网信彩票

 

附件1

 

diyisangongzhiyao（beijing）youxiangongsizuoyangfushaxingkoufuhezhushejishuomingshu

qingzixiyuedushuomingshubingzaiyishizhidaoxiashiyong

 

 

 

【yaopinmingcheng】genjuyuanshenpiwenjianqueding

通用名称：

商品名称：

英文名称：

汉语拼音：

【成份】

benpinzhuyaochengfenweizuoyangfushaxing，qihuaxuemingchengwei：(-)-(s)-3-jiaji-9-fu-2,3-erqing-10-(4-jiaji-1-paiqinji)-7yangdai-7h-bidingbing[1,2,3-de]-1,4 benbingkoue qin-6-suosuanbanshuihewu。

其化学结构式：

 

fenzishi：c18h20fn3o4 ·h2o

fenziliang：370.38

benpinqitachengfenwei：genjuyuanshenpiwenjianqueding。

【xingzhuang】genjujutipinzhongqueding

【适应症】

weijianshaonaiyaojundechansheng，baozhengzuoyangfushaxingjiqitakangjunyaowudeyouxiaoxing，zuoyangfushaxingzhiyongyuzhiliaohuoyufangyizhengminghuogaoduhuaiyiyouminganxijunyinqideganran。zaixuanzehuoxiugaikangjunyaowuzhiliaofanganshi，yingkaolvxijunpeiyangheyaominshiyandejieguo。ruguomeiyouzheixieshiyandeshujuzuocankao，zeyinggenjudangdiliuxingbingxuehebingyuanjunminganxingjinxingjingyanxingzhiliao。

zaizhiliaoqianyingjinxingxijunpeiyangheyaominshiyanyifenlibingjiandingganranbingyuanjun，quedingqiduizuoyangfushaxingdeminganxing。zaihuodeyishangjianyanjieguozhiqiankeyixianshiyongzuoyangfushaxingjinxingzhiliao，dedaojianyanjieguozhihouzaixuanzeshidangdezhiliaofangfa。

yucileizhongdeqitayaowuxiangtong，shiyongzuoyangfushaxingjinxingzhiliaoshi，tonglvjiadanbaojundemouxiejunzhukeyihenkuaichanshengnaiyaoxing。zaizhiliaoqijianyingdingqijinxingxijunpeiyangheyaominshiyanyizhangwobingyuanjunshifouduikangjunyaowuchixumingan，bingzaixijunchuxiannaiyaoxinghounenggoujishifaxian。

zuoyangfushaxingkoufuzhijihezhushejikeyongyuzhiliaochengnianren（≥ 18sui）youxialiexijundeminganjunzhusuoyinqidexialieqing、zhong、zhongduganran。rujingmaidizhuduihuanzhegengweiyoulishi（ruhuanzhebunengnaishoukoufujiyaodeng）keshiyongzuoyangfushaxingzhusheye。

1.医院获得性肺炎

 zhiliaoyouduijiayangxilinmingandejinhuangseputaoqiujun、tonglvjiadanbaojun、zhanzhishaleishijun、dachangaixijun、feiyankeleibaiganjun、liuganshixueganjunhuofeiyanlianqiujunyinqideyiyuanhuodexingfeiyan。tongshiyinggenjulinchuangxuyaocaiquqitafuzhuzhiliaocuoshi。ruguoyizhengminghuohuaiyishitonglvjiadanbaojunganran，jianyilianheyingyongkangjiadanbaojunβ-neixiananleiyaowujinxingzhiliao。

2.社区获得性肺炎

7～14tianzhiliaofangan：zhiliaoyouduijiayangxilinmingandejinhuangseputaoqiujun、feiyanlianqiujun[baokuoduozhongnaiyaoxingjunzhu（mdrsp*）]、liuganshixueganjun、fuliuganshixueganjun、feiyankeleibaiganjun、katamolajun、feiyanyiyuanti、feiyanjuntuanjunhuofeiyanzhiyuantiyinqideshequhuodexingfeiyan。

zhu：mdrsp（duozhongnaiyaoxingfeiyanlianqiujun）zhiduixialieliangzhonghuoduozhongkangjunyaowunaiyaodejunzhu：qingmeisu（mic ≥ 2 µg/ml），erdaitoubaojunsu（rutoubaofuxin）、dahuanneizhilei、sihuansujijiayangbiananmiding/huanganjiakouezuo。

5tianzhiliaofangan：zhiliaoyoufeiyanlianqiujun、liuganshixueganjun、fuliuganshixueganjun、feiyanzhiyuantihuofeiyanyiyuantiyinqideshequhuodexingfeiyan。

3.jixingxijunxingbidouyan

5tianzhiliaofangan：zhiliaoyoufeiyanlianqiujun、liuganshixueganjunjikatamolajunyinqidejixingxijunxingbidouyan。

10～14tianzhiliaofangan：zhiliaoyoufeiyanlianqiujun、liuganshixueganjunjikatamolajunyinqidejixingxijunxingbidouyan。

4.manxingzhiqiguanyandejixingxijunxingfazuo

zhiliaoyoujiayangxilinmingandejinhuangseputaoqiujun、feiyanlianqiujun、liuganshixueganjun、fuliuganshixueganjunhuokatamolajunyinqidemanxingzhiqiguanyandejixingxijunxingfazuo。

5.fuzaxingpifujipifujiegouganran

zhiliaoyoujiayangxilinmingandejinhuangseputaoqiujun、fenchangqiujun、huanongxinglianqiujunhuoqiyibianxingganjunyinqidefuzaxingpifujipifujiegouganran。

6.feifuzaxingpifujipifuruanzuzhiganran

zhiliaoyoujiayangxilinmingandejinhuangseputaoqiujunhuohuanongxinglianqiujunyinqidefeifuzaxingpifujipifujiegouganran（qingduzhizhongdu），baokuonongzhong、fengwozhiyan、jie、nongpaobing、nongpibing、shangkouganran。

7.manxingxijunxingqianliexianyan

zhiliaoyoudachangaixijun、fenchangqiujunhuojiayangxilinmingandebiaopiputaoqiujunyinqidemanxingxijunxingqianliexianyan。

8.复杂性尿路感染

5tianzhiliaofangan：zhiliaoyoudachangaixijun、feiyankeleibaiganjunhuoqiyibianxingganjunyinqidefuzaxingniaoluganran。

10tianzhiliaofangan：zhiliaoyoufenchangqiujun、yingouchangganjun、dachangaixijun、feiyankeleibaiganjun、qiyibianxingganjunhuotonglvjiadanbaojunyinqidefuzaxingniaoluganran（qingduzhizhongdu）。

9.急性肾盂肾炎

5tianzhiliaofangan：zhiliaoyoudachangaixijunyinqidejixingshenyushenyan，baokuohebingjunxuezhengdebingming。

10tianzhiliaofangan：zhiliaoyoudachangaixijunyinqidejixingshenyushenyan，baokuohebingjunxuezhengdebingming。

10.feifuzaxingniaoluganran：

zhiliaoyoudachangaixijun、feiyankeleibaiganjunhuofushengputaoqiujunyinqidefeifuzaxingniaoluganran（qingduzhizhongdu）。

11.xiruxingtanju（baoluhou）

shiyongyuxiruxingtanju（baoluhou）dezhiliao，zaibaoluyutanjuganjunpenwuzhihoujianshaojibingdefashenghuojianhuanjibingdejinzhan。zuoyangfushaxingdeyouxiaoxingjiyurentidexuejiangnongduzheiyitidaizhongdianlaiyucelinchuangliaoxiao。

zuoyangfushaxingduitanjuxirubaoluhoudeyufangzuoyongshangweiduirentijinxingshiyan。chengrenzhongchaoguo28tianliaochengzhiliaodezuoyangfushaxingdeanquanxingshangweiyanjiu。jinzaihuoyidayufengxianshi，cainengshiyongzuoyangfushaxingzhangqizhiliao。

【guige】   genjuyuanshenpiwenjianqueding

【用法用量】

zuoyangfushaxingkoufuzhijihezhushejiyongyushangshuganranxingjibing（xiangjianshiyingzheng）dezhiliao，tongyongdeyongfayongliangruxiasuoshi，danbixujiehejibingyanzhongchengduyoulinchuangyishengzuizhongqueding。

