明显，疼痛时伴有恶心、呕吐、嗳气、反酸，上腹部有烧灼感。肾功能检查提示:内生肌酐清除率(Ccr)为48毫升/分钟。就医后，医生给其用药为:法莫替丁，每次20毫克，早晚各1次。 用药分析:患者所患胃溃疡，使用法莫替丁确实是适应证，但是该用药的使用剂量存在缺陷。因为患者为中度肾功能不全，在使用法莫替丁时，应该将口服剂量降低为正常剂量的一半，或者是根据患者的临床反应，将用药间隔延长到36~48小时使用1次。 典型病例2:患者周某，男，32岁，因非甾体抗炎药物引起出血性消化道溃疡入院。入院后，使用米索前列醇为其治疗，每次0.4毫克，每日两次。治疗后，should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 患者出现腹泻、腹痛症状，且有加重趋势。 用药分析:该患者的出血性消化道溃疡，为使用非甾体抗炎药物引起，使用米索前列醇可以取得理想疗效。但是该药物在治疗消化性溃疡时，使用的最佳剂量为每次0.2毫克，每日2~3次。这是防治胃及十二指肠溃疡的最佳剂量。该药可以引起腹痛、腹泻，高剂量使用更会加重，所以此病例应该调整降低剂量。 典型病例3:患者杨某，男，6岁，因恶心、呕吐来院就诊。医生为其使用了治疗呕吐、恶心的常用药物甲氧氯普胺，每次5毫克，每日3次，口服。 用药分析:该患者为一名6岁儿童，在使用甲氧氯普胺时，必须按照儿童体重进行换算使用。6~14岁儿童使用剂量为2.5毫克~5毫克，每日剂量不宜超过0.5毫克/千克。该患者体重20千克，每日用量不超过10毫克，而该患者一次使用5毫克，每日3次，剂量太大，应该调整减少，否则容易引起锥体外系反应。 典型病例4:患者洪某，女，75岁，半年前出现上腹部疼痛，多在餐后3~4个小时发作，尤其在睡前更明显。医院检查后，确诊为十二指肠溃疡，使用泮托拉唑治疗，每次40毫克，每天3次，口服。 用药分析:该患者年龄为75岁，属于老年患者，对药物的代谢减慢，应该调整降低使用剂量，泮托拉唑每日剂量不超过40毫克。如果大剂量使用，可导致心律不齐、肾功能改变等，所以必须注意。 消化类药物常见用药误区(二) 不注意使用禁忌，不治病反致病 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection ?王秋冬 临床上有很多药物，都是有其使用禁忌的。如果忽视这些禁忌证，不但达不到治疗的预期效果，而且会导致不治病反致病的相反后果。因此，在使用时必须严格注意禁忌证。 典型病例1:患者封某，女，45岁，有3年胃溃疡病史，发作时，疼痛伴有恶心、呕吐，嗳气、反酸，并有烧灼等症状。经常服用氢氧化铝片，每次0.6克，1天3次。患者上周无诱因突发急性阑尾炎，仍继续服用上述药物，阑尾炎症状逐渐加重，幸亏抢救及时，没有发生穿孔。 用药分析:在该患者用药中，明显忽视了一个问题，就是对于阑尾炎患者，使用氢氧化铝片，可能会使阑尾炎病情越来越重，甚至导致穿孔的危险，所以在有阑尾炎时，是不宜使用氢氧化铝片的，否则不治病反致病。 典型病例2:患者党某，男，78岁，反流性食管炎，经常反酸、烧心、疼痛。发病时，服用西咪替丁，每次0.3克，1天3次。使用5天后，出现头痛、头晕、嗜睡，继而出现意识障碍、不安等症状。 用药分析:该患者为老年人，而且据了解，以前有精神病史，此时在使用西咪替丁时必须注意，该药物可以导致精神系统不良反应。尤其是对于老年人、有精神病史者更容易发生，所以这是该药的使用禁忌证，应该注意。 典型病例3:患者毛某，男，47岁，出租车司机，平时吃饭没有规律，患胃溃疡5年，每次发病时均出现疼痛、反酸症状，自己就自行服用盐酸雷尼替丁150毫克，1天两次。此次发作时，症状较重，自己加大了服用剂量，每次300毫克，1天两次。使用3天后，出现惊厥、心动过缓等，于是来医院抢救。经过催吐和洗胃，静脉给予地西泮，同时给予阿托品抑制心动过缓，最后转危为安。 