综述抗肿瘤药物研究论文

Any survey of tax sources should begin with the nation’s fairest and most productive soure of revenue, the individual income tax. 任何税收来源的调查都应开始于国家最公正、生产性最强的国民收入来源--个人所得税. All advanced industrial countries levy a dircct tax on individual incomes, but nowhere is this tax as important as in the United States. In recent years,about 40 percent of federal cash receipts has been collected from this source. 所有先进的工业国家都对个人所得直接征税，但没有哪个国家在征此税时像美国一样重要。近年来,约40%的联邦现金收入都来源于此. The individual income tax is uniquely suited for raising revenue in a democratic country where the distribution of income, and therefore of ability to pay,is unequal. Theoreticians may disagree about the meaningfulness of the term “ability to pay,” but the close association between a man’s income and taxpaying ability is commonly accepted. There is also general acceptance of the idea of progression in income taxation. 个人所得税是非常适合民主国家增加国民收入的,在民主国家里收入分配和支付能力是不平等的. 理论家可能不赞成"支付能力"的长远意义,但个人收入和纳税能力间的密切关系却是普遍接受的. 级数所得税的观点也被普遍接受. The individual income tax has still another attractive feature. Income alone does not differentiate a man’s ability to pay—his family responsibilities are also important. A single person may be able to along on an income of $3000 a year, but a married man with two children would have great diffculty making ends meet. The individual income tax takes such differences into account through the personal exemptions and deductions, which are subtracted before arriving at the income subject to tax. 个人所得税还有另一个吸引人的特点. 收入不足以区分一个人的支付能力—他的家庭责任也是很重要的. 单身男士也许每年收入达3000美元, 但带着两个孩子的已婚男人要想收支相抵却很困难. 个人所得税通过个人豁免和扣除将这种差异解决了, 个人免税额在应纳税收之前就扣除了. The revenue potential of the individual income tax has been recognized only recently. For almost thirty years after its adoption in 1913, the tax applied mainly to a small group of high income people. Exemptions were high by current standards and few incomes were large enough rates. In the national effort to raise needed revenue during World War Ⅱ, exemptions were drastically were increased in 1946 and 1948,but have remained low by prewar standards. Tax rates were also raised in wartime, and have remained much higher than in earlier years. At the same time, personal incomes have continued to increase with the growth of the economy (and with the inflation that occurred during and after World WarⅡ and the Korean War). The combination of lower exemptions, higher rates, and higher incomes increased the yield of the individual income tax manyfold. In1939, tax liabilities were about $1 billion; in 1966, they are in excess of $50 billion. 个人所得税的收入潜力最近才得到公认. 在1913年实施后的30年里，个人所得税主要应用于一小部分高收入人士. 在现行标准下豁免是很高的，低收入者占很大的比率. 二战期间,国家努力增加收入，豁免急剧减少。1946年和1948年有所提高，但从战前的水准看，仍然很低。税率在战时也有人提出,但比起早些年仍高多了. 在此同时, 个人收入随经济增长继续增加,(也与其间和二战后的通货膨胀和朝鲜战争的因素) . 较低的豁免,高利率,高收入的结合成倍地增加了个人所得税. 1939年，纳税义务约为10亿美元; 但1966年,超过了500亿美元. This tremendous expansion could not have been possible without ready compliance with income tax laws and effective many countries where compliance is poor and administration is weak, there is great reluctance to rely heavily on the income tax. In this country, the record of compliance is good—although it can still be improved—and practical methods have been developed for administering a mass income tax (at a cost of only about 1/2 of 1 percent of tax collected). In the late 1930’s many people—even high-placed officials of the Internal Revenue Service—doubted that an income tax covering almost everyone could be administered effectively. Although some problems remain, in an advanced country the administrative feasibility of an individual income tax of almost universal coverage is no longer questioned. 没有所得税法律的遵守和有效的管理，这个巨大的扩张是不可能的。许多国家法律意识差，管理松散,过于依赖所得税就很困难. 在这个国家, 守法记录还好--虽然它仍可以得到改善--实用方法已制定用来管理大量所得税(按成本仅约为1%的税收额的1 / 2 ) . 在20世纪30年代后期，很多人甚至美国国内税局的高级官员都认为关系每个人的所得税应得到有效管理. 尽管一些问题依然存在, 在一个先进的国家个人所得税的几乎全面普及在行政上的可行性已不存在质疑. There are good economic reasons for using the income tax as a major source of revenue. The automatie flexibility of the income tax promotes economic stability and the progressive rates help prevent excessive concentration of economic power and control. Some believe that the income tax is also needed to moderate the growth of private savings of high income people, which is likely to hold down private demand for goods and believe that a high income tax impairs work and investment incentives and , therefore, reduces the nation’s economic growth. These are difficult questions which will be discussed later. Nonetheless, it is correct to say that the modern individual income tax. If carefully designed and well administered, is a powerful and essential economic instrument for a modern indusrtial econmy. 