中国国家处方集节选 眼科疾病用药

中国国家处方集节选 眼科疾病用药 眼科疾病用药 1眼科疾病用药概论6 1.1给药方式和途径6 1.2控制污染7 2眼部感染及其用药7 2.1抗细菌物8 2.2抗真菌药17 2.3抗病毒药18 3眼用抗炎药..20 3.1糖皮质激素..20 3.2其他抗炎药23 4散瞳药和睫状肌麻痹药28 5青光眼及其用药32 5.1β肾上腺素受体拮抗药.33 5.2前列腺素类似药36 5.3肾上腺素受体激动药.39 5.4碳酸酐酶抑制药40 5.5拟M胆碱药..42 5.6高渗药.43 6眼用局部麻醉药44 7眼科其他用药.46 7.1人工泪液、眼润滑剂和收敛药46 - 1 - 7.2眼部诊断药..49 7.3眼科围手术期用药..51 7.4眼用抑制新生血管药..52 本章包括下列常见疾病的药物治疗方案: 1眼部感染 2青光眼 - 2 - 1.1眼科疾病用药概论 1.1.1给药方式和途径 眼科最常用的给药方式是眼局部给药，如将滴眼液(包括溶液、混悬液、乳剂等)、眼用凝胶或眼膏等滴入或涂入结膜囊内。如果眼部治疗需要较高药物浓度，可以采用眼局部注射方式，如球结膜下注射、眼内注射等。 结膜囊内给药 滴用滴眼液的通常是嘱患者将头部稍后仰或平卧，眼向上注视。滴药者用手指轻轻向下牵开下睑，然后将药液缓慢地滴入下穹窿部，一般滴用1滴即可。轻提上睑使药液在结膜囊内充分弥散。嘱患者轻轻闭合眼睑2,3分钟。以干棉球拭去流出结膜囊的药液。眼用凝胶和眼膏的给药方法与滴眼液大致相同，将凝胶或眼膏涂入结膜囊的下穹窿部。用药后轻轻闭眼和按摩眼球有助于药物的扩散。 当两种不同的滴眼液同时使用时，如果用完一种后马上就用第二种，就会发生药物被稀释或药物溢出结膜囊的情况。因此当需要同时使用两种滴眼液时，应当在用完一种至少5分钟后再用第二种。 滴入结膜囊的药物可以通过结膜血管吸收，或者结膜囊中多余的药物从鼻泪管流入鼻腔，由鼻黏膜吸收而进入全身循环，可以引发全身性效应，其程度与眼部给药的剂型有很大关系。经鼻泪道流入鼻腔的药物多与滴眼液有关，而很少与眼用凝胶和眼膏有关。当应用滴眼液时，用手指轻压内眦部的泪囊区，可以明显减少药物经鼻泪道流入鼻腔的量，从而减少药物引起的全身效应。 - 3 - 结膜囊冲洗 在清除结膜囊内刺激物、异物或分泌物等急救处置时，可以应用眼用冲洗液冲洗结膜囊。通常使用的眼部冲洗液为无菌的0.9%氯化钠溶液。在紧急情况下，也可以应用洁净水作为眼部冲洗液。 结膜下注射 为了有效地控制病情，或者结膜囊内给药后疗效不显著时，抗感染药、散瞳剂或糖皮质激素等可以采用结膜下注射方式来给药。药物通过角膜和巩膜扩散到前房、后房和玻璃体内而发挥治疗作用。结膜下注射的单剂量体积是有限的，通常不超过1ml。 眼内注射 为了有效地控制病情和提高疗效，必要时可以采用眼内注射的方式，包括前房内注射和玻璃体腔内注射来给药。由于药物的剂量-容积是有一定限度的，通常单剂量体积不超过0.3ml。由于眼内注射有可能发生一些严重的并发症，因此应当慎用。全身给药一些药物，如抗菌药和糖皮质激素，可以采用全身给药的方式，来治疗一些眼部易感的疾病。一些降眼压药物也需要采用全身给药的方法，如口服乙酰唑胺、甘油盐水，静脉滴注高渗剂甘露醇等，来达到快速降低眼压的目标。 1.1.2控制污染 临床所用的眼用制剂应当是无菌的。对于装在多剂量容器中、并且加有防腐剂的滴眼液，在使用时仍然需要注意避免污染。 患者在家中自用的保存于多剂量容器中的眼用药物(包括滴眼液、眼用凝胶和眼膏)，在首次开封后使用时间不应当超过4周，除 - 4 - 非另有说明。 医院病房里使用的眼用药物一般在开封后1周弃用。应当给每位患者提供个人专用的眼用药物。如果遇到需要特别关注的污染问题，应当为每只眼提供单独使用的眼用药物容器。 对于出院的患者应当提供新的眼用药物。在出院时让患者带走当天已经发给他们的药品是可以接受的做法。 在门诊部，以使用单剂量包装的滴眼液为好。如果使用多剂量包装的滴眼液，应当在一日工作结束时弃用。在意外事件时和急诊等感染高风险的地方，应当尽量使用单剂量包装的滴眼液。如果使用多剂量包装的滴眼液，应当在单次使用后弃用。 诊断用染料，如荧光素钠等，应当尽量使用单剂量包装的药品。如果使用多剂量包装的滴眼液，应当在一日工作结束时弃用。 