1.剂量和给药方法

（1）shengongnengzhengchanghuanzhezhongdejiliang

zuoyangfushaxingkoufuzhijidechangyongjiliangwei250 mghuo500 mghuo750 mg，mei24xiaoshikoufuyici。genjuganranqingkuanganzhaoxiabiao（biao1）suoshifuyong。

zuoyangfushaxingzhushejidechangyongjiliangwei250 mghuo500 mg，huanmandizhu，dizhushijianbushaoyu60fenzhong，mei24xiaoshijingdiyici；huo750 mg，huanmandizhu，shijianbushaoyu90fenzhong，mei24xiaoshijingdiyici。genjuganranqingkuanganzhaobiao1suoshishiyong。

jiganqingchulv≥ 50 ml/minshibuxudiaozhengyongliang。jiganqingchulv＜50 ml/minshi，xudiaozhengyongliang。

biao1：shengongnengzhengchanghuanzhezhongdejiliang（jiganqingchulv≥50 ml/min）

 

zhu：①youtedingbingyuanzaocheng（canjianshiyingzheng）。

②yishikeyigenjuzijidepanduancaiyonglianxuzhiliao（jingmaizhushehuokoufu）。

③youjiayangxilinminganxingjinhuangseputaoqiujun、feiyanlianqiujun[baokuoduozhongnaiyaoxingjunzhu（mdrsp）]、liuganshixueganjun、fuliuganshixueganjun、feiyankeleibojun、zhanmoyanmolajun、feiyanyiyuanti、shifeijuntuanganjunhuofeiyanzhiyuantidaozhi（canjianshiyingzheng）。

④youfeiyanlianqiujun[baokuoduozhongnaiyaoxingjunzhu（mdrsp）]、liuganshixueganjun、fuliuganshixueganjun、feiyanzhiyuantihuofeiyanyiyuantidaozhi（canjianshiyingzheng）。

⑤benfanganshiyongyuyoudachangganjun、feiyankeleibojun、qiyibianxingganjundaozhidecutiheyoudachangganjundaozhidejixingyixianyan，baokuotongshibanjunxuezhengdebingming。

⑥benfanganshiyongyuyoufenchangqiujun、yingouchangqiujun、dachangganjun、feiyankeleibojun、qiyibianxingganjun、tonglvjiadanbaojundaozhidecuti，yijiyoudachangganjundaozhidejixingyixianyan。

⑦yingdangzaihuaiyihuomingquedetanjuganjunpenwubaoluzhihoujinkuaiyongyao。zheiyizhizhengjiyutidaizhongdian。zairentizhongdadaodezuoyangfushaxingxuejiangnongdukenengyucelinchuangliaoxiao。

⑧zuoyangfushaxingzaichengrenzhongchaoguo28tian、erkehuanzhezhongchaoguo14tiandezhiliaoanquanxingweijingyanjiu。yuduizhaoxiangbi，zaierkehuanzhezhongguanchadaojirougugedebuliangfanyingfashenglvzengjia（xiangjianjinggaoyuzhuyishixiang）。jindanghuoyichaoguofengxianshi，caikecaiyongzuoyangfushaxingzhangqizhiliao。

（2） erkehuanzhe（＜ 18sui）zhongdejiliang

erkehuanzhe（≥6geyue）dejiliangmiaoshuyuxiabiao（biao2）。

biao2：erkehuanzhe（≥6geyue）dejiliang

 

zhu：①youtanjuganjunzaocheng（canjianshiyingzheng）。

②yishikeyigenjuzijidepanduancaiyonglianxuzhiliao（jingmaizhushehuokoufu）。

③yingdangzaihuaiyihuomingquedetanjuganjunpenwubaoluzhihoujinkuaiyongyao。zheiyizhizhengjiyutidaizhongdian。zairentizhongdadaodezuoyangfushaxingxuejiangnongdukenengyucelinchuangliaoxiao。

 ④zuoyangfushaxingzaierkehuanzhezhongchaoguo14tiandezhiliaoanquanxingweijingyanjiu。yuduizhaoxiangbi，zaierkehuanzhezhongguanchadaojirougugedebuliangfanyingfashenglvzengjia（canjianjinggaoyuzhuyishixiang）。jindanghuoyichaoguofengxianshi，caikecaiyongzhangqizuoyangfushaxingzhiliao。

（3）shengongnengbuquanhuanzhezhongdejiliangdiaozheng

ruguocunzaishengongnengbuquan，yingshenyongzuoyangfushaxing。youyuzuoyangfushaxingdeqingchulvkenengxiajiang，zaikaishizhiliaoqianhezhiliaoguochengzhong，yingdangjinxingzixidelinchuangguanchaheshidangdeshiyanshiyanjiu。

duiyujiganqingchulv≥50 ml/minhuanzhemeiyoubiyaojinxingjiliangdiaozheng。

zaishengongnengbuquandehuanzhezhong（jiganqingchulv＜50 ml/min），youyujiganqingchulvxiajiang，xuyaodiaozhengjiyaojiliang，yibimianzuoyangfushaxingdexuji（canjianzaiteshurenqunzhongdeshiyong）。

xiabiao（biao3）shiruhegenjujiganqingchulvdiaozhengjiliang。

 

biao3：shengongnengbuquanhuanzhezhongdejiliangdiaozheng（jiganqingchulv＜50 ml/min）

 

（4）给药说明

yuaohejideyaowuxianghuzuoyong：kangsuanji、liutanglv、jinshuyanglizi、duozhongweishengsu

zuoyangfushaxingkoufuzhijiyingdangzaishiyongxiashuyaowuqianhouzhishao2xiaoshifuyong：hanmeikangsuanji、lv、liutanglv、jinshuyanglizirutielizi、hanxindeduozhongweishengsuzhiji、quqiangjiganjujiaopian/fensanpianhuoerkechongji。

zuoyangfushaxingzhushejibunengyurenhehanyouduojiayanglizi（rumeilizi）derongyetongguotongyitiaojingmaitonglutongshijiyao。

shiwuyuzuoyangfushaxingkoufuzhiji

zuoyangfushaxingkoufuzhijidefuyongkeyibukaolvjinshideyingxiang。jianyizaizhishaojinshiqian1xiaoshihuojinshihou2xiaoshifuyongzuoyangfushaxingkoufuzhiji。

左氧氟沙星注射剂

zhuyi： zuoyangfushaxingzhusheji®xunsujingmaijiyaohuotuizhukenengdaozhidixueya，yingdangbimian。zuoyangfushaxingzhushejiyingdangqujueyujiliang，zaibudiyu60huo90fenzhongdeshijianneihuanmanjingmaidizhu。zuoyangfushaxingzhushejijinkejingjingmaidizhujiyao，bukeyongyujinei、qiaonei、fumoneihuopixiajiyao。

jieshouzuoyangfushaxingkoufuzhijihezhushejidehuanzhedeshuisheru

koufuhuojingmaidizhukoufuzhijihezhushejidehuanzheyingbuchongzugoudeshuifen，yizuzhiniaozhongyaowunongduguogao。yiyoukuinuotongleiyaowuyinqiguanxingniaodebaogao。

2.jingmaidizhuyaowudezhibei

duiyufeikoufuyaowuzhiji，zhiyaorongyeherongqiyunxu，yingdangzaijiyaoqianmujianyouwukeliwuhetuosexianxiang。

youyujinkeyidedaoyouxiandeguanyuzuoyangfushaxingzhusheyeheqitajingmaiyongyaoxiangrongxingdeziliao，budexiangyicixingrouxingrongqizhongdeyuhunzuoyangfushaxingzhusheye、yicixingxiaopingzhongdezuoyangfushaxingzhusheyezhongjiarutianjiajihuoqitayaowu，huozheyuzhicongtongyitiaojingmaitonglushuzhu。ruguoshiyongtongyitiaojingmaitonglulianxushuzhuyixiebutongdeyaowu，yingdangzaishuzhuzuoyangfushaxingzhusheyeqianhou，shiyongyuzuoyangfushaxingzhusheyehetongguotongyitonglushuzhudeqitayaowuxiangrongdezhusheyechongxi。

zuoyangfushaxinglvhuanazhusheye（dashuye）keyizhijiejingmaidizhujiyao，dizhushijianyijujiliangbutongzhishaowei60fenzhonghuo90fenzhongyishang，dizhunongduyingwei5 mg/ml。

zuoyangfushaxingzhusheye（xiaozhen）zaijingmaidizhuqianbixuyaoyongshidangderongyejinyibuxishi，kepeiwudejingmairongyejianbiao4，shiyongqianrongyedezuizhongxishinongduyingwei5 mg/ml。

zhusheyongzuoyangfushaxingzaijingmaidizhuqianbixushouxianyongzhusheyongshuirongjie，ranhouzaiyongshidangderongyejinyibuxishi，kepeiwudejingmairongyejianxiabiao（biao4），shiyongqianrongyedezuizhongxishinongduyingwei5 mg/ml。

kepeiwudejingdirongye：keyiyongxialierenyijingmaizhusheyezhibeishidangphzhide5 mg/mlzuoyangfushaxingrongye。

 

 

 