使用所得税作为财政收入主要来源有很好的经济原因. 该所得税的自动灵活性能促进经济稳定，累进税率有助于防止经济权力和控制过分集中. 有人认为所得税也需缓和高收入人群的私人储蓄增长, 这很可能压抑商品的服务的私人需求。有人认为高所得税降低工作和投资动力,因此,减少了国家的经济增长. 这些都是日后讨论的难题. 但是,现代的个人所得税是正确的. 如果经过精心设计和良好管理,是现代工业化经济的有力而必要的经济手段。 Structure of the Federal Income Tax 联邦所得税结构 The basic structure of the federal income tax is simple. The taxpayer adds up all his taxable sources of income, subtracts certain allowable deductions and exemptions for himself, his wife, children, and other dcpendents,and then applies the tax rates to the difference. But this procedure has many pitfalls for the taxpayer, and difficult questions of tax policy arise at almost every stage. Consequently, it is important to understand the main features of the income tax structure. 联邦所得税的基本结构是很简单的. 纳税人增添了他的一切应纳税收入,减去某些自己的、妻子的、孩子的和其他相关人的允许扣除和豁免权,然后适用税率差额. 但这种程序对纳税人也有很多陷阱,税收政策的难题几乎出现在每一阶段. 因此,了解所得税结构的主要特征是重要的. Adjusted Gross Income and Taxable Income调整过的总收入和应纳税收入 The two major concepts of income that appear on the tax return are: adjusted gross income and taxable income. 出现在纳税申报单上的两大收益好象是:调整过的总收入和应纳税收入. Adjusted gross income is the closest approach in tax law to what all economist might call “total income.” But it departs from an economic definition of income in some important respects. It represents the total income from all taxable sources, less certain expenses incurred in earning that income. In general, only money income is treated as taxable, but many items are excluded. Such exclusions include one-half of realized capital gains on assets held six months or more, interest on state and local government bonds,all transfer payments(for example,social security benefits and unemployment compensation), fringe benefits received by employees from their employers(the most important of these are contributions to pension plans), and income on savings through life insurance. The emphasis on money income automatically excludes unrealized capital gains and such imputed income as the rental value of owner-occupied homes. 在税法上调整的总收入是所有经济学家称之为"总收入"的最接近说法。 但是,在某些重要方面，它背离了收入的经济学定义. 它表示所有应纳税来源的总收入，较少的赚取收入中的确定开支. 一般说来,只有货币收入被视为应税的,但很多项目都被排除在外. 这种排除包括二分之一的持有六个月或以上的已实现资本收益，国家和当地政府公债的利息,所有的转移支付(例如,社会保障福利和失业补偿) , 雇员从其雇主那得到的附加福利(贡献中最重要的是为养老金计划) , 和加入了人寿保险的储蓄收入. 对货币收入的强调自动排除了未实现资本收益和这种像所有者租税价的推算收入. Adjusted gross income is used on the tax return in two ways. First, it is the income concept built into the simplified tax table, which is used for determining tax on more than 25 million returns. Second,it provedes the basis for placing limits on some of the personal deductions which are subrtacted in computing taxable income. 调整后的总收入用于纳税申报单有两种方式. 第一,它是收入概念建成的简易税表, 用于决定税收突破2500万美元的回报. 第二,它提供了限制某些个人扣除的基础，个人扣除在计算应纳税收入时已经减去了. Taxable income is computed by making two sets of deductions from adjusted gross income. The rirst are personal expenditures which are allowed as deductions by law—charitable contributions, interest paid,state-local income, general sales, property and gasoline taxes, medical and dental expenses above 3 percent of adjusted gross income, and casualty and theft losses above $100 for each lieu of these deductions, the taxpayer may use the standard deduction of 10 percent of adjusted gross income(with a minimum of $200 plus $100 for each exemption,and a maximum of $1000 for single persons and married persons filing joint returns and $500 for married couples filing separate returns). 应税收入是从调整过的总收入中制作两套扣除法计算而来的. 剩下的是法律允许扣除的个人支出--慈善捐款,所付利息,国有地方收入,一般销售 财产和汽油税, 高于调整后总收入3%的医疗及牙科服务费用, 伤亡和每次损失100美元以上的偷盗损失。代替上述扣减， 纳税人可使用10%调整后的总收入的标准扣除额 (最低200美元,加上每项豁免100美元,单身和夫妻联合备案的已婚人士每人最高1000美元，并返回500美元为已婚备案夫妻分开报税) . When the present standard deduction was first adopted in 1944, it was used by over 80 percent of the persons filing incomes have risen and deductible expenditures have increased,the percentage using the standard deduction has declined. In 1963, the standard deduction was still being used on million returns, or 56 percent of the million filed(Appendix Table C-6). But the amount of the standard deduction was small compared to home ownership, state-local taxes,and use of consumer credit, as well as the normal increase in expenditures that occurs as incomes rise. Total deductions reported on all 1963 returns amounted to $ billion; of this amount, $ billion were itemized deductions and $ billion were standard deduction. 现行标准扣除额首次在1944年应用时， 它被用于个人存档返还的80%以上.随着收入的增加和可扣除支出增加, 用于标准扣除额的比率也有所下降. 1963年标准扣除额仍被用于3580万的回报, 或6390万存档56% (附录表C 6 ) . 但征收的标准扣除额是比较小的，与国有、地方税,消费品信贷的使用, 以及随收入增加而不断增加的正常开支相比.1963年报告的总扣除额回到了592亿美元; 这一数额中, 有461亿美元详细说明了扣除项目,131亿美元为标准扣除额.