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 用药分析:该患者使用雷尼替丁本来是治疗胃溃疡的，但是由于在使用中超过使用剂量，而且后追问病史发现患者肾功能还有损害，导致药物代谢降低，血药浓度升高，从而引起中毒。这种有肾功能损害者，超量用药不仅没有达到治疗效果，而且更容易发生中毒危险。 典型病例4:患者邱某，女，23岁，有3年胃溃疡、反流性食管炎病史，发作时症状时轻时重，疼痛难忍，反酸明显，于是服用奥美拉唑，每次20毫克，每天早晚各1次。使用第二天时，患者身上出现皮疹、瘙痒症状，而且越来越重，于是来医院就诊，停药后症状减轻，继而消失。 用药分析:该患者出现皮疹、瘙痒属于奥美拉唑的不良反应，是皮肤过敏反应。在使用该药物时，应该在用前详细询问药物过敏史，对于有过敏的患者，在使用时，应该慎重。尤其是对于有过敏家族史或者有过敏体质的患者，更应该注意，一旦出现过敏症状，应该立即停药，必要时对症处理。 消化类药物常见用药误区(三) 联合用药不合理导致疗效降低 ?王秋冬 在临床上，联合使用药物是很常见的，有时也是必需的。恰当的联合用药，可以达到增强临床疗效的目的，但是不合理的联合用药，不仅无法达到增强疗效的目的，相反却会遇到一些联合用药禁忌，导致疗效降低。 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 典型病例1:患者孔某，女，59岁，平时有十二指肠溃疡病史，偶尔会出现消化不良。目前用药为:多潘立酮片每次20毫克，每天3次;盐酸雷尼替丁片，每次150毫克，每天早晚各服用1次。 用药分析:该患者使用的两种消化类药物存在相互作用。由于盐酸雷尼替丁属于H2受体拮抗剂，它可以改变胃内pH值，从而减少多潘立酮在胃肠道的吸收，导致其疗效降低，所以这两者是不宜联合使用的。 典型病例2:患者刘某，男，69岁，经常出现胃部疼痛和有饱胀感，同时常伴有嗳气、反酸、烧心、恶心、呕吐等症状。胃镜检查显示为慢性胃炎。目前使用药物如下:硫糖铝每次1克，每天4次，同时使用有助消化的多酶片，每次3片，每天3次，饭前服用。 用药分析:该患者在有消化不良、胃炎等疾病下，使用这两种药物，都有适应证，但是这两种药物存在相互作用，硫糖铝与多酶片合用时，两者疗效都会降低。这是由于硫糖铝可以与多酶片中的胃蛋白酶络合，降低多酶片的疗效，且多酶片中所含的消化酶，特别是胃蛋白酶可以影响硫糖铝的疗效，故两者不宜合用。 典型病例3:患者陈某，女，29岁，半年前出现腹部疼痛、大便干结等症状，同时有反酸现，经过相关检查未发现器质性病变，诊断为功能性便秘。目前用药如下:口服乳果糖每次10克，每天两次;口服氢氧化铝片，每次0.6克，每天3次，餐前服用。 用药分析:该患者使用的口服氢氧化铝与乳果糖存在相互作用。氢氧化铝属于碱性药物，可以使肠道内pH值升高，降低乳果糖药物的疗效，所以两者不宜联合使用。 典型病例4:患者曹某，女，35岁，上周出现胃部灼热、嗳气、恶心、呕吐、上腹胀等症状，有时伴有疼痛。目前用药如下:莫沙比利每次5毫克，每天3should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 次，饭前服用。因为腹痛，后加用颠茄合剂，每次10毫升，疼痛时服用。 用药分析:莫沙比利属于治疗功能性消化不良的胃肠动力药，而颠茄合剂是属于缓解胃肠道疼痛的胃肠解痉药，此患者使用这两药，都有适应证。但是这两种药物同时使用时存在相互作用，会导致药物疗效降低，原因是莫沙比利是通过促进肠壁肌层节后神经释放乙酰胆碱而发挥胃肠道动力作用的，胃肠解痉药颠茄合剂会降低其疗效。 消化类药物常见用药误区(四) 选择药物不当 ?王秋冬 在临床上，经常会遇到治疗同一种疾病，有多种药物可以选择的情况。有的药物是该病的严格适应证，当然可以选择，但是有些药物并不具有严格的适应证，医生的选择依据似是而非。