 

biao4：kepeiwudejingdirongye

 

youyuyaowuzhongbuhanyoufangfujihuoyijunji，yincizaizhibeijingdirongyeshiyingcaiyongwujunjishu。

zaishiyongqianyingzixiguancharongyeneishifouhanyoukelizazhi。hanyourouyankejiankelideyaopinyingdiuqi。

xishihouzuoyangfushaxingzhusheyedewendingxing：yongkepeiwudejingmaizhusheyejiangzuoyangfushaxingzhusheyexishizhinongduwei5 mg/ml，zai25°c（77°f）huodiyu25°ctiaojianxiakeyibaocun72xiaoshi，zai5°c（41°f）bingxiangzhongzhiyujingmaidizhuyongdesuliaorongqizhongkebaocun14tian。yongkepeiwudejingmaizhusheyexishiderongye，lengdongyubolipinghuojingmaidizhuyongdesuliaorongqizhong，chucunyu-20°c（-4°f），zai6geyueneikeyibaochiwending。shiwen25°c（77°f）huozhiyu8°c（46°f）bingxiangzhongrongjieyilengdongderongye。buyaoyongweibohuoshuiyujiasuqirongjie。rongjieyicihoubuyaozaifanfudongrong。

zhusheyeshiyongshuoming：shiyongqianyaojiancharongqiyouwuweixiaoshenlou。ruguoyoushenlouhuofengkoubuwanzheng，zerongyeyingdiuqi，yinweirongyekenengyijingbushiwujunde。ruguorongyehunzhuohuochuxianchendianwuzebuyingshiyong。yingshiyongwujunshebei。

jingshi：buyaojiangrongqichuanlianqilai。zheiyangkenengzaierjirongqineideyetishuwanzhiqianyouyuxiruleyijirongqineidecanliukongqierdaozhikongqishuansai。

【不良反应】

1.yanzhongdeheqitazhongyaodebuliangfanying

xiashuyanzhongheqitazhongyaodebuliangfanyingyizai【zhuyishixiang】zhongxiangxishuoming：jijianyanhejijianduanlie、zhongzhengjiwuliehua、chaominfanying、qitayanzhongheyoushizhimingdefanying、ganduxing、zhongshushenjingxitongxiaoying、nanbiansuojunxiangguanxingfuxie、zhouweishenjingbing、qtjianqiyanzhang、erkehuanzhezhongdejirougugejibing、xuetangwenluan、guangminganxing/guangduxinghenaiyaoxijunchansheng。

zuoyangfushaxingkuaisujingmaidizhuhuozhetuizhukenengdaozhidixueya。yinggenjujiliang，jingmaidizhubushaoyu60～90fenzhong。

jubaogao，shiyongkuinuotongleiyaowu（baokuozuoyangfushaxing）kenengdaozhijiejingniaoheguanxingniao。yinci，duiyujieshouzuoyangfushaxingzhiliaodehuanzhe，yingdangweichishidangdeshuihua，yifangzhixingchenggaodunongsuoniao。

2.临床试验经验

youyulinchuangshiyanzaibutongdetiaojianxiawancheng，zailinchuangshiyanzhongguanchadaodeyizhongyaowudebuliangfanyinglvbunengzhijieheqitayaowuzailinchuangshiyanzhongdebuliangfanyinglvxiangbijiao，qieweibifanyingzaishijiyingyongzhongdebuliangfanyinglv。

xiamianmiaoshudeshuju，fanyingle29geⅲqilinchuangshiyande7537minghuanzheduizuoyangfushaxingdezonghebaolu。yanjiurenqunpingjunnianlingwei50sui（yue74%derenqun＜65sui），qizhong50%weinanxing，71%weibaizhongren，17%weiheizhongren。huanzheyinweifanweiguangfandeganranxingjibingerjieshouzuoyangfushaxingzhiliao（canjianshiyingzheng）。huanzhejieshoudezuoyangfushaxingjiliangwei750 mgmeiriyici、250 mgmeiriyici、huo500 mgmeiri1huo2ci，liaochengtongchangwei3～14tian，pingjunliaochengwei10tian。

buliangfanyingdezongfashenglv、leixinghefenbuzaishiyongzuoyangfushaxing 750 mgmeiriyici、250 mgmeiriyici、huo500 mgmeiri1huo2cidehuanzhezhongleisi。zonggongyou4.3%dehuanzheyouyubuliangyaowufanyingertingyongzuoyangfushaxing，zaijieshou250 mghe500 mgmeirijiliangdehuanzhezhong，zheigebiliwei3.8%；zaijieshou750 mgmeirijiliangdehuanzhezhong，zheigebiliwei5.4%。zaijieshou250 mghe500 mgmeirijiliangdehuanzhezhongzuichangjiandedaozhitingyaodeyaowubuliangfanyingweiweichangdaofanying（1.4%），zhuyaoweiexin（0.6%）、outu（0.4%）、touyun（0.3%）hetoutong（0.2%）。zaijieshou750 mgmeirijiliangdehuanzhezhongzuichangjiandedaozhitingyaodebuliangyaowufanyingweiweichangdaofanying（1.2%），zhuyaoweiexin（0.6%）、outu（0.5%）、touyun（0.3%）hetoutong（0.3%）。

zaixiabiao（biao5hebiao6）zhongfenbieliejulefashengyu≥1%dejieshouzuoyangfushaxingzhiliaodehuanzhezhongdebuliangfanying，yijifashengyu0.1zhi＜1% jieshouzuoyangfushaxingzhiliaodehuanzhezhongdebuliangfanying。zuichangjiandebuliangfanying（≥3%）weiexin、toutong、fuxie、shimian、bianmihetouyun。

biao5：zaizuoyangfushaxinglinchuangshiyanzhongbaogaodechangjian（≥1%）buliangfanying

zhu：a. n = 7274；

b. n=3758（nvxing）。

 

biao6：zuoyangfushaxinglinchuangshiyanzhongbaogaodejiaobuchangjian（0.1zhi1%）debuliangfanying（n=7537）

   zhu： a. n = 7274。

 

zaishiyongduocijiyaozhiliaodelinchuangshiyanzhong，zhuyidaozaijieshoukuinuotongleikangshengsu，baokuozuoyangfushaxingzhiliaodehuanzhezhong，chuxianyankeyichang，baokuobaineizhanghejingzhuangtiduofadianzhuangbanpian。muqianshangweijianliyaowuhezheixieshijiandelianxi。

3.上市后监测

xiabiao（biao7）liejulezuoyangfushaxinghuodeshangshipizhunzhihouzaishiyongzhongjianbiedebuliangfanying。youyuzheixiefanyingshicongshuliangbudingderenqunzhongzifabaogaode，youshiwufakekaodipingjiazheixieshijiandefashenglv，huojianliyaowubaoluyuzheixieshijiandeyinguoguanxi。

 

biao7：shangshihouyaowubuliangfanyingbaogao

 

【禁忌】

duikuinuotongleiyaowuguominzhe、renshenjiburuqifunv、18suiyixiahuanzhejinyong。

【注意事项】

1.jijianyanhejijianduanlie

suoyounianlingzuhuanzhe，shiyongbaokuozuoyangfushaxingzaineidefukuinuotongleikangshengsujinxingzhiliaodehuanzhekenengfashengjijianyanhejijianduanliedeweixianxingzengjia。zuichangjiandebuliangfanyingbaokuoachilles genjian,bingqieachilles genjianxuyaoshoushuxiubu。yiyoubaodaofashengjijianyanhejianpoliedebuweibaokuojianbu、shou、ertouji、muzhiheqitabuweidejijian。60suiyishangzhe，huotongshishiyongtangpizhijisu，huojieshoushenzang、xinzanghefeizangyizhizhefashengfukuinuotongxiangguandejijianyanhejijianduanliedeweixianxingjinyibuzengjia。chulenianlingheshiyongtangpizhijisu，nengyinqijijianduanlieweixianxingzengjiadeyinsuhaibaokuojuliedetilihuodong、shenshuaijiehejiwangyouleifengshiguanjieyandengjijiansunhaizhe。yiyoubaodaowushangshuweixianyinsucunzaidehuanzheshiyongfukuinuotongleiyinqilejijianyanhejijianduanlie。yongyaoguochengzhonghuoyongyaojieshuhoukeyifashengjijianduanlie，yiyouyongyaojieshuhoushuyuefashengjijianduanliedebaodao。ruguohuanzhechuxiantengtong、shuizhong、yanzhenghuojijianduanlieyingtingyongzuoyangfushaxing，yifaxianyoujijianyanhuojijianduanliedezhengzhuangyinglijijianyihuanzhexiuxi，binglianxitamendeyiliaofuwurenyuankaolvhuanyongfeikuinuotongleiyaowuzhiliao。

2.重症肌无力恶化

baokuozuoyangfushaxingzaineidefukuinuotongleikangshengsuhuiyinqishenjingjirouzuduan，kenengshizhongzhengjiwulihuanzhedejiwuliehua。baokuosiwanghexuyaotongqizhichizaineideshangshihouyanzhongbuliangshijian，hezhongzhengjiwulihuanzheshiyongfukuinuotongleiyouguan。bimianyizhizhongzhengjiwulishidehuanzheshiyongzuoyangfushaxing。