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【分享】有奖翻译外文文献摘要（药物专区） 药物专区 这篇综述重点阐述了藻类中具有食用和保健价值的各种长链不饱和脂肪酸的研究状况。 文题：Lipids and lipid metabolism in eukaryotic algae 作者：Guschina, I. A. Harwood, J. L. 杂志全名：Progress in Lipid Research 年份，卷（期）: 起止页码： 2006, Vol 45, No 2, 160-186 英文摘要： Eukaryotic algae are a very diverse group of organisms which inhabit a huge range of ecosystems from the Antarctic to deserts. They account for over half the primary productivity at the base of the food chain. In recent years studies on the lipid biochemistry of algae has shifted from experiments with a few model organisms to encompass a much larger number of, often unusual, algae. This has led to the discovery of new compounds, including major membrane components, as well as the elucidation of lipid signalling pathways. A major drive in recent research have been attempts to discover genes that code for expression of the various proteins involved in the production of very long-chain polyunsaturated fatty acids such as arachidonic, eicosapentaenoic and docosahexaenoic acids. Such work is described here together with information about how environmental factors, such as light, temperature or minerals, can change algal lipid metabolism and how adaptation may take place. 中文译文： 真核藻类中脂类及其代谢研究综述 真核藻类是一大类具有多样性的种群，它的覆盖范围很广的，栖息地遍及从南极圈到沙漠的各类生态系统。藻类占据了初级生产力的一半以上，成为食物链的基础。近年来，人们对藻细胞中脂类物质的生化研究已经从很少的几种模式微生物其他物种拓展，开展了对众多物种包括一些非常见藻类的研究。这些研究带来了许多新的化合物的发现，包括一些细胞膜的主要组分、以及脂类信号转导途径中的重要分子。这些研究的主要目标是寻找这些长链不饱和脂肪酸合成蛋白的编码基因。同时本文中还综述了环境因子（例如光、温度、微量元素）对藻类脂肪代谢的影响以及藻细胞的应答机制的相关研究信息。 影响因子（2005） -------------------------------------------------------------------------------- 全文连接 and lipid metabolism in eukaryotic () -------------------------------------------------------------------------------- 全文连接－2 and lipid metabolism in eukaryotic () -------------------------------------------------------------------------------- 共翻译了5篇，其中三篇综述，两篇研究性文章。都是有关海洋药物方面的，大部分是海洋抗癌药物。尽我所能进行了翻译，部分词汇查不到中文译名，就没有翻译。 个人认为第四篇文章的水平很高，这时发表在PNAS上面的文章，一般化学类的文章，JACS（影响因子7左右）是顶级的杂志了。做的是海洋复杂天然产物的构型构象确定，该化合物是一个含侧链的25元环的大环内酯。类似于沙海葵毒素，研究方法也是从结构的片断开始，逐步确定其立体结构，当然本文所研究的结构没有沙海葵毒素（由129个碳原子组成的聚醚化合物，分子量为2677，含有40个羟基和8个甲基）那么复杂。虽然本文没有确定整个结构的立体结构，但本文的研究为确定该类型化合物的立体结构打下了基础。 第一篇（文章类型：Review） 文题：Marine pharmacology in 2003–2004: Anti-tumour and cytotoxic compounds 作者：Alejandro . Mayer, Kirk R. Gustafson 杂志全名：European Journal of Cancer（IF for 2005：；IF for 2005：） 年份，卷（期）: 起止页码：42 (2006 )：2241－2270 英文摘要：During 2003 and 2004, marine pharmacology research directed towards the discovery and development of novel anti-tumour agents was published in 163 peer-reviewed articles. The purpose of this reviewis to present a structured assessment of the anti-tumour and cytotoxic properties of 150 marine natural products, many of which are novel compounds that belong to diverse structural classes, including polyketides, terpenes, steroids and peptides. The organisms yielding these bioactive marine compounds include invertebrate animals, algae, fungi and bacteria. Anti-tumour pharmacological studies were conducted with 31 structurally defined marine natural products in a number of experimental and clinical models that further defined their