手术前使用的滴眼液瓶应当在手术时弃用，并提供新的滴眼液瓶。如有可能，眼科手术时应当使用单剂量包装的滴眼液。如果使用多剂量包装的滴眼液，应当为每位患者提供个人专用的滴眼液瓶，并在手术结束时弃用。在施行内眼手术和其他进入前房的处置时所使用的制剂必须是等渗的，而且不含防腐剂和抗氧剂，如有必需应当加入缓冲液将pH值调至中性。用于内眼手术的液体应当按特别的处方配制，一般静脉输注的制剂并不适用于这种目的。 1.2眼部感染及其用药 眼部感染眼部感染是眼科常见的病变，可以发生在眼睑、眼表和眼内等不同部位，引起睑缘炎、结膜炎、沙眼、角膜炎和眼内炎等疾 - 5 - 病。睑缘炎、结膜炎等会造成严重不适。角膜炎可以导致角膜混浊，产生严重的视力下降。眼内炎可以破坏眼球，如不及时控制，会导致失明。引起眼部感染的微生物有细菌、衣原体、真菌和病毒等。睑缘炎和结膜炎经常是由于葡萄球菌感染所引起，沙眼是由于衣原体感染引起，角膜炎和眼内炎可以由细菌、病毒或真菌感染引起。治疗眼部感染的目标是控制感染，保护眼组织及其功能。 1.2.1抗细菌物 细菌性睑缘炎(bacterialblepharitis)的治疗是将抗菌眼膏涂至结膜囊内或睑缘部分。偶尔需要抗菌药物进行全身治疗，这种治疗通常是在睑缘取样进行微生物培养，确定抗菌敏感性后再进行。给予3个月或更长时间的抗菌药物，如四环素类药物是恰当的。 虽然大多数细菌性结膜炎(bacterialconjunctivitis)的病例是自限的，但是应用抗菌滴眼液或眼膏是恰当的治疗。如果用药后反应很差，就表明可能是病毒性或过敏性结膜炎。对于淋球菌性结膜炎应当采用全身及眼局部抗菌药物来治疗。 衣原体感染会导致致盲性沙眼和包涵体性结膜炎。对于衣原体感染的治疗除了注意个人卫生和环境卫生之外，主要是抗菌药物的治疗。急性期或严重的沙眼应当采用口服阿奇霉素(azithromycin)进行全身治疗，首次500mg口服，以后一日250mg,共四日为一疗程。为了保证患者的依从性，也可以采用单次口服，剂量为1g。眼局部治疗可以滴用抗菌滴眼液或眼膏，如0.3%氧氟沙星、0.25%氯霉素滴眼液、红霉素眼膏、金霉素眼膏等，以及0.1%利福平滴眼液。 - 6 - 对于细菌性角膜溃疡(bacterialcornealulcer)和角膜炎(keratitis)患者，需要由眼科专科医师进行治疗。如果病情严重，可以将这类患者收住入院，进行加强治疗。 细菌性眼内炎(bacterialendophthalmitis)是一种医学急症，同样需要眼科专科医生进行处理，通常需要采用多种途径，如结膜下注射、前房内注射、玻璃体腔内注射及全身途径来给予抗菌药物。其中以玻璃体腔内注射最为重要，如果是眼科手术后引起的细菌性眼内炎，可以向眼内注入万古霉素1mg/0.1ml或头孢他啶2.25mg/0.1ml，2,3日后重复注射。 有多种药物可以用于眼局部抗感染治疗。左氧氟沙星是氧氟沙星的左旋体，其抗菌活性约为氧氟沙星的2倍，具有抗菌谱广、作用强的特点。本品是用于治疗眼部浅层感染的可供选择的药物。滴用左氧氟沙星滴眼液后有很好的耐受性。本品的滴眼液和眼用凝胶均不宜长期使用，以免诱发耐药菌或真菌感染。 氯霉素滴眼液具有广谱抗菌活性，也是治疗眼表浅层感染的可供选择的药物。滴用本品后耐受性良好。由于滴用氯霉素滴眼液后存在不易发现的再生障碍性贫血的风险，因此在临床中应当慎用。 其他具有广谱抗菌活性的抗菌药包括氟喹诺酮类药物，如诺氟沙星、环丙沙星、氧氟沙星，氨基糖苷类药物，如妥布霉素、庆大霉素、新霉素等。妥布霉素、庆大霉素、环丙沙星、左氧氟沙星、氧氟沙星和多黏菌素B对铜绿假单胞菌引起的感染有效。夫西地酸在治疗葡萄球菌感染时是有用的。 - 7 - 氟喹诺酮类药对婴幼儿的安全性尚未确定，可能会对软骨发育有影响，因此对18岁以儿童不推荐使用，妊娠及哺乳期妇女慎用。 抗菌药物与糖皮质激素合并使用许多抗菌制剂中加入糖皮质激素。虽然这类制剂具有抗菌、抗炎、加速治愈过程的优点，但有诱发真菌或病毒感染、延缓创伤愈合、升高眼压和导致晶状体混浊等风险，因此不应当随意使用，除非患者是在眼科专科医师的密切监护下。特别是不能给尚未确诊的“红眼”患者开具这类药物，因为这种情况有时是由于难以诊断的单纯性疱疹病毒感染所致。如果使用这类制剂，不应当超过10日，并在使用期间应当定期测量眼压。 