3.超敏反应

shiyongbaokuozuoyangfushaxingzaineidefukuinuotongleikangshengsujinxingzhiliaodehuanzheouerhuifashengyanzhongde、youshishenzhishizhimingxingdechaominhe/huoguominfanying，zheixiefanyingduofashengzaidiyiciyongyaohou。yixiefanyingkenenghuibanyouxinxueguanxingxutuo、dixueya/xiuke、dianxianfazuo、yishisangshi、macigan、xueguanshenjingxingshuizhong（baokuoshe、hou、yanhuomianbushuizhong/zhongzhang）、qidaozusai（baokuozhiqiguanjingluan、qicujijixinghuxijiongpo）、huxikunnan、qianmazhen、saoyangjiqitayanzhongpifufanying。zaishoucichuxianpizhenhuochaominfanyingrenheqitazhengzhuangshiyinglijitingzhishiyongzuoyangfushaxing。yanzhongdejixingchaominfanyingxushiyongshenshangxiansuyuyizhiliao，tongshigenjulinchuangxuyaocaiquqitafusucuoshiruxiyang、jingmaibuye、shiyongkangzuanji、pizhileiguchun、shengyaanleiyaojiqidaochuli。

4.qitayanzhongyoushizhimingdebuliangfanying

shiyongbaokuozuoyangfushaxingzaineidefukuinuotongleikangshengsujinxingzhiliaodehuanzhezaijishaoshuqingkuangxiahuifashengyanzhongde、youshishenzhishizhimingdebuliangfanying，zheixiebuliangfanyingyouxieshuyuchaominfanying，youxiebingyinbuming。zheixiebuliangfanyingkeyihenyanzhong，tongchangfashengzaiduociyongyaohou。linchuangbiaoxianbaokuoxiashuqingkuangdeyizhonghuoduozhong：

l         fashao、pizhenhuoyanzhongdepifufanying（liruzhongduxingbiaopihuaisisongjiezheng、duoxingxinghongban）。

l         xueguanyan、guanjietong、jitong、xueqingbing。

l         guominxingfeiyan。

l         jianzhixingshenyan、jixingshengongnengbuquanhuoshenshuai。

l         ganyan、huangdan、jixingganhuaisihuoganshuaijie。

l        pinxue，baokuorongxuexingpinxuehezaishengzhangaixingpinxue；xuexiaobanjianshaozheng，baokuoxueshuanxingxuexiaoban           jianshaoxingzidian；baixibaojianshaozheng；lixibaoquefazheng；quanxuexibaojianshaozhenghe/huoqitaxueyebing。

zaishoucichuxianpizhenhuoqitachaominfanyingzhengzhuangshiyinglijitingzhiyongyaobingcaiquxiangyingdezhichicuoshi。

5.肝毒性

yishoudaojieshouzuoyangfushaxingzhiliaodehuanzhechuxianyanzhongganduxing（baokuojixingganyanhezhimingshijian）deshangshihoubaogao。zaiduichaoguo7,000minghuanzhedelinchuangshiyanzhong，weifaxianyanzhongyaowuxiangguanxingganduxingdezhengju。yanzhongganduxingtongchangzaikaishizhiliaohou14tianneichuxian，zaidaduoshubinglizhong，chuxianzaikaishizhiliao6tiannei。duoshuyanzhongganduxingbingliyuguominwuguan。daduoshuzhimingxingdeganduxingbaogaojianyunianling≥65suidehuanzhe，daduoshuyuchaominwuguan。ruguohuanzhechuxianganyandetizhenghezhengzhuang，yingdanglijitingzhishiyongzuoyangfushaxing。

6.zhongshushenjingxitongyingxiang

cengyoushiyongbaokuozuoyangfushaxingzaineidefukuinuotongleikangshengsudehuanzhechuxianjingjuehezhongduxingjingshenbingdebaodao。kuinuotongleikangshengsuyekeyidaozhiluneiyashenggaohezhongshushenjingxitongcijizhengzhuang，congeryinqizhenzhan、zaodong、jiaolv、touyun、yishimohu、huanjue、wangxiang、yiyu、emeng、shimian，jishaoshuqingkuanghaikedaozhihuanzhechanshengzishadeniantouhuoxingdong。shangshufanyingkenenghuizaidiyiciyongyaohouchuxian。ruguoshiyongzuoyangfushaxingdehuanzhechuxianzheixiefanying，yinglijitingyao，bingcaiqushidangdezhiliaocuoshi。yuqitakuinuotongleikangshengsuxiangtong，ruyizhihuohuaiyihuanzhehuanyourongyifashengdianxianhuodianxianfazuoyuzhijiangdi（liruyanzhongdenaodongmaiyinghua、dianxian）decnsjibinghuocunzaiqitaweixianyinsuerrongyifashengdianxianhuodianxianfazuoyuzhijiangdi（lirushiyongmouxieyaowujinxingzhiliao、shengongnengbuquan）dehuanzheyingshenyongzuoyangfushaxing。

7.nanbiansuojunxiangguanxingfuxie

jubaogao，jihusuoyoudekangshengsu（baokuozuoyangfushaxing）junyoukenengyinqinanbiansuojunxiangguanxingfuxie（cdad），yanzhongchengdukeyouqingdufuxiedaozhimingxingchangyan。kangshengsuzhiliaokeyigaibianjiechangdezhengchangjunqun，shinanbiansuojundaliangfanzhi。nanbiansuojunkeyichanshengdusuahedusub，jinercujincdaddefasheng。youyuganranbinglidekangjunzhiliaonanyiqixiaobingqiekenengxuyaojiechangqiechushuzhiliao，chanchaodusudenanbiansuojunjunzhukeyizengjiagaibingdefabinglvhesiwanglv。duiyushiyongkangshengsuhouchuxianfuxiedesuoyouhuanzheyingkaolvcdad。jubaogao，cdadchuxianzaishiyongkangshengsu2geyuehou，yinciyoubiyaozixixunwenbingshi。

ruguohuaiyihuozheyijingquezhencdad，zexuyaotingzhibuzhijiezhenduinanbiansuojundekangjunzhiliao。anzhaolinchuangxuyaojinxingheshideyetihedianjiezhiguanli、buchongdanbai、jiyukangnanbiansuojunzhiliaoyijijinxingshoushuzhiliaopingjia。

8.外周神经病变

使用包括左氧氟沙星在内的氟kuinuotongleikangshengsujinxingzhiliaodehuanzhehanyouchuxianganjueshenjinghuoganjueyundongshenjingzhoutudeduoshenjingyuanbing，bingbiankeleijixixiaozhoutuhe/huodaxingzhoutu，daozhiganjuecuoluan、ganjuechidun、chuwutongganhewuli。ruguohuanzhechuxianshenjingyuanbingdezhengzhuangrutengtong、shaozhuogan、macigan、mamuhe/huowulihuoqitaganjuecuoluanruqingchujue、tongjue、wendujue、weizhijuehezhendongjueyichangshi，yinglijitingzhishiyongzuoyangfushaxingyimianfazhanweibukenixingsunshang。

9.QT间期延长

baokuozuoyangfushaxingzaineidemouxiefukuinuotongleikangshengsukeyishixindiantudeqtjianqiyanzhang，shaoshuhuanzhekeyichuxianxinlvshichang。shangshihoujianceqijianzifabaogaojieshoubaokuozuoyangfushaxingzaineidekuinuotongleikangshengsuzhiliaodehuanzhechuxianjianduanniuzhuanxingshisudehuanzhehanjian。yizhiqtjianqiyanzhangdehuanzhe，weijiuzhengdedixuejiahuanzhejishiyongialei（kuiniding、pulukayinan）heⅲlei（andiantong、suotaluoer）kangxinlvshichangyaowudehuanzheyingbimianshiyongzuoyangfushaxing。laonianhuanzhegengrongyiyinqiyaowuxiangguandeqtjianqideyingxiang。

10.erkehuanzhezhongdejirougugejibinghedongwuzhongdeguanjiebingxiaoying

zaierkehuanzhe（≥6geyue）zhong，zuoyangfushaxingjinshiyongyutanjuxiru（baoluhou）debaohu。heduizhaoxiangbi，zaijieshouzuoyangfushaxingdeerkehuanzhezhongguanchadaojirougugejibing（guanjietong、guanjieyan、jijianbingzhenghebutaiyichang）fabinglvdezengjia。

zaiweichengniandedashuhegouzhong，koufuhejingmaijiyuzuoyangfushaxingdaozhiguruangubingdezengjia。duiyujieshouzuoyangfushaxingdeweichengniangouchengzhongguanjiedezuzhibinglixuejianchaxianshicunzairuangudechixusunshang。qitakuinuotongleiyaowuyekezaiduogewuzhongdeweichengniandongwuzhongchanshengchengzhongguanjieleisidemilan，yijiguanjiebingdeqitatizheng。