mechanisms of action. Particularly potent in vitro cytotoxicity data generated with murine and human tumour cell lines was reported for 119 novel marine chemicals with as yet undetermined mechanisms of action. Noteworthy is the fact that marine anti-cancer research was sustained by a global collaborative effort, involving researchers from Australia, Austria, Canada, China, Egypt, France, Germany, Italy, Japan, Mexico, the Netherlands, New Zealand, Papua New Guinea, the Philippines, South Africa, South Korea, Spain, Switzerland, Taiwan, Thailand and the United States of America (USA). Finally, this 2003–2004 overview of the marinepharmacology literature highlights the fact that the discovery of novel marine anti-tumour agents continued at the same pace as during 1998–2002. 中文译文(包括题目)： 2003-2004海洋药理学：抗肿瘤及细胞毒化合物 2003至2004年度，研究方向为寻找发现新抗肿瘤药物的海洋药理学论文总共发表了163篇。 本综述旨在对大约150个海洋天然产物的抗肿瘤及细胞毒活性进行化学结构上的分析，其中许多化合物属于不同的结构类型，包括聚酮化合物、帖类、甾体以及多肽。产生这些活性化合物的生物包括无脊椎动物、海藻、真菌和细菌。在大量的实验及临床模型上，研究人员对31个结构明确的海洋天然产物进行了抗肿瘤药理研究，这样的研究进一步明确了其作用机制。据报道，共有119种新的海洋化合物在体外对鼠或人类肿瘤细胞有特别强的细胞毒作用，作用机制尚未阐明。值得注意的是，全球许多国家合作进行海洋抗肿瘤药物研究，包括澳大利亚、奥地利、加拿大、埃及、法国、德国、意大利、日本、墨西哥、荷兰、新西兰、新几内亚、菲律宾、南非、南朝鲜、西班牙、瑞士、台湾、泰国及美国。最后，2003－2004年的海洋药理学研究综述表明发现新抗肿瘤化合物的速度与1998－2002期间一致。 第二篇（文章类型：Review） 文题：Indole alkaloid marine natural products: An established source of cancer drug leads with considerable promise for the control of parasitic, neurological and other diseases 作者：Waseem Gul, Mark T. Hamann 杂志全名：Life Sciences（IF for 2005：；IF for 2005：） 年份，卷（期）: 起止页码：78 (2005)：442－453 英文摘要：The marine environment produces natural products from a variety of structural classes exhibiting activity against numerous disease targets. Historically marine natural products have largely been explored as anticancer agents. The indole alkaloids are a class of marine natural products that show unique promise in the development of new drug leads. This report reviews the literature on indole alkaloids of marine origin and also highlights our own research. Specific biological activities of indole alkaloids presented here include: cytotoxicity, antiviral, antiparasitic, antiinflammatory, serotonin antagonism, Ca-releasing, calmodulin antagonism, and other pharmacological activities. 中文译文(包括题目)： 吲哚生物碱海洋天然产物：明确的抗癌药物先导化合物库，在治疗寄生虫病、神经病及其它疾病具有良好的前景 海洋产生了大量的各种结构类型的天然产物，它们作用于不同的疾病靶点。历史上，对海洋天然产物的研究大都是在抗癌方向。海洋中的吲哚类生物碱在作为新药先导化合物方面，具有独一无二的良好前景。本文综述了有关海洋来源的吲哚生物碱的文献，同时也包括了我们自己的研究。在这里，我们展示了吲哚类生物碱的独特生物活性，包括：细胞毒、抗病毒、抗寄生虫、抗炎、拮抗5-羟色胺、钙释放、拮抗钙调蛋白及其他药理活性。 第三篇（文章类型：Review） 文题：Marine natural products as anticancer drugs 作者：T. Luke Simmons, Eric Andrianasolo, Kerry McPhail, Patricia Flatt, and William H. Gerwick 杂志全名：Molecular Cancer Therapeutics（IF for 2005：；IF for 2004：） 年份，卷（期）: 起止页码：2005;4(2)：333–42 英文摘要：The chemical and biological diversity of the marine environment is immeasurable and therefore is an extraordinary resource for the discovery of new anticancer drugs. Recent technological and methodologic advances in structure elucidation, organic synthesis, and biological assay have resulted in the isolation and clinical evaluation of various novel anticancer agents. These compounds range in structural class from simple linear peptides, such as dolastatin 10, to complex macrocyclic polyethers, such as halichondrin B; equally as diverse are the molecular modes of action by which these molecules impart their biological activity. This review highlights several marine natural products and their synthetic derivatives that are currently undergoing clinical evaluation as anticancer drugs. 