给药方法抗菌药物用药的频次决定于感染的严重程度和眼部发生不可逆损伤的可能性。常用眼部抗菌药物制剂的给药方法为: 滴眼液 一次1滴，可以每2小时1次。感染控制后减少使用频次。痊愈后持续用药48小时。 眼用凝胶或眼膏 如果白天使用滴眼液，则每晚涂用1次眼用凝胶或眼膏;如果只用眼用凝胶或眼膏，则一日涂用3,4次。 左氧氟沙星Levofloxacin 【适应证】用于治疗细菌性结膜炎、角膜炎、角膜溃疡、泪囊炎等外眼感染。 【注意事项】(1)不宜长期使用，以免诱发耐药菌或真菌感染。 (2)使用中如出现过敏症状，应立即停止使用。 【禁忌证】对本品或喹诺酮类药物过敏者禁用。 - 8 - 【不良反应】偶尔有轻微似蜇样的刺激症状。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日3,5次。 (2)眼用凝胶涂于眼下睑穹窿部，一次适量，一日3次。 【制剂与規格】乳酸左氧氟沙星滴眼液:(1)5ml:15mg;(2)8ml:24mg。 盐酸左氧氟沙星眼用凝胶:5g:15mg。 氧氟沙星Ofloxacin 【适应证】用于治疗细菌性结膜炎、角膜炎、角膜溃疡、泪囊炎、术后感染等外眼感染。 【注意事项】(1)不宜长期使用。 (2)使用中出现过敏症状，应立即停止使用。 【禁忌证】对本品或喹诺酮类药物过敏者禁用。 【不良反应】偶尔有辛辣似蜇样的刺激症状。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日3,5次。7 (2)眼膏涂于眼睑内，一次适量，一日3次。 【制剂与規格】氧氟沙星滴眼液:(1)5ml:15mg;(2)8ml:24mg。 氧氟沙星眼膏:(1)2g:6mg;(2)3.5g:10.5mg;(3)0.25g:0.75mg。 诺氟沙星Norfloxacin 【适应证】用于敏感菌所致的外眼感染，如结膜炎、角膜炎、角膜溃疡等。 【注意事项】(1)不宜长期使用。 - 9 - (2)使用中出现过敏症状，应立即停止使用。 【禁忌证】对本品或喹诺酮类药物过敏者禁用。 【不良反应】眼部滴用后出现轻微一过性的刺激症状，如刺痛、痒、异物感。 【用法和用量】滴眼一次1,2滴，一日3,6次。 【制剂与規格】诺氟沙星滴眼液:8ml:24mg。 环丙沙星Ciprofloxacin 【适应证】用于敏感菌引起的外眼部感染，如结膜炎等。 【注意事项】(1)使用过程中若出现皮疹等过敏表现或其他严重不良反应，应当立即停药。 (2)哺乳期妇女慎用，用药期间应暂停哺乳。 (3)不宜用于18岁以下的小儿及青少年。 (4)老年患者慎用。 【禁忌证】(1)对本品和喹诺酮类药物过敏者。 (2)孕妇禁用。 【不良反应】(1)偶有局部一过性刺激症状。 (2)可产生局部灼伤和异物感。 (3)眼睑水肿、流泪、畏光、视力减低、过敏反应等。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日3,5次。 (2)眼膏经眼给药，一次约0.1g，一日2次。 【制剂与規格】盐酸环丙沙星滴眼液:5ml:15mg(按环丙沙星计)。 - 10 - 乳酸环丙沙星滴眼液:8ml:24mg(按环丙沙星计)。 盐酸环丙沙星眼膏:2.5g:7.5mg(按环丙沙星计)。 妥布霉素Tobramycin 【适应证】用于敏感细菌所致的外眼及附属器的局部感染。 【注意事项】(1)肾功能不全、肝功能异常、前庭功能或听力减退者、失水、重症肌无力或帕金森病及老年患者慎用。 (2)孕妇慎用，哺乳期妇女使用本品期间宜暂停哺乳。 (3)对一种氨基糖苷类抗生素如链霉素、庆大霉素过敏的患者，对本品也可能过敏。若出现过敏反应，应立即停药。 (4)长期应用本品可能导致耐药菌过度生长，甚至引起真菌感染。 (5)若患者同时接受氨基糖苷类抗生素的全身用药，应监测本品及氨基糖苷类抗生素的血药浓度。 【禁忌证】对本品及其他氨基糖苷类抗生素过敏者禁用。 【不良反应】偶有眼局部刺激，如眼睑发痒与红肿、结膜充血。罕见过敏反应。 【用法和用量】(1)滴眼液滴眼，轻度及中度感染，一次1,2滴，4小时1次;重度感染，一次2滴，一小时1次。 (2)眼膏?轻度及中度感染的患者，一日2,3次，一次取约1.5cm长的药膏涂入患眼，病情缓解后减量;?妥布霉素滴眼液可与眼膏联合使用，即白天滴用滴眼液，晚上使用眼膏。 