11.血糖紊乱

yuqitafukuinuotongleikangshengsuxiangtong，cengyouguanyuxuetangwenluanruzhengzhuangxinggaoxuetanghedixuetangdebaodao，zheizhongqingkuangduofashengyutongshikoufujiangtangyao（ruyoujiangtang/geliebenniao）huoshiyongyidaosudetangniaobinghuanzhe。yinciduiyucileihuanzhe，jianyiyingmiqiejianceqixuetangbianhuaqingkuang。ruguohuanzhezaijieshouzuoyangfushaxingzhiliaoshichuxiandixuetangfanying，yinglijitingzhishiyongzuoyangfushaxingbingcaiqushidangdezhiliaocuoshi。

12.guangminganxing/guangduxing

shiyongfukuinuotongleiyaowukenengdaozhiriguanghuoziwaiguangbaoluhouzhongduzhizhongdudeguangminganxing/guangduxingfanying，houzhekenengbiaoxianweibaoluyuguangzhaobuwei（dianxingzhebaokuomianbu，jingbuvqu，qianbeishence，shoubei）deguoduderishaifanying（liru，shaishang、hongban、shenchu、shuipao、dapao、shuizhong）。yinci，yingdangbimianguodubaoluyushangshuguangyuan。ruguofashengguangminganxing/guangduxingzeyingtingyao。

13. naiyaojundechansheng

zaishangweiquezhenhuogaoduhuaiyixijunganranyijibufuheyufangshiyingzhengdeqingkuangxiakaizuoyangfushaxingchufangbingbuhuiweihuanzhedailaiyichu，bingkezengjiachanshengnaiyaojundefengxian。

【yunfujiburuqifunvyongyao】

妊娠

huaiyunyongyaofenjic。dashukoufujilianggaoda810 mg/kg/tianshi，zuoyangfushaxingmeiyouzhijizuoyong，zheiyijiliangxiangdangyuxiangduitibiaomianjixiangtongshirenleizuidatuijianjiliangde9.4bei。jingmaidizhujiliangwei160 mg/kg/tianshi，zuoyangfushaxingyemeiyouzhijizuoyong，zheiyijiliangxiangdangyuxiangduitibiaomianjixiangtongshirenleizuidatuijianjiliangde1.9bei。dashukoufujiliangwei810 mg/kg/tianshikeyishitaishutizhongjiangdi，siwanglvzengjia。tukoufujiliangda50 mg/kg/tianshi，weiguanchadaozuoyangfushaxingjuyouzhijizuoyong，zheiyijiliangxiangdangyuxiangduitibiaomianjixiangtongshirenleizuidatuijianjiliangde1.1bei。jingmaidizhujiliangwei25 mg/kg/tianshi，zuoyangfushaxingyemeiyouzhijizuoyong，zheiyijiliangxiangdangyuxiangduitibiaomianjixiangtongshirenleizuidatuijianjiliangde0.5bei。

danduirenshenfunvhaiweijinxingzugoudesheyoulianghaoduizhaodeshiyan，bunengquebaorenshenfunvdeyongyaoanquan，suoyirenshenhuoyoukenengrenshendefunvjinyong。zhiyoudangduitaierdeqianzaiyichudayuqianzaiweixianshicainengjiangzuoyangfushaxingyongyurenshenfunv。

 buruqifunv

genjuqitafukuinuotonghezuoyangfushaxingyouxiandeshuju，tuicezuoyangfushaxingyingkeyifenmizhirenleimuruzhong。youyuzuoyangfushaxingkenenghuiduimuruweiyangdeyingerchanshengyanzhongbuliangfanying，yinciburuqifunvjinyong。zhiyoudangduiburuqifunvqianzaiyichudayuqianzaiweixianshicainengjiangzuoyangfushaxingyongyuburuqifunv，danyingzantingburu。

【儿童用药】

baokuozuoyangfushaxingzaineidekuinuotongleikangshengsukeyiyinqimouxiezhongshudongwudeyoutifashengguanjiebingbianhegu/ruangubingbian。duiertongdeanquanxingshangweiqueli，gujinyongyuxiaoyu18suidehuanzhe，danyongyutanjuxiru（baoluhou）debaohuchuwai。

xiruxingtanju（baoluhou）

zuoyangfushaxingshiyongyuerkexiruxingtanju（baoluhou）huanzhe。fengxian-shouyipinggutishi，zaierkehuanzhezhongjiyuzuoyangfushaxingshishihede。shangweizaierkehuanzhezhongduiweiqi14tianyishangdezuoyangfushaxingzhiliaodeanquanxingjinxingyanjiu。zainianlingwei6geyuezhi16suideerkehuanzhezhong，duidancijingmaizhushezuoyangfushaxingdeyaodaidonglixuejinxingleyanjiu。zaiertonghuanzhezhong，zuoyangfushaxingdeqingchusudukuaiyuchengrenhuanzhe，yincizaitedingdemg/kgjiliangxia，suodedexuejiangbaolushuipingdiyuchengren。

不良反应

zailinchuangshiyanzhong，1534mingertong（nianling6geyuezhi16sui）jieshoulekoufuhejingmaizuoyangfushaxingzhiliao。nianlingzai6geyuezhi5suideertongjieshou10 mg/kgmeiri2cidezuoyangfushaxing，nianlingchaoguo5suideertongjieshou10 mg/kgmeiriyicidezuoyangfushaxing（zuidajiliangweimeiri500 mg），zongliaochengwei10tian。

zailinchuangshiyanzhongyigeyazudeertong（1340mingjieshouzuoyangfushaxingzhiliao，893mingjieshoufeifukuinuotongleiyaowuzhiliao）canyuleyixiangqianzhanxingzhangqijianceyanjiu，yipingguzaidiyicijiyuyanjiuyaowu60tianhe1nianhoudeshiyanfangandingyidejirougugejibing（guanjietong、guanjieyan、jijianbingzheng、butaiyichang）defashenglv。jieshouzuoyangfushaxingzhiliaodeertongjirougugejibingdefashenglvxianzhudigaoyufeifukuinuotongleiyaowuzhiliaodeertong，ruxiabiao

（表8）所示。

biao8：erkelinchuangshiyanzhongdejirougugejibingfashenglv

zhu：a.feifukuinuotonglei：toubaoqusong、amoxilin/kelaweisuan、kelameisu。

b.shuangcefisher’sjingquexingshiyan。

c.dui1199mingzuoyangfushaxingzhiliaodeertonghe804mingfeifukuinuotongleiyaowuzhiliaodeertongjinxingleweiqi1niandepingjiafangshi。raner，jirougugejibingdefabinglv，caiyongzaizhidingqijianneisuoyoucanyushiyanertongdesuoyoubaogaoshijianjisuan，buguantamenshifouwanchengweiqi1niandepingjiafangshi。

zailianggezhiliaozuzhong，guanjietongdoushizuichangfashengdejirougugejibing。zailianggezuzhong，juedaduoshujirougugejibingshejiduogechengzhongguanjie。jibingzai8/46（17%）zuoyangfushaxingzhiliaodeertongzhongweizhongdu，zai35/46（76%）zuoyangfushaxingzhiliaodeertongzhongweiqingdu，daduoshujieshoulezhentongjizhiliao。zuoyangfushaxingzhiliaozudezhongweihuanjieshijianwei7tian，zaifeifukuinuotongyaowuzhiliaozuzhongweihuanjieshijianwei9tian（zailianggezuzhong，junyouyue80%dehuanzhezai2geyueneihuanjie）。meiyouertongchuxianyanzhonghuozhongdadejibing，suoyougugejiroujibinghuanjieweiyiliuhouyizheng。

outuhefuxieshizuichangbaogaodebuliangshijian，zaizuoyangfushaxingzhiliaozuhefeifukuinuotongyaowuzhiliaozuzhongfashenglvxiangsi。

chulezaierkehuanzhelinchuangshiyanzhongbaogaodeshijian，zaichengrenhuanzhezhongyulinchuangshiyanhuoshouhoujiancezhongbaogaodeshijianyekenengfashengyuerkehuanzhezhong。