这样的用药，不仅难以达到理想疗效，甚至会导致适得其反的效果。所以选择用药时必须恰当，才能发挥最佳疗效，减少不良反应的发生。 典型病例1:患者台某，男，54岁，1年前患反流性食管炎。医生给予多潘立酮治疗，每次20毫克，每天4次。使用两周后，症状改善不明显。 用药分析:多潘立酮主要对反流性胃炎效果满意，而对反流性食管炎效果并不理想，所以是不宜使用的。如果治疗反流性食管炎，可以使用质子泵抑制剂，效果较好，如奥美拉唑、泮他拉唑等。 典型病例2:患者唐某，女，40岁，胃肠道绞痛。医生给予山莨菪碱治疗，每次10毫克，每天3次。患者使用后，出现头痛、头晕症状，最后确诊为颅内压升高。追问病史发现，患者曾有颅内压升高史。 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 用药分析:医生在为该患者开具山莨菪碱时，没有严格把握其适应证。该患者曾有颅内压升高病史，而山莨菪碱一般是禁用于颅内压升高的患者，此类患者使用时比较危险。所以在此该药选用不当，可以使用其他不升高颅内压的类似药物，如丁溴东莨菪碱等。 典型病例3:患者罗某，男，65岁，有3年的慢性肝炎病史，同时还有早期白内障。在住院治疗时，医生给予水飞蓟宾治疗，每次70毫克，每天3次。 用药分析:水飞蓟宾可以治疗慢性肝炎，在此有其适应证。但是考虑到该患者同时有白内障，如果能有更好的药物，既可以治疗慢性肝炎，又可以治疗白内障，当然是更好。硫普罗宁就是这类药物，它不仅对急慢性肝炎有治疗效果，而且还可以对白内障有治疗作用，所以对此例患者应该首选硫普罗宁，而不是水飞蓟宾。 典型病例4:患者王某，女，47岁，胃溃疡、上呼吸道感染。入院后用药如下:西咪替丁口服，每次200毫克，每天3次，硫酸阿米卡星针0.3克，每天两次，加入到250毫升0.9%氯化钠注射液中静脉滴注。 用药分析:该患者同时使用抗感染药物硫酸阿米卡星和抗溃疡药物西咪替丁，两者都有相似的神经肌肉阻断作用，合用可能导致呼吸抑制或停止。所以，在使用硫酸阿米卡星时，是不宜选择西咪替丁的，可以选择其他药物，如质子泵抑制剂奥美拉唑、泮他拉唑等。 消化类药物常见用药误区分析(五) 中西药物合用不当 ?王秋冬 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 近年来，在临床上中西药物合用在发挥药物的协同作用方面，发挥了较好的疗效。但是由于中药的作用复杂，很容易与西药发生相互作用，合用常导致适得其反的效果，这在临床上很容易被忽视。 典型病例1:患者闫某，女，42岁，近1周出现上腹部不适、饱胀、烧心、嗳气等症状，被诊断为消化不良。医生给其使用胃蛋白酶合剂每次10毫升，每天3次。同时因为患者脚踝扭伤，医生给其使用三七片，每次3片，每天3次。 用药分析:该患者在用药中，既有西药，又有中药，其中三七片中含有苷类成分，与胃蛋白酶合剂联用后，可以导致胃蛋白酶分解失效，所以在此联合使用是不当的。此类含苷的中药还有桂枝、白芥子、杏仁、远志等。 典型病例2:患者连某，女，40岁，近段时间常有胸骨后烧灼感或烧灼痛、泛酸、咽下困难等症状。经检查诊断为反流性食管炎。医生给其用药为:胃复安20毫克，加入到10%葡萄糖注射液中静脉滴注，每日1次，5日后减量为10毫克，10日为一疗程;同时因为患者有头晕症状而使用藿香正气丸，每次6克，每日两次。 用药分析:该患者使用的中药藿香正气丸与西药胃复安可以发生相互作用，导致胃复安的疗效降低。因为藿香正气丸对抗肠痉挛作用与阿托品相似，与胃复安联用会产生药理性拮抗作用，两者药效都会减弱，所以不宜合用。 典型病例3:患者童某，女，43岁，平时经常反酸，被诊断为胃酸分泌过多，使用碳酸氢钠片治疗，每次0.3克，每天3次;该患者还有冠心病，因此同时服用丹参片，每次3片，每天3次。 用药分析:该患者使用碳酸氢钠与丹参片合用是错误的。