【制剂与規格】妥布霉素滴眼液:5ml:15mg。 - 11 - 妥布霉素眼膏:10g:50mg。 庆大霉素Gentamycin 【适应证】用于治疗葡萄球菌属(金黄色葡萄球菌及凝固酶阴性葡萄球菌中甲氧西林敏感株)及敏感革兰阴性杆菌，如大肠埃希菌、克雷伯菌属、变形杆菌属、肠杆菌属、沙雷菌属、铜绿假单胞菌等所致的结膜炎、角膜炎、泪囊炎、眼睑炎、睑板腺炎等感染。 【注意事项】(1)过敏体质者慎用。 (2)本品不宜长期连续使用，使用3,4日症状未缓解时，应停药就医。 (3)滴眼后出现眼部充血、水肿和眼痒时，应停药就医。 【禁忌证】对本品或其他氨基糖苷类抗生素过敏者禁用。 【不良反应】滴眼后可能出现轻微刺激感。偶见过敏反应，出现眼红、眼痒和水肿等。 【用法和用量】滴眼一次1,2滴，一日3,5次。 【制剂与規格】硫酸庆大霉素滴眼液:8ml:4万U。9 氯霉素Chloramphenicol 【适应证】用于由大肠杆菌、流感嗜血杆菌、克雷伯菌属、金黄色葡萄球菌、溶血性链球菌和其他敏感菌所致的结膜炎、角膜炎、眼睑缘炎、沙眼等。 【注意事项】(1)如使用3,4日不见症状改善，应立即停止使用并就医。 - 12 - (2)出现不良反应应停止使用(口腔苦味为氯霉素的物理特性，可继续使用)。 (3)长期使用(超过3个月)可引起视神经炎或视神经乳头炎(特别是小儿)。长期应用本品的患者，应事先作眼部检查，并密切注意患者的视功能和视神经炎的症状，一旦出现即停药。同时服用维生素C和维生素B。 (4)孕妇及哺乳期妇女宜慎用。 【禁忌证】新生儿和早产儿禁用。 【不良反应】(1)偶见眼睛疼痛、视力改变、持续性发红或有刺激感。 (2)口腔苦味。 (3)偶见儿童使用后出现再生不良性障碍性贫血。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日3,5次。 (2)眼膏涂入眼睑内，一次适量，一日3次。 【制剂与規格】氯霉素滴眼液:(1)5ml:12.5mg;(2)8ml:20mg。 氯霉素眼膏:(1)2.5g:25mg;(2)2.5g:75mg。 红霉素Erythromycin 【适应证】用于沙眼、结膜炎、角膜炎、眼睑缘炎及眼外部感染。 【注意事项】(1)用药部位如有烧灼感、瘙痒、红肿等情况应停药，并将局部药物洗净。 (2)孕妇及哺乳期妇女应在医师指导下使用。 (3)避免接触其他黏膜(如口、鼻等)。 - 13 - 【禁忌证】对本品任何成分过敏者禁用。 【不良反应】涂眼后偶见眼痛、视力改变、持性眼红或刺激症状。 【用法和用量】涂于眼睑内一次适量，一日2,3次，最后1次宜在睡前使用。 【制剂与規格】红霉素眼膏:1g:5mg。 金霉素Chlortetracycline 【适应证】(1)用于细菌性结膜炎、麦粒肿及细菌性眼睑炎。 (2)用于沙眼。 【注意事项】(1)本品不宜长期连续使用，使用5日症状未缓解，应停药。 (2)若出现充血、眼痒、水肿等症状应停药。 (3)急性或慢性沙眼的疗程应为1,2个月或更长，眼膏可作为夜间治疗用药，以保持感染部位与 药物接触较长时间。 【禁忌证】(1)对本品或大环内酯类药物过敏者禁用。 (2)有四环素类药物过敏史者禁用。 【不良反应】(1)轻微刺激感。 (2)偶见过敏反应，出现充血、眼痒、水肿等症状。 【用法和用量】涂于眼睑内一日1,2次，最后1次宜在睡前使用。 【制剂与規格】盐酸金霉素眼膏:1g:5mg。 - 14 - 夫西地酸Fusidicacid 【适应证】用于急性细菌性结膜炎。 【注意事项】(1)新生儿慎用。(2)配戴隐形眼镜者用药时应先取下镜片。 【禁忌证】(1)肝功能不全患者禁用。(2)哺乳期妇女禁用。 【不良反应】偶见过敏反应，可有短暂性刺激感。 【用法和用量】滴眼一次1滴，一日2次。用药至少持续到症状消除后2天。 【制剂与規格】夫西地酸滴眼液:5g:50mg。 利福平Rifampicin 【适应证】主要用于治疗细菌性外眼感染，如沙眼、结核性眼病及某些病毒性眼病。 【注意事项】(1)酒精中毒，肝功能不全者慎用。 (2)孕妇及哺乳期妇女慎用。 (3)5岁以下小儿及老年人慎用。 (4)利福平可能引起白细胞和血小板减少，并导致齿龈出血和伤口愈合延迟等，此时应避免拔牙手术，刷牙及剔牙均需慎重。 (5)治疗沙眼的疗程为6周。 【禁忌证】(1)严重肝功能不全患者禁用。 (2)胆道阻塞患者禁用。11 【不良反应】(1)滴眼后有眼局部刺激症状。 - 15 - (2)可能引起白细胞和血小板减少，导致齿龈出血和感染、伤口延迟愈合等。 (3)畏寒、呼吸困难、头昏、发热、头痛、泪液呈桔红色或红棕色等。 (4)可引起皮肤发红、皮疹、瘙痒等。 【用法和用量】滴眼一次1,2滴，一日4,6次。使用前请将滴丸放入缓冲液中，振摇，使完全溶解。 【制剂与規格】利福平滴眼液:滴丸每丸含利福平10mg，缓冲液每瓶10ml。 复方硫酸新霉素滴眼液CompoundNeomycinSulfateEyeDrops 【适应证】用于结膜炎、角膜炎、虹膜炎、巩膜炎、葡萄膜炎、白内障、青光眼、角膜移植术后及眼部机械或化学损伤处理。 【注意事项】(1)长期频繁滴用可致眼内压增高或青光眼、晶状体后囊下混浊的白内障和眼部真菌感染。 (2)角膜、巩膜溃疡者滴用后可能会引起穿孔。 (3)化脓性角膜溃疡的恢复期，应在医生指导下慎用。 【禁忌证】真菌性角膜溃疡，树枝状、地图状角膜炎禁用。 【不良反应】滴眼后有眼局部刺激症状。长期频繁滴用后可引起青光眼、白内障、眼部真菌感染。 【用法和用量】滴眼一次1滴，一日4,8次。 【制剂与规格】复方硫酸新霉素滴眼液:5ml:硫酸新霉素17.5mg，地塞米松磷酸钠5mg。 - 16 - 四环素可的松眼膏TetracyclineCortisoneEyeOintment 【适应证】用于沙眼、结膜炎等眼病。 【注意事项】(1)妊娠及哺乳期妇女不宜长期使用。 (2)长期频繁滴用可致青光眼、白内障和眼部真菌感染。 (3)角膜、巩膜溃疡者滴用后可能会引起穿孔。 【禁忌证】(1)对本品及四环素类药物过敏者禁用。 (2)单纯疱疹性或溃疡性角膜炎患者禁用。 【不良反应】长期应用可引起青光眼、白内障。 【用法和用量】涂于结膜囊内一次适量，一日1,2次。 【制剂与规格】四环素可的松眼膏:(1)2g:四环素5mg，醋酸可的松5mg;(2)2.5g:四环素6.25mg，醋酸可的松6.25mg。 妥布霉素地塞米松滴眼液TobramycinandDexamethasoneEyeDrops 【适应证】(1)用于对肾上腺皮质激素敏感的眼科炎性病变伴有眼部表面的细菌感染，或有感染危险的以下情况:眼睑、球结膜、角膜、眼球前段组织及一些可接受激素潜在危险性的感染性结膜炎等炎性疾病，可以减轻水肿和炎症反应。 (2)用于慢性前葡萄膜炎。 (3)用于化学性、放射性、灼伤性及异物穿透性角膜病变。 【注意事项】(1)对其他氨基糖苷类抗生素过敏的患者对本品有可能过敏。如果用药后发生过敏反应，应当停用。 - 17 - (2)2岁以下儿童慎用。 (3)孕妇及哺乳期妇女慎用。 (4)长期滴用可致青光眼、白内障或眼部真菌感染。使用过程中应当监测眼压。 (5)长期滴用可能掩盖或加重已有的感染，以及增大眼部继发严重感染的机会。 (6)在一些导致角膜、巩膜变薄的病变中可能会引起眼球穿孔。 【禁忌证】(1)单纯疱疹病毒性角膜炎，牛痘、水痘及一些因病毒感染引起的角膜和结膜疾患，眼部分枝杆菌感染，眼部真菌感染患者禁用。 (2)对本品或氨基糖苷类药物过敏者禁用。 (3)角膜异物未完全去除患者禁用。 【不良反应】 (1)滴眼后可以出现眼睑刺痒、水肿、结膜充血。 (2)眼内压升高并可能导致青光眼、偶尔有视神经的损害、后囊下白内障形成和伤口愈合延迟。 (3)长期使用后极易发生角膜真菌感染，也可能导致继发眼部细菌感染。 【用法和用量】滴眼 一次1,2滴，每4,6小时用1次。在最初1,2日剂量可增加至每2小时1次。根据临床症状的改善状况逐渐减少用药的频度，注意不要过早停止治疗。 【制剂与规格】妥布霉素地塞米松滴眼液:5ml:妥布霉素15mg，地塞米松5mg。 - 18 - 妥布霉素地塞米松眼膏 TobramycinandDexamethasoneOphthalmicOintment 【适应证】(1)用于眼科手术前、后预防，治疗感染与炎症反应。 (2)用于严重的细菌性结膜炎、角膜炎、泪囊炎与化学灼伤等。 【注意事项】孕妇、哺乳期妇女、儿童及青光眼患者慎用。 【禁忌证】(1)对本品或氨基糖苷类药物过敏者禁用。 (2)树枝节状角膜炎、眼部分枝杆菌及真菌感染患者禁用。 (3)牛痘、水痘及其他因疱疹性病毒引起的角膜炎、结膜炎患者禁用。 (4)角膜上异物未完全去除患者禁用。 【不良反应】见妥布霉素及地塞米松。 【用法和用量】涂于结膜囊内一次适量(长约1,1.5cm)，一日3,5次。 【制剂与规格】(1)妥布霉素地塞米松眼膏3.5g:妥布霉素10.5mg，地塞米松3.5mg;(2)妥布霉素地塞米松眼膏3g:妥布霉素9mg，地塞米松3mg。 硫酸庆大霉素氟米龙滴眼液 SulfateGentamicinandFluorometholoneEyeDrops 【适应证】(1)用于对庆大霉素敏感细菌引起的眼前段细菌性感染，如细菌性结膜炎。 (2)用于眼前段炎症，以及有发生细菌性感染危险的治疗，如眼科术 - 19 - 后治疗等。 【注意事项】(1)长期频繁滴用可致青光眼、白内障和继发性眼部真菌感染。 (2)长期使用本品治疗，可能会导致角膜和巩膜变薄，建议定期进行角膜厚度检查; (3)长期使用本品治疗，可能会增加继发性真菌或非易感细菌感染，故使用本品请勿超过两周。 (4)眼内手术后立即使用本品，可能延缓伤口的愈合。 (5)隐形眼镜戴用者务必在使用前取下隐形眼镜，用药5分钟后再戴上。若发生眼部感染，则应停戴隐形眼镜数天，以防感染蔓延。 (6)若使用本品7,8天，病情未见改善应停用，可考虑改用其它疗法。 【禁忌证】(1)对本品所含成分过敏者禁用。 (2)角膜损伤或溃疡患者禁用。 (3)病毒感染(如单纯疱疹病、牛痘)或真菌病患者禁用。 (4)眼结核及青光眼患者禁用。 【不良反应】(1)偶有短暂的灼热感等局部刺激症状。 (2)罕见发痒、发热等过敏反应。 【用法和用量】(1)细菌性感染:滴眼 一次1滴，一日5次;严重者可在1,2日内每小时1滴。 (2)眼科手术后治疗滴眼，第一星期，一次1滴，一日4次，之后再依治疗情况酌减使用次数。 【制剂与规格】硫酸庆大霉素氟米龙滴眼液:5ml:硫酸庆大霉素1.5 - 20 - 万U，氟米龙5mg。14 1.2.2抗真菌药 很多种类的真菌都能引起眼部感染，如真菌性角膜炎、真菌性眼内炎和眼眶真菌感染。可以通过实验室检查来鉴别真菌菌种。 真菌性角膜炎通常采用滴眼液滴眼治疗。有时需要合并全身用药。对于真菌性眼内炎，可以采取多种途径进行治疗，如结膜下注射、前房内注射、玻璃体腔内注射和全身用药(见第9章感染疾病用药)等，如向玻璃体腔内注入两性霉素B0.005,0.001mg/0.1ml。 两性霉素B、那他霉素具有广谱抗真菌活性，是治疗眼部真菌感染可选择的药物。其他具有抗真菌活性的药物有酮康唑、氟康唑、伊曲康唑、伏立康唑等。 给药方法:(1)滴眼液:一次1滴，至少每2小时1次。感染控制后减少滴药频次。痊愈后持续用药48小时。(2)眼膏:如果白天滴用滴眼液，则涂用眼膏每晚1次。如果只用眼膏，每天3,4次。 那他霉素Natamycin 【适应证】用于对本品敏感的真菌性眼睑炎、结膜炎和角膜炎，包括腐皮镰刀菌角膜炎。 【注意事项】(1)如果使用本品7,10天后，角膜炎仍无好转，则提示引起感染的微生物对本品不敏感，应根据临床情况和实验室其他检查结果决定是否继续治疗。 (2)孕妇和哺乳妇女慎用。 - 21 - 【禁忌证】对本品所含成分过敏者禁用。 【不良反应】滴眼后有可能引起过敏反应，导致球结膜水肿和充血。 【用法和用量】(1)治疗真菌性角膜炎滴眼，初始一次1滴，每1,2小时1次;3,4日后改为一次1滴，一日6,8次，连用14,21天，或者一直持续到活动性真菌性角膜炎消退。 (2)治疗真菌性眼睑炎和结膜炎滴眼，初始一次1滴，一日4,6次，连用14,21天，或者一直持续到活动性真菌性角膜炎消退。 【制剂与規格】那他霉素滴眼液:15ml:750mg。 氟康唑Fluconazole 【适应证】用于治疗白色念珠菌、烟曲霉菌、隐球菌及球孢子菌属等引起的真菌性角膜炎。 【注意事项】(1)对其他咪唑类药物过敏者，对本品也可能过敏。 (2)肝、肾功能严重障碍者慎用。 (3)不推荐儿童使用。 (4)重度真菌性角膜炎应以全身抗真菌治疗为主，本品局部治疗为辅。 (5)用药前需要眼科专科医师诊治，确定是否需要局部清创处理。 (6)使用过程中发现异常，应立即停药。 【禁忌证】(1)对本品或其他三唑类、吡咯类药物过敏者禁用。 (2)妊娠及哺乳期妇女禁用。 【不良反应】(1)偶见眼部刺激反应和过敏反应。 