【老年用药】

laonianhuanzhezaijieshoufukuinuotongleiyaowu，liruzuoyangfushaxingqijian，yanzhongbuliangfanying（jijianbingzhengbaokuojijianduanlie）defengxianzengjia。zaijieshoutangpizhijisulianhezhiliaodehuanzhezhong，zheigefengxianjinyibuzengjia。jijianyanhuojijianduanliekeleijizhongbu、shoubu、jianbuhuoqitajijianbuwei，bingkezaizhiliaoqijianhuozhiliaojieshuhoufasheng。cengbaogaolefukuinuotongleiyaowuzhiliaojieshuhoujigeyuefashengdebingming。zailaonianhuanzhe，youqishijieshoutangpizhijisuzhiliaodehuanzhezhong，bixushenyongzuoyangfushaxing。bixujiangzheixieqianzaidefuzuoyonggaozhihuanzhe，ruguochuxianjijianyanhuojijianduanliederenhezhengzhuang，jianyitingzhizuoyangfushaxingzhiliao，bingyuyiliaobaojianrenyuanqudelianxi。

zaiⅲqilinchuangshiyanzhong， 1,945mingjieshouzuoyangfushaxingzhiliaodehuanzhe（26％）nianling≥ 65sui，1081ming（14％）nianlingjieyu65zhi74suizhijian，864ming（12％）nianlingdengyuhuodayu75sui。zheixiehuanzhehenianlingjiaoxiaohuanzheyaowudeanquanxingheyouxiaoxingwumingxianchayi，danbingbunengpaichumouxielaonianhuanzhedeminganxingkenenghuigenggao。

shangshibaogaozhong，yiyouyuzuoyangfushaxingyouguandeyanzhong，shenzhizhimingdeganduxing。zhuyaodezhimingxingganduxingbaogaofashengzai65suihuogengdanianlingzhong，qiedaduomeiyouguominfanying。ruguohuanzheyouganyandezhengzhuanghuozhizhengyinglijitingyongzuoyangfushaxing。

laonianhuanzhekenengduiqtjianqideyaowuxiangguanxingzuoyonggengmingan。yincitongshishiyongzuoyangfushaxinghemouxiekeyidaozhiqtjianqiyanzhangdeyaowu（liruiahuoⅲleikangxinlvshichangyao）huocunzaijianduanniuzhuanxingshisuweixianyinsu（ruyizhiqtjianqiyanzhang、wanguxingdixuejia）dehuanzheshiyongzuoyangfushaxingshiyingjinshen。

ruguokaolvjiganqingchulvdechayi，neimeqingnianshoushizhehelaonianshoushizhezuoyangfushaxingdeyaodaidonglixuetezhengmeiyouxianzhuchabie。danshiyouyuzuoyangfushaxingdabufenshicongshenzangpaixiede，yincishengongnengsunhaidehuanzhefashengyaowuduxingfanyingdeweixianxingjiaogao。erlaonianhuanzheshengongnengjiantuidekenengxingjiaoda，yincixuanzejiliangshiyingtebiejinshen，erqiexuyaotongshijianceshengongneng。

【药物相互作用】

1.aoheji：kangsuanji、liutanglv、jinshuyanglizi、duozhongweishengsuzhiji

左氧氟沙星口服制剂

suiranzuoyangfushaxingyuerjiayanglizideaohezuoyongruoyuqitafukuinuotongleikangshengsu，dantongshishiyongzuoyangfushaxingkoufuzhijihekangsuanjirumeihuolvyijiliutanglv、jinshuyanglizilirutiejihanxindeduozhongweishengsuzhijirengkeyiyingxiangzuoyangfushaxingdeweichangxishou，daozhiquanshenyaowunongduxianzhudiyuyuqinongdu。hanyoukangsuanjirumeihuolvyijiliutanglv、jinshuyanglizilirutiejihanxindeduozhongweishengsuzhijihuoquqiangjigandeyaowukeyimingxianyingxiangzuoyangfushaxingdeweichangxishou，daozhiquanshenyaowunongduxianzhudiyuyuqi。zheixieyaowuyingzhishaozaifuyongzuoyangfushaxingqianliangxiaoshihuofuyaohouliangxiaoshifuyong。

左氧氟沙星注射剂

shangwuguanyujingmaidizhukuinuotongleikangshengsuyukoufukangsuanji、liutanglv、duozhongweishengsuzhiji、quqiangjiganhuojinshuyanglizizhijianxianghuzuoyongdeshuju。danshikuinuotongleikangshengsubuyingyurenhehanyouduojiayanglizirumeiderongyetongguotongyijingmaishuyetongdaodizhu。

2.华法林

yixiangzaijiankangzhiyuanzhezhongjinxingdelinchuangshiyanxianshizuoyangfushaxingduir-hes-huafalindexuejiangfengnongdu、aucheqitadaixiecanshumeiyoumingxianzuoyong。tongyangyeweiguanchadaohuafalinduizuoyangfushaxingdexishouhedaixieyoumingxianzuoyong。cengyoushangshihoujiancebaogaozhichuzuoyangfushaxingkeyizengqianghuafalindeyaoxiao。tongshiyingyonghuafalinhezuoyangfushaxingkeyiyanzhangningxuemeiyuanshijian，congerdaozhichuxueshijianyanzhang。tongshiyingyongzuoyangfushaxinghehuafalinshiyingmiqiejianceningxuemeiyuanshijian、guojibiaozhunhuabizhi（inr）huoqitakangningshiyan，bingzhuyihuanzheyouwuchuxuedebiaoxian。

3.抗糖尿病药物

lianheyingyongkuinuotongleikangshengsuhekangtangniaobingyaowudehuanzhekenengchuxianxuetangwenluanrugaoxuetanghedixuetang。yinci，tongshiyingyongzheixieyaowushiyingmiqiejiancexuetangshuiping。

4.feizaitileikangyanyaowu

tongshishiyongfeizaitileikangyanyaowuhebaokuozuoyangfushaxingzaineidekuinuotongleikangshengsukeyizengjiafashengcnscijihechouchufazuodeweixian。

5.茶碱

zaiyixiangyou14mingjiankangzhiyuanzhecanjiadelinchuangshiyanzhongweifaxianzuoyangfushaxingduichajiandexuejiangnongdu、aucjiqitadaixiecanshuyoumingxianyingxiang。tongyangyeweiguanchadaochajianduizuoyangfushaxingdexishouhedaixieyoumingxianzuoyong。danshi，tongshiyingyongqitakuinuotongleikangshengsuhechajiankedaozhihuanzhechajiandeqingchubanshuaiqiyanzhang、xueyaonongdushenggao，congerzengjiachajianxiangguanbuliangfanyingdefashenglv。yinci，yuzuoyangfushaxingtongshishiyongshi，yingmiqiejiancechajianshuipingbingduiyaowujiliangjinxingshidangdiaozheng。wulunchajiandexueyaonongdushifoushenggaojunyoukenengchuxianbuliangfanyingrudianxian。

6.环孢霉素

yixiangzaijiankangzhiyuanzhezhongjinxingdelinchuangshiyanxianshizuoyangfushaxingduihuanbaomeisudexuejiangfengnongdu、aucheqitadaixiecanshumeiyoumingxianzuoyong。dancengyoubaodaoyuqitamouxiekuinuotongleikangshengsutongshishiyongshi，huanzhedehuanbaomeisuxueyaoshuipingshenggao。yuqitawubansuiyongyaodeshiyanxiangbi，tongshishiyonghuanbaomeisukeyiqingdujiangdizuoyangfushaxingdecmaxheke，ertmaxhet1/2shaoyouyanzhang，dancichayibingbujuyoulinchuangyiyi。yinci，tongshishiyongshibuxudiaozhengzuoyangfushaxinghehuanbaomeisudejiliang。

7. digaoxin

yixiangzaijiankangzhiyuanzhezhongjinxingdelinchuangshiyanxianshizuoyangfushaxingduidigaoxindexuejiangfengnongdu、aucheqitadaixiecanshumeiyoumingxianzuoyong。digaoxinduizuoyangfushaxingdexishouhedaixiedonglixueyemeiyouxianzhuyingxiang。yinci，tongshishiyongshibuxudiaozhengzuoyangfushaxinghedigaoxindejiliang。

8.binghuangshuheximitiding

yixiangzaijiankangzhiyuanzhezhongjinxingdelinchuangshiyanxianshibinghuangshuhuoximitidingduizuoyangfushaxingdexishousulvhexishouchengdumeiyoumingxianzuoyong。yuzuoyangfushaxingdanduyongyaoshixiangbi，yubinghuangshuhuoximitidinglianheyongyaoshi，zuoyangfushaxingdeauchet1/2fenbieshenggao27%～38%he30%，cl/fheclrjiangdi21%～35%。suiranzheiyichayijuyoutongjixuexianzhuxing，danyubinghuangshuhuoximitidinglianheyongyaoshibuxuyaodiaozhengzuoyangfushaxingdejiliang。

9.yushiyanshihuozhenduanjianchadexianghuzuoyong

baokuozuoyangfushaxingdefukuinuotong，yongshishoushijihejinxingniaoshaichaapianzhijikenenghuichanshengjiayangxingjieguo，youbiyaocaiyonggengteyidefangfaquedingapianyangxingjieguo。

【药物过量】

zuoyangfushaxingdejixingduxinghendi。dancijiyudajiliangzuoyangfushaxinghou，xiaoshu、dashu、gouhehoukeyichuxianxialielinchuangtizheng：gongjishidiao、shangjianxiachui、zifahuodongjianshao、huxikunnan、shuaijie、zhenzhanjijingjue。koufujiliangchaoguo1500 mg/kgjizhushejiliangchaoguo250 mg/kgshikeshiniechileidongwusiwanglvxianzhushenggao。

kuinuotongleiyaowuguoliangshi，kechuxianyixiazhengzhuang：exin、outu、weitong、weizhuore、fuxie、kouke、kouqiangyan、panshan、touyun、toutong、quanshenjuandai、mamugan、faleng、fare、zhuitiwaixizhengzhuang、xingfen、huanjue、chouchu、zhankuang、xiaonaogongjishidiao、luneiyashenggao（toutong、outu、shishenjingrutoushuizhong）、daixiexingsuanzhongdu、xuetangzenggao、got/gpt/alpzenggao、baixibaojianshao、shisuanxinglixibaozengjia、xuexiaobanjianshao、rongxuexingpinxue、xueniao、ruangu/guanjiezhangai、baineizhang、shilizhangai、sejueyichangjifushi。

jixingguoliangshiyingxiwei（jinzaifuyongkoufuzhijishi），guanchabingjiyushui、dianjiezhizhichiliaofa。xueyetouxihuofumotouxibunengyouxiaoqingchuzuoyangfushaxing。