因为丹参片与抗酸类药物，如碳酸氢钠、氢氧化铝等可以形成螯合物，从而降低其生物利用度，可should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 以使血药浓度下降，导致疗效降低。 典型病例4:患者李某，男，41岁，长期便秘，曾使用过一些药物治疗但效果不明显，于是口服硫酸镁5克，每天空腹时使用，同时饮用200毫升水;因为咽喉红肿、发炎，还使用牛黄消炎丸，每次3克，每天3次。 用药分析:该患者因为便秘，使用硫酸镁口服治疗，同时口服大量的水，这样是可以达到导泻的效果。但是，硫酸镁属于碱性药物，它会分解产生微量硫酸，与牛黄消炎丸合用时，可以使牛黄消炎丸中的雄黄中所含的硫化砷氧化，使其毒性增加，所以两者合用是错误的。 消化类药物常见用药误区分析(六) 配伍禁忌联用 未掌握时间差 剂型选择不当 ?黎春辉 联用配伍禁忌药物 典型病例1 男性患者，49岁，上消化道出血。给予5%葡萄糖氯化钠注射液150毫升，止血敏2.0克，止血芳酸0.4克，维生素C 2.0克，静滴，每天两次;5%葡萄糖500毫升，奥美拉唑40毫克，静滴，每天两次;胶体枸橼酸铋110毫克，口服，每天4次。结果，静滴后在第二组液体衔接中，奥美拉唑溶液产生淡红色沉淀。 用药分析 奥美拉唑为弱碱性药物，与酸性药物止血敏、止血芳酸、维生素C及5%葡萄糖接触后极不稳定，易分解变色而产生淡红色沉淀。该药只能与0.9%氯化钠或5%葡萄糖注射液配伍，且在0.9%氯化钠溶液中较5%葡萄糖溶液中稳定。配制应注意将稀释溶液的量控制在100毫升，用500毫升及250毫升配制会发生should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 变色，其原因不明确，有可能为奥美拉唑对光不稳定。因此宜快速静滴，在15~30分钟内滴完。 溃疡出血的治疗以制酸为主，奥美拉唑为质子泵抑制剂，能迅速提高胃内pH值，使胃液pH值,6，使胃蛋白酶失活，同时促进血小板聚集，诱导血浆凝血功能而达到止血效果。铋剂则需要在胃酸作用下，以铋盐形式沉积于胃黏膜而保护溃疡面。由于奥美拉唑作用时间长，制酸作用强，使铋剂因为失去酸性环境而不能发挥有效功能。况且活动性出血期间，铋剂可因在胃内形成硫化物出现黑便而影响对出血的评价，因此，此时铋剂使用不当。 典型病例2 男性患者，68岁，胰腺癌。给予5%葡萄糖氯化钠200毫升，水溶性维生素6毫升，静滴;20%脂肪乳250毫升，10%氯化钾7.5毫升，静滴，每天1次。 用药分析 水溶性维生素不宜与强电解质在同一容器中混合。强电解质的加入可产生同离子效应、电位中和作用、盐析作用等，析出不溶性的有机碱、有机酸，造成不溶性微粒数增加;同时造成水包油乳滴的油相和水相分裂、油水分离，药物被损坏。所以水溶性维生素不能加入含电解质的葡萄糖注射液中，只能加入无电解质的葡萄糖注射液、注射用水中。同理，也不应向脂肪乳中加任何药物或电解质，因其可致破乳，或引起脂肪小球聚集。 未正确掌握用药时间间隔 典型病例 男性患者，80岁，胆囊炎伴有腹部闷涨。给予头孢哌酮2.0克，静滴，每天两次;奥美拉唑胶囊20毫克，口服，每天两次;多潘立酮片10毫克，口服，每天3次。 3天后患者上腹部胀痛无缓解，经询问，问题在于护士发药时，将奥美拉唑与多潘立酮一起交代患者同服。 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection 用药分析 奥美拉唑为质子泵抑制剂，可抑制胃酸分泌，会降低胃动力药多潘立酮的口服生物利用度;而多潘立酮可加速胃的排空，降低奥美拉唑的疗效。两药合用多潘立酮就不能在饭前服用，应予饭后服用。两者错开服用后，药物疗效才能得到更好发挥。 剂型选择不合理 典型病例 男性患者，32岁，腹泻。给予庆大霉素注射液8万单位，口服，每天3次。 用药分析 庆大霉素注射液水溶性好，在弱碱性环境中作用强，而经口服在胃液中大部分会被胃酸破坏，抗菌效果大打折扣。