中文译文(包括题目)： 作为抗肿瘤药物的海洋天然产物 海洋环境的化学与生物多样性是无法衡量的，因此海洋是发现新抗癌药物的特别资源库。今年来，结构鉴定、有机合成、生物分析在技术及方法学方面的发展带动了各种新抗癌药物的分离及临床评价。这些化合物的结构各异，从简单的线性多肽如多拉司他汀10，到复杂的大环聚醚类化合物如软海绵素B。有如结构差异，这些化合物赖以传递作用的分子模式也各不相同。本文综述了一些来自海洋的天然产物及其合成衍生物，目前这些化合物正作为抗癌药进行临床评价。 第四篇（文章类型：research article） 文题：Synthesis of antimicrofilament marine macrolides: Synthesis and configurational assignment of a C5–C16 degradation fragment of reidispongiolide A 作者：Ian Paterson, Robert Britton, Kate Ashton, Henner Knust, and Jonathan Stafford 杂志全名：proceedings of the national academy of sciences of the united states of america 年份，卷（期）: 起止页码：2004 August 17; 101(33): 11986–11991. 英文摘要：Reidispongiolide A is a representative member of the sphinxolide/reidispongiolide group of cytotoxic 26-membered macrolides of marine origin. By interacting with actin in the cell cytoskeleton, the reidispongiolides and sphinxolides are potent microfilament destabilizing agents that represent a promising mechanism of action for developing novel anticancer drugs. An aldol-based synthesis of a library of diastereomers of C8–C16 and C5–C16 fragments and detailed NMR comparison with a reported degradation fragment enabled a configurational assignment for a major part of the reidispongiolide macrocyclic core, thus setting a solid foundation for ongoing synthetic efforts. 中文译文(包括题目)： 具抗微丝活性的海洋大环内酯合成：reidispongiolide A分解片断C5–C16的合成及构象指定 Reidispongiolide A是来自海洋的含sphinxolide/reidispongiolide 基团的26元环大环内酯类化合物的代表。通过与细胞骨架的肌动蛋白相互作用，这些大环内酯类化合物使得微丝失稳，这是研发新抗癌药物的有望机制。从丁间醇醛开始，合成了C8-C16及C5–C16的非对映体库，并将其NMR数据与一已报道的分解片断进行详细的比较，从而指定了reidispongiolide大环母核主要部分的构象，为后续的合成工作提供了坚实的基础。 第五篇（文章类型：research article） 文题：Aureoverticillactam, a novel 22-atom macrocyclic lactam from the marine actinomycete Streptomyces aureoverticillatus. 作者：Scott S. Mitchell, Benjamin Nicholson, Sy Teisan, Kin S. Lam, and Barbara C. M. Potts 杂志全名：journal of natural products（IF for 2005：； IF for 2004：） 年份，卷（期）: 起止页码：2004 Aug;67:1400-2. 英文摘要：During the course of our screening program designed to discover novel anticancer and anti-infective agents from marine microorganisms, a strain of Streptomyces aureoverticillatus (NPS001583) isolated from a marine sediment was found to produce a novel macrocyclic lactam with cytotoxicity against various tumor cell lines. Using extensive MS, UV, and NMR spectral analyses, the structure has been established as compound 1, aureoverticillactam, a 22-atom macrocyclic lactam incorporating both triene and tetraene conjugated olefins. 中文译文(包括题目)： 由海洋放线菌Streptomyces aureoverticillatus产生的22元环大环内酰胺Aureoverticillactam 在试图从海洋微生物中筛选得到新抗癌药物的过程中，我们发现一株分离自海洋沉积物的链酶菌属放线菌aureoverticillatus (NPS001583) 能产生一种新的大环内酰胺，其对数种不同的肿瘤细胞都有细胞毒作用。运用包括质谱、紫外及核磁共振的多种光谱分析，解析确定了该化合物1（aureoverticillactam）的结构，是一个含有共轭三烯和共轭四烯的22元环大环内酰胺。 如果你英语水平可以的话，可以直接到 （美国专利网）找找。《外文文献信息检索》PPT版(包括：外文图书信息检索、外文期刊论文检索、外文报纸检索），如有需要再联系我。