急救措施及解毒药：

（1）    shuye（jiabaoganyaowu）：daixiexingsuanzhongdujiyutansuanqingnazhusheye，niaojianhuajiyutansuanqingnazhusheye，yizengjiabenpinyoushenzangdepaixie。

（2）qiangzhiliniao：jiyufunanbenansuanzhusheye。

（3）duizhengliaofa：chouchushiyingfanfujiyuandingjingmaizhusheye。

【临床试验】

zuoyangfushaxingdelinchuangshiyanqingkuangruxia：

1.医院获得性肺炎

jinglinchuanghefangshexuequezhenweiyiyuanhuodexingfeiyandechengnianhuanzheruxuanyixiangduozhongxin、suiji、kaifangshiyan，bijiaoliangzhongzhiliaofangandezhiliaoxiaoguo。yizhongzhiliaofanganshixianjingmaijiyuzuoyangfushaxing（meici750 mg，meiriyici）zaikoufuzuoyangfushaxing（meici750 mg，meiriyici），liaocheng7～15tian。lingyizhongzhiliaofanganshixianjingmaijiyuyaanpeinan/xisitading(meici500～1000 mg，mei6～8 xiaoshiyici)zaikoufuhuanbingshaxing(meici750 mg，mei12xiaoshiyici)，liaocheng7～15tian。zuoyangfushaxingzhiliaozuhuanzhepingjunjieshoule7tianjingmaizhiliao（fanwei：1～16tian）；erduizhaozuhuanzhepingjunjieshoule8tianjingmaizhiliao（fanwei：1～19tian）。

zaijieshoulinchuangheweishengwuxuepingjiadequanburenqunzhong，zuoyangfushaxingzude93minghuanzhezhongyou56ming（60.2％）huanzhezaishiyankaishishijigenjujingyanjiyulefuzhuzhiliao，erduizhaozude94minghuanzhezhongyou53ming（56.4％）。zuoyangfushaxingzufuzhuzhiliaopingjunchixu7tian，erduizhaozuyewei7tian。zaitonglvjiadanbaojunganrandeqiejinxinglelinchuangheweishengwuxuepingjiadehuanzhezhong，zuoyangfushaxingzu17minghuanzhezhongyou15ming（88.2％）jieshouletoubaotading（n＝11）huopailaxilin/sanzuobatan（n=4）zhiliao，erduizhaozude17minghuanzhezhongyou16ming（94.1％）jieshouleanjitangganleikangshengsudezhiliao。zaiyiweinaijiayangxilinjinhuangseputaoqiujunganranqiejinxinglelinchuangheweishengwuxuepingjiadequanbuhuanzhezhong，zuoyangfushaxingzu93minghuanzhezhongde37ming（39.8％）tongshishiyonglewangumeisujinxingzhiliao，erduizhaozude94minghuanzhezhongyou28ming（29.8％）huanzhetongshishiyonglewangumeisujinxingzhiliao。

zhiliaohousuifang（jieshuzhiliaohoudi3～15tianduizhuyaoshiyanzhongdianjinxingpingjia）faxian，zaijinxinglelinchuangheweishengwuxuepingjiadehuanzhezhong，zuoyangfushaxingdelinchuangyouxiaolvwei58.1％，erduizhaozuwei60.6％。youxiaolvchayi（zuoyangfushaxingzujianquduizhaozu）de95％ ciwei[-17.2, 12.0]。zhiliaohousuifangfaxian，zuoyangfushaxingzubingyuanjundeqingchulvwei66.7％，erduizhaozuwei60.6％。qingchulvchayi（zuoyangfushaxingzujianquduizhaozu）de95％ ciwei[-8.3, 20.3]。genjubingyuanjunfenlei，qilinchuangyouxiaolvhebingyuanjunqingchulvfenbieruxiabiao（biao9）suoshi：

biao9：linchuangyouxiaolvhebingyuanjunqingchulv（yuanneifeiyan）

zhu：a. jiayangxilinmingandejinhuangseputaoqiujun。

b. lianhezhiliaocanjianshangshuwenzi。

c. linchuangheweishengwuxuejieguobimingdechayikenengfanyinglebenshiyanzhongweikaolvdeyixieyinsu。

2.shequhuodexingxijunxingfeiyan

7～14天治疗方案

zailiangxiangzhongyaodelinchuangshiyanzhongduizhenduanweishequhuodexingxijunxingfeiyandechengnianzhuyuanbingrenhemenzhenbingrenjinxinglepingjia。590minghuanzheruxuandiyixiangqianzhanxing、duozhongxin、feimangfasuijishiyan，bijiaoleliangzhongzhiliaofangandeliaoxiao，diyizhongzhiliaofanganshikoufuhuojingmaijiyuzuoyangfushaxing500 mg，meiriyici，lianxujiyao7～14tian，dierzhongzhiliaofanganshijingmaijiyutoubaoqusong1～2 g，meiriyicihuojiangjiliangdengfen，meirijiyaoliangci，tongshifuyongtoubaofuxinzhi500 mg，meiriliangci，gongzhiliao7～14tian。ruguohuaiyihuoyizhengshiyoufeidianxingbingyuanjunyinqiganrandeduizhaozuhuanzhekeyishiyonghongmeisu（ruguobunengnaishouhongmeisu，keyiyongqianglimeisutidai）jinxingzhiliao。zhiliaoqijian、zhiliaohou5～7tianjizhiliaohou3～4zhoujinxinglinchuangheweishengwuxuepingjia。genjubenshiyanzhongsuoyongdezhuyaoyouxiaoxingcanshupanduan，zhiliaohou5～7tianzuoyangfushaxingdelinchuangyouxiaolv（zhiyujiagaishan）（95％）gaoyuduizhaozu（83％）,tongjixuebijiaomingxianchayi（zuoyangfushaxingzujianquduizhaozu）de95％ ciwei[-6, 19]。264minghuanzhecanjialedierxiangqianzhanxing、duozhongxin、feibijiaoshiyan，shiyanzhongkoufuhuojingmaijiyuzuoyangfushaxing500 mg，meiriyici，gong7～14tian，linchuangyouxiaolvwei93％。zaishangshuliangxiangshiyanzhong，duiyoufeiyanyiyuanti、feiyanzhiyuantihefeiyanjuntuanjunyinqidefeidianxingxingfeiyandelinchuangyouxiaolvfenbiewei96％、96％he70％，weishengwuqingchulvruxiabiao（biao10）suoshi：

biao10：shequhuodexingxijunxingfeiyanlinchuangyanjiudeweishengwuqingchulv

 

youduozhongnaiyaoxingfeiyanlianqiujun（mdrsp）yinqideshequhuodexingfeiyan

zuoyangfushaxingkeyiyouxiaozhiliaoyouduozhongnaiyaoxingfeiyanlianqiujun（mdrsp）yinqideshequhuodexingfeiyan。mdrsp（duozhongnaiyaoxingfeiyanlianqiujun）zhiduixialieliangzhonghuoduozhongkangjunyaowunaiyaodejunzhu：qingmeisu（mic ≥ 2 µg/ml），erdaitoubaojunsu（rutoubaofuxin）、dahuanneizhilei、sihuansujijiayangbiananmiding/huanganjiakouezuo。dui40mingganranmdrspdehuanzhejinxingleweishengwuxuepingjia，qizhong38minghuanzhe（95.0％）jingguozhiliaohouqudelelinchuanghexijunxuedechenggong。linchuanghexijunxuedeyouxiaolvjianxiabiao（biao11）。

biao11：zuoyangfushaxingzhiliaomdrspyinqidecapdelinchuanghexijunxueyouxiaolv（qunti：shihejinxingyouxiaolvyanjiu）

zhu：a.n=jinxingweishengwuxuepingjiadelinchuangyouxiaodehuanzherenshu；n=zhidingnaiyaozujinxingweishengwuxuepingjiadehuanzherenshu。

b.n=jinxingweishengwuxuepingjiadehuanzhezhongmdrspjunqunbeiqingchuhuotuiceyibeiqingchudehuanzherenshu；n=zhidingnaiyaozumdrspzhongqungeshu。

c.cong1minghuanzheqihuxidaozhongfenlichuduisihuansu、toubaofuxin、dahuanneizhileikangshengsuhetmp/smxnaiyao，duiqingmeisuzhongdunaiyaodexijun，erxueyebiaobenzhongdexijunduiqingmeisuhetoubaofuxinzhongdunaiyao，duiqitaleikangshengsunaiyao。shujukuzhongbaokuodegaihuanzheshujushiqihuxidaofenlichudexijunshuju。

fenlichudejunqunbingfeiduisuoyoushiyandekangjunyaodounaiyao。xiabiao（biao12）zongjieleyouxiaolvheqingchulv。

biao12：naiyaofeiyanlianqiujundelinchuangyouxiaoxinghexijunqingchulv（shequhuodexingfeiyan）