另外注射剂口服，改变针剂给药途径给药，用药不方便，患者依从性差，可改用片剂或颗粒冲剂服用，抗菌效果较好。 编后:消化类药物常见用药误区分析至此告一段落。从这两位作者对消化系统不合理用药的几点归纳分析中我们可以看出:药师应积极参与临床，利用药学信息优势，进行全程药学监护，并开展用药分析，指导临床工作;在临床实践中，要求临床医师加强药物药动学、药效学、药物相互作用及药物不良反应等方面知识的学习，同时药师也应与医师通力协作，相互学习，相互促进，不断积累经验，促进消化系统疾病药物的合理使用，确保临床用药安全有效。 should be in the 5mm range, the incision should not curl, Burr. Steel brackets and hangers should be solid welding, no significant deformation, even weld, weld length shall conform to the requirements, shall not be cracks, undercut, porosity, depression, lack of weld, welding and other defects. Brackets and hangers should be mounted firmly to ensure horizontal even vertical, building on the slope of mount bracket and hanger and the buildings have the same slope. 4.1.6.3 bridge installation requirements: bridge should be flat, no distortion, no burrs on the inside wall, accessories complete. Trunking interface should be formed, should close the straight at the seams. After the Groove on the cover should be formed, no corners, and outlet location accurately. When installed in the ceiling, if the ceiling should be unable to master a manhole. Is not allowed to pass through the walls of the trough and put to death with the holes on the wall. Slots of all non-conductive parts of the iron should be connected and bridged, making it a continuous conductor, and the whole earth. When the floor trunking distance less than 2.4m, trunking and trunking cover must be installed to protect the ground wire. 2.4m the slot cover plate without protective ground wire. Slot after building of deformation joints (expansion joints, settlement joints), the line itself should be disconnected, connection