论文中医药的网络推广(英文版本)。。 文件密码 RAR文件密码为：

摘要: 目的探讨住院肿瘤患者开展药学服务的必要性及措施。方法通过临床药师查房对医院住院257例患者进行药学服务必要性调查，对药物咨询人群及需求状况进行调查分析。结果共调查257例，男116例，女141例，有的患者希望得到药师的药学服务，的患者希望了解药品的不良反应;患者对正确服药时间的知晓率为;对自己过敏情况了解的患者占;了解药品的存放条件的为。结论肿瘤患者在用药方面存在安全隐患，对药学服务有需求，临床药师应积极开展药学服务工作，为肿瘤患者提供全面的药学服务，进行用药咨询，普及药物知识，指导肿瘤患者的合理用药。

关键词: 肿瘤患者;临床药师;药学服务;调查

恶性肿瘤对于人类健康的威胁越来越严重，已经成为仅次于心血管疾病的第二大疾病［1］。使用药物治疗肿瘤，是延长患者生存时间、提高生活质量的重要手段。但由于肿瘤治疗药物本身的选择性较低，在杀灭肿瘤细胞的同时也对正常细胞和组织造成了一定的危害，因此正确合理的使用抗肿瘤药物对于肿瘤的治疗尤为重要。药学服务(pharmaceuticalcare)的理念已经获得广泛认同和接受，并付诸实践。近年来，卫生部试点推广实施的临床药师制度标志着药学工作的方向已经从“以药物保障供应为中心”转变为“以患者合理药物治疗为中心”［1］。通过对住院肿瘤患者发放问卷，调查对药学服务的认知程度，分析在肿瘤患者中开展药学服务必要性，从而促进合理用药，提高患者的依从性和用药效果，提供更周到的药学服务。

1资料与方法

1．1一般资料

采集对象为2015年1～5月来我院住院的住院肿瘤患者，调查内容包括患者性别、年龄、所患疾病、用药问题。然后对采集到的257例患者的数据进行处理及统计分析。

1．2调查方法

针对肿瘤专科医院的特点，本次调查主要包括患者用药情况调查和患者需要的药学服务内容调查。采用随机抽样问卷法。为保证数据的可靠性，所有调查问卷均当场收回，对问卷进行综合，数据整理，为下一步分析做好准备。

2结果

2．1一般情况调查

本次调查一共发出调查问卷300份，收回257份，回收率为。其中男116例();女141例()。在所有的调查问卷中，有228例希望得到药师的药学服务，占总数的。

2．2用药情况调查

大多数患者对基本的用药知识有所了解，其中的患者知晓正确的服药时间，的患者清楚自己对那些药物过敏，的患者知道药品应如何存放，这可能与药学人员的用药教育有关，有的患者表示药学人员向其交代清楚了药品使用情况和注意事项。同时结果也显示出部分患者依从性较差，有的患者出现过为增强疗效而自行增加药量，的患者曾自行更换过药品。有的患者表示相信药品广告。