 

5天治疗方案

528mingjinglinchuanghefangshexuequezhenweiqingduzhizhongdushequhuodexingfeiyandemenzhenhezhuyuanchengnianhuanzhecanjialeyixiangshuangmang、suiji、qianzhanxing、duozhongxinshiyan，yipingjiazuoyangfushaxingzaijiliangjiaogaoheliaochengjiaoduanshideanquanxingheyouxiaoxing。shiyanduizuoyangfushaxing750 mglianxujingmaizhushehuokoufuyongyao5tianhougaiweizuoyangfushaxing500 mg jingmaizhushehuokoufulianxuyongyao10tianliangzhongzhiliaofanganjinxinglebijiao。

zuoyangfushaxing750 mgzulinchuangyouxiaolv（zhiyujiagaishan）wei90.9％，500 mgzuwei91.1％。youxiaolvchayi（zuoyangfushaxing750 mgzujianquzuoyangfushaxing500 mgzu）de95％ ciwei[-5.9, 5.4]。zaijinxinglinchuangpingjiaderenqunzhong（canjiashiyanhou31～38tian），zuoyangfushaxing750 mgzude151minghuanzhezhongyou7mingfashengfeiyan，500 mgzude147minghuanzhezhongyou2mingfashengfeiyan，youyuyangbenliangjiaoxiao，chayibujuyoutongjixuexianzhuxing。xiabiao（biao13）miaoshule5tianzhiliaofanganduiyixiaweishengwuganrandeyouxiaoxing。

biao13：weishengwuqingchulv（shequhuodexingfeiyan）

 

3.jixingxijunxingbidouyan

5tianhe14tianzhiliaofangan

zuoyangfushaxingyibeipizhunyongyuzhiliaojixingxijunxingbidouyan(abs)，anzhao750 mg meiriyicilianxukoufu5tianhuo500 mgmeiriyicilianxukoufu10～14 tianjiyao。weilepingjiaduanqishiyonggenggaojiliangdezuoyangfushaxingdeanquanxingheliaoxiao，zaiyixiangshuangmang、suiji、qianzhanxing、duozhongxinyanjiuzhong，pingjiale780mingjinglinchuanghefangshexuequezhenweijixingxijunxingbidouyandechengnianmenzhenhuanzhe，yibijiaozuoyangfushaxing750 mg meiriyicilianxujiyao5tianhezuoyangfushaxing500 mg meiriyicilianxujiyao10tianliangzhongjiyaofangandechayi。

zaizhiyujianyanfangshishi，zuoyangfushaxing750 mgzuweishengwuxuepinggurenqundelinchuangchenggonglv(dingyiweizhiliaoqianabstizhengyuzhengzhuangchedihuobufenhuanjie：jirenweimeiyoubiyaojinxingjinyibudekangshengsuzhiliao)shi91.4%(139/152)，zuoyangfushaxing500mgzushi88.6% (132/149)，zuoyangfushaxing750mgjianquzuoyangfushaxing500mgde95%ci [-4.2, 10.0]。

zairuzuyanjiushitongguodouqingpai（antral tap）huodebiaobendeweishengwuxuepinggurenqunzhong，anbingyuanjunhuafendelinchuangchenggonglvbiaoming，5tianhe10tianfangandezhiliaohou22tiandezhiyujianyanfangshidejieguoxiangdang。

biao14：jinxingweishengwuxuepinggudedouchuancihuanzheanbingyuanjunhuafendelinchuangchenggonglv

（jixingxijunxingbidouyan）

 zhu：*benshiyanzhong40％deshoushizhetongguodouneikuijingfahuodebiaoben。yongneikuijingfadedaolaidebiaobendeshoushizhedeliaoxiaoshujuyushangbiaozhongjichudeshujuxiangdang。

 

4.fuzaxingpifuhepifuruanzuzhiganran

399minghuanzhecanjialeyixiangyouguanfuzaxingpifuhepifuruanzuzhiganrandekaifang、suiji、bijiaoshiyan。huanzhesuijijieshouzuoyangfushaxing750 mg （xianjingmaizaikoufu，meiriyici）huopizhundeduizhaoyaowuzhiliao，zhiliaoshijiandezhongweishuwei10 ± 4.7tian。zhengrusuoyuqide，duiyufuzaxingpifuhepifuruanzuzhiganran，zuoyangfushaxingzuheduizhaozujunyouhuanzhexuyaojinxingshoushuzhiliao。zuoyangfushaxingzhiliaozuheduizhaozuxushoushuzhiliao（qiekai，yinliuhuoqingchuang）dehuanzhefenbieyou45％he44％，shoushushaozaoyukangshengsuzhiliaohuozaikangshengsuzhiliaoqijianjinxing，shuyucileijibingdezhiliaofangfadeyibufen。

duiyuneixiezaishiyanyaowuzhiliaojieshuhou2～5tiankeyijinxinglinchuangpingjiadehuanzhe，zuoyangfushaxingzhiliaozuheduizhaozuzongtiyouxiaolv（gaishanhuozhiyu）fenbiewei116/138（84.1％）he106/132（80.3％）。

youxiaolvgenjuganranleixingeryousuochabie，kuiyangganranhuanzhedeyouxiaolvwei68％，ershangkouganranhenongzhonghuanzhedeyouxiaolvwei90％，qiyouxiaolvyuduizhaoyaopinxiangdang。

5.manxingxijunxingqianliexianyan

linchuangzhenduanweiqianliexianyandechengnianhuanzheruxuanyixiangduozhongxin、suiji、shuangmangshiyan，zheixiehuanzhezaijinxingqianliexiananmo（vb3）houcaijiniaoyebiaobenhuotongguomeares-stameyfenduanfahuodeqianliexiananmoye（eps）jinxingxijunpeiyang。zheixiangshiyanbijiaolemeicikoufuzuoyangfushaxing500 mg、meiriyici，yongyao28tianhemeicikoufuhuanbingshaxing500 mg、meiriliangci，yongyao28tiandezhiliaoxiaoguo。jinxingweishengwuxuepingjiahuanzhedezhuyaoxiaolizhongdianshiweishengwuxueyouxiaoxing。

zuoyangfushaxingzuhehuanbingshaxingzufenbieyou136minghe125minghuanzhejinxingleweishengwuxuepingjia。zuoyangfushaxingzuhehuanbingshaxingzuzaizhiliaojieshuhou5～18tiandeweishengwuxueqingchulvfenbiewei75.0％he76.8％[zuoyangfushaxingzujianquhuanbingshaxingzuhou95％ ciwei(-12.58, 8.98)]。xiabiao（biao15）zhongliechulezhuyaobingyuanjundezongtiqingchulv：

biao15：bingyuanjundeqingchulv（manxingxijunxingqianliexianyan）

zhu：biaozhongsuolieqingchulvweizhiganranyizhongbingyuanjundehuanzhedeshuju，paichulehunhepeiyangdejieguo。

 

yuqitabingyuanjunhunheganranshibiaopiputaoqiujundeqingchulvyudanduganranshixiangtong。jinxingweishengwuxuepingjiadezuoyangfushaxingzhiliaozuhuanzhehehuanbingshaxingzhiliaozuhuanzhezaizhiliaojieshuhou5～18tiandelinchuangyouxiaolv（zhiyu＋bingqinggaishanerbuxukangshengsuzhiliao）fenbiewei75.0％he72.8％[zuoyangfushaxingzujianquhuanbingshaxingzuhou95％ ciwei(-8.87, 3.27)]。zuoyangfushaxingzhiliaozuhehuanbingshaxingzhiliaozudelinchuangzhangqiyouxiaolv（zhiliaojieshuhou24～45tian）fenbiewei66.7％he76.9％[zuoyangfushaxingzujianquhuanbingshaxingzuhou95％ ciwei(-23.40, 2.89)]。

 

6.fuzaxingniaoluganranhejixingshenyushenyan

5天治疗方案：

meiguoyixiangsuiji、shuangmang、duozhongxindelinchuangshiyanpingjialezuoyangfushaxinggaojiliang、duanliaochengzhiliaodeanquanxingheyouxiaoxing，shijianzi2004nian11yuezhi2006nian4yue。gongyou1109mingcutiheaphuanzhecanyuleyanjiu。ciyanjiubijiaozuoyangfushaxing 750 mg jingmaizhushehuokoufumeiri1cigong5tiandeliaocheng（546minghuanzhe）hehuanbingsha