2．3需要药学服务内容调查

患者中希望了解药品的不良反应，是患者最希望得到的药学服务内容，的患者希望了解药品的适应证。6成左右的患者希望得到药品用法、用量、相互作用方面的内容。同时价格也是患者比较关心的内容，的患者对药品价格、的患者对医保用药目录比较关心。对于药品名称、药品的储存、药品有效期等基本药品信息，患者关心程度较低，分别为、、。

3讨论

本次研究发现，本院药师的药学服务有一定的成果，有的患者表示药学人员向其交代清楚了药品使用情况和注意事项。用药教育使患者对于基本的用药知识有了一定的了解，本次研究结果显示，有的'患者知晓正确的服药时间，的患者清楚自己对那些药物过敏，的患者知道药品应如何存放。有研究显示，很多患者用药依从性差，存在过量服药、慢性病不能坚持长期服药、随意更改药物剂量从而导致药源性疾病的现象［2］。本次调查结果显示，有的患者出现过为增强疗效而自行增加药量，的患者曾自行更换过药品。与文献结果一致。因此，加强患者的依从性教育，对于患者的安全用药有重要意义。

3．1开展用药教育，提高患者依从性

用药教育包括很多方面，例如化疗药物不良反应教育，使患者了解化疗药物的不良反应，同时又不被化疗药物的毒性所吓倒;口服化疗药物的依从性教育;治疗结束后的院外用药教育等。为患者建立用药教育卡，可以让患者感觉被重视、被关爱，从心理、意识、身体上主动接受治疗，有助于患者及家属掌握与疾病相关的用药常识，知道疾病的原因、治疗、用药及饮食注意事项等，使用药教育贯穿全部治疗过程，使患者及家属掌握自我保健知识。

3．2开展患者用药教育有利于开展个体化药物治疗监护

要做到个体化药物治疗，需要了解一部分特殊群体用药，例如肝肾功能不全，或并发感染、糖尿病、心血管疾病，或特殊人群如老人、儿童等，全程参与其住院期间的治疗，对患者进行用药教育，询问变态反应史和用药史，记录每天病情变化及用药，分析用药特点及合理性，完成药历，对该患者住院期间的药物治疗进行简单评价。

3．3患者用药教育有助于评价临床用药方案

在一些伴有其他疾病的患者治疗中，药师进行患者用药教育并结合专业特色，配合医师改进化疗方案的制定、止吐、保肝、止痛等辅助治疗，医药护人员相互协作，各自发挥专业特长，使临床药学服务具有全面性和及时性，针对患者不依从性用药的原因，制定出科学的个体化药学服务干预计划。

3．4向医护人员宣传药品信息，提升药学服务质量

医护人员提供治疗药物相关内容，有助于医师更多层面了解药品信息。选择专题为医护人员进行小型讲座。例如:常用口服药用药时间;易透过血脑屏障的化疗药物;β受体阻断剂的临床应用及不良反应;常用糖皮质激素类药物分类及作用特点;化疗常用镇吐药物及注意事项;铂类药物分代及应用等。

4小结

肿瘤患者的化疗是一种常用的治疗手段，但是抗肿瘤药物不可避免的会产生一些不良反应，严重影响患者的生活质量，同时还限制了药物的使用，影响了药物的疗效［3］。本次研究显示，肿瘤患者最希望得到的药学服务内容是药品的不良反应，占。抗肿瘤药物的不良反应是可以预见和防治的，例如化疗药物顺铂有较强的致吐性［4］，应告知患者使用后可能出现恶心呕吐等现象，同时使用甲氧氯普胺或5－羟色胺受体阻断剂等药物预防消化道反应［5］。又如化疗常见的不良反应脱发，应提前告知患者一般停止化疗后，头发扔可再生［6］。综上所述，药师参与临床工作，对患者进行药学服务是非常重要的。通过对患者的用药教育，使患者了解基本的用药知识，了解药品的不良反应，增加患者用药依从性，对于患者的治疗和康复有重要意义。同时，药师也需要增强学习，增加自己的业务知识，提高服务质量，重视与患者的交流，加强与医师护士的合作，共同推进患者合理，安全用药。

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