【用法和用量】滴眼 一次1,2滴，一日4,6次，重症每1,2小 - 22 - 时1次。 【制剂与規格】氟康唑滴眼液:(1)5ml:25mg;(2)8ml:40mg。 1.2.3抗病毒药 腺病毒可致流行性角结膜炎，微小核糖核酸病毒可致传染性极强的急性出血性结膜炎。单纯性疱疹病毒可致结膜炎和角膜炎，巨细胞病毒可致巨细胞病毒性视网膜炎。一些病毒的眼部感染会产生严重视力障碍，甚至失明，如单纯性疱疹病毒性角膜炎、巨细胞病毒性视网膜炎。可以应用利巴韦林、阿昔洛韦、更昔洛韦治疗单纯性疱疹病毒性眼部感染，应用羟苄唑治疗病毒性结膜炎，应用阿昔洛韦、更昔洛韦进行全身治疗(见第9章-感染疾病用药)或玻璃体腔内注射来治疗急性视网膜坏死综合征。 利巴韦林Ribavirin 【适应证】用于单纯疱疹病毒性角膜炎。 【注意事项】(1)严重贫血、肝功能不全者慎用。 (2)哺乳期妇女应用时应暂停授乳。 (3)若长期大量使用本品可能会产生与全身用药相似的不良反应，如肝功能和血象的异常。 (4)本品不宜用于其他病毒性眼病。 【禁忌证】孕妇禁用。 【不良反应】偶见眼部轻微的刺激症状。 【用法和用量】(1)滴眼液滴眼，一次1滴，每小时1次，病情好转 - 23 - 后每2小时1次。 (2)眼膏涂于眼结膜囊内，一次适量，一日2,4次。 【制剂与規格】利巴韦林滴眼液:(1)0.8ml:0.8mg;(2)8ml:8mg。 利巴韦林眼膏:(1)2g:8mg;(2)2.5g:12.5mg。 阿昔洛韦:用于单纯疱疹性角膜炎。滴眼液滴眼，一次1滴，每2小时1次。 (2)眼膏涂于眼睑内，一次适量，一日4,6次。 【注意事项】滴眼液中如有结晶或粉末状物析出，温热溶解后使用。 【禁忌证】对本品过敏者禁用。 【不良反应】偶见眼局部轻微疼痛和烧灼感。 【制剂与規格】阿昔洛韦滴眼液:8ml:8mg。 阿昔洛韦眼膏:2g:60mg。 更昔洛韦Ganciclovir 【适应证】用于单纯疱疹病毒性角膜炎。 【注意事项】(1)儿童慎用。 (2)孕妇及哺乳期妇女慎用。 (3)精神病患者及神经中毒症状者慎用。 【禁忌证】(1)对本品过敏者禁用。 (2)严重中性粒细胞减少(少于0.5×10'/L)或严重血小板减少(少于25×10'/L)者禁用。 【不良反应】滴眼后可以发生短暂的眼痒、灼热感、针刺感和轻微的 - 24 - 视物模糊。偶见白细胞下降。 【用法和用量】(1)滴眼液滴眼，一次1滴，每2小时一次。 (2)眼膏涂于眼睑内，一次5,6mm(约含更昔洛韦0.25,0.30mg)，一日4,6次。 (3)眼用凝胶一次1滴，一日4次，疗程3周。 【制剂与規格】更昔洛韦滴眼液:8ml:8mg。 更昔洛韦眼膏:2g:20mg。 更昔洛韦眼用凝胶:5g:7.5mg。 羟苄唑Hydrobenzole 【适应证】用于急性流行性出血性结膜炎。 【注意事项】本品需防止阳光直射。 【禁忌证】对本品过敏者禁用。 【不良反应】滴眼后可有轻度的刺激性。 【用法和用量】滴眼一次1,2滴，一小时1,2次。病情严重者一小时3,4次。 【制剂与規格】盐酸羟苄唑滴眼液:(1)0.8ml:0.8mg;(2)8ml:8mg。 1.3眼用抗炎药 1.3.1糖皮质激素 眼部炎症是一种重要的病症，累及眼附属器、眼前节和眼后节等各个部位，可以产生严重的后果。糖皮质激素局部给药，如使用滴眼 - 25 - 液、眼膏，结膜下注射或眼内注射给药是控制眼部炎症(包括手术引起的炎症)的重要措施。全身应用(见第5章-内分泌代谢疾病用药)，例如口服糖皮质激素对一些眼部病变是有益的。 糖皮质激素和抗感染药物的复合制剂有时用于眼科手术后，以便减少炎症反应和预防感染。除此之外，这种复合制剂的应用几乎都是不合理的。 应用糖皮质激素存在三个主要危险:(1)加重病毒性、细菌性、真菌性和阿米巴原虫眼部感染的病情，导致角膜溃疡，损伤视力，甚至失明。(2)易感个体中眼局部应用糖皮质激素制剂可能会继发糖皮质激素性青光眼。(3)长期使用糖皮质激素可能继发糖皮质激素性白内障，其风险随着用药剂量和持续时间的增加而增加。 眼局部应用糖皮质激素的其他不良反应包括角膜和巩膜变薄。 泼尼松龙Prednisolone 【适应证】(1)用于需要抗炎治疗的眼部疾病，如非化脓性结膜炎、睑炎、巩膜炎、非疱疹性角膜炎、泪囊炎。 (2)用于在眼科手术后、异物去除后、化学或热烧伤、擦伤、裂伤或其他眼部创伤时作预防性治疗。 【注意事项】(1)长期用药后若出现眼部慢性炎症的表现，应考虑角膜真菌感染的可能。(2)如果发生双重感染，应立即停药并进行适当的治疗。 (3)孕妇及儿童慎用。 - 26 - 【禁忌证】(1)未行抗感染治疗的急性化脓性眼部感染患者禁用。 (2)急性单纯疱疹病毒性角膜炎、角膜及结膜的病毒感染、眼结核、眼部真菌感染患者禁用。 (3)牛痘、水痘等感染性疾病患者禁用。 【不良反应】(1)继发眼部的真菌和病毒感染在一些角膜及巩膜变薄的患者长期使用时，还可导致眼球穿孔。 (2)有单纯疱疹病毒性角膜炎病史患者、急性化脓性感染患者慎用。 (3)长期应用本品可能导致非敏感菌过度生长。长期或大剂量眼部使用本品可导致后囊膜下白内障。 (4)本品可引起眼内压升高，从而导致视神经的损害和视野的缺损，因此建议使用该药期间应常测眼内压。. 【用法和用量】滴眼一次1,2滴，一日2,4次。开始治疗的24,48小时，剂量可酌情增大至每小时2滴，必要时可加大用药频率。不宜中途终止治疗，应逐步减量停药。 【制剂与規格】醋酸泼尼松龙滴眼液:5ml:50mg。 氟米龙Flurometholone 【适应证】用于对糖皮质激素敏感的外眼、眼前节组织的炎症，如睑结膜炎、球结膜炎、角膜炎等。 【注意事项】(1)对孕妇或可能妊娠的妇女应避免长期、频繁用药。 (2)对未满2周岁的婴幼儿应慎重用药。 (3)长期使用可导致角膜真菌感染，治疗期间常测眼内压。 - 27 - (4)单纯疱疹病毒感染病史者慎用。 (5)多种眼部疾病及局部长期使用可能导致角膜和虹膜变薄，这种情况下，局部使用可能引起穿孔。 (6)未经抗菌治疗的眼部急性化脓性感染，用本品可能掩盖病情或使病情恶化。 【禁忌证】(1)角膜上皮剥脱或角膜溃疡患者禁用。 (2)病毒性结膜、角膜病变患者禁用。 (3)结核性、真菌性或化脓性眼病患者禁用。 【不良反应】可能引起眼内压升高，甚至青光眼，偶致视神经损害，后囊膜下白内障、继发性感染，眼球穿孔和延缓伤口愈合。 【用法和用量】滴眼一次1,2滴，一日2,4次。开始治疗的24,48小时内可酌情增至每小时2滴，或根据患者年龄、病情适当增减。应逐步减量停药。 【制剂与規格】氟米龙滴眼液:(1)5ml:5mg;(2)10ml:10mg。 可的松Cortisone 【适应证】用于虹膜睫状体炎、虹膜炎、角膜炎、过敏性结膜炎等。 【注意事项】(1)妊娠及哺乳期妇女不宜频繁、长期使用。 (2)青光眼患者应在眼科医师指导下使用。 (3)本品不宜长期滴用，一般连续不得超过2周，若症状未缓解应停药就医。 (4)眼部细菌性或病毒性感染时应与抗菌药物合用。 - 28 - 【禁忌证】单纯疱疹性或溃疡性角膜炎禁用。 【不良反应】长期频繁用药可引起青光眼、白内障。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日3,4次。用前摇匀。 (2)眼膏涂于结膜囊内，一次适量，一日1次，睡前用。 【制剂与規格】醋酸可的松滴眼液:3ml:15mg。 醋酸可的松眼膏:(1)1g:5mg;(2)1g:2.5mg。 地塞米松Dexamethasone 【适应证】用于虹膜睫状体炎、虹膜炎、角膜炎、过敏性结膜炎、眼睑炎、泪囊炎等。 【注意事项】(1)青光眼慎用。 (2)眼部细菌性或病毒性感染时应与抗菌素药物合用。 (3)长期使用应定期检查眼压和有无真菌、病毒感染早期症侯。 【禁忌证】单纯疱疹性或溃疡性角膜炎禁用。 【不良反应】长期频繁用药可引起青光眼、白内障，诱发真菌性眼睑炎。 【用法和用量】滴眼一次1滴，一日3,4次。 【制剂与規格】地塞米松磷酸钠滴眼液:5ml:1.25mg。 氯替泼诺LoteprednolEtabonate 【适应证】(1)0.2,(Alrex)品，用于季节性过敏性结膜炎的治疗。 - 29 - (2)0.5,(Lotemax)品，用于眼睑和球结膜、角膜和眼球前部的糖皮质激素敏感的炎症的治疗，如过敏性结膜炎、红斑性角膜炎、浅层点状角膜炎、带状疱疹性角膜炎、虹膜炎、睫状体炎、选择性感染性结膜炎;本品也适用于眼科手术后炎症的治疗。 【注意事项】(1)孕妇及哺乳期妇女慎用。 (2)未满2周岁的婴幼儿慎用。 (3)长期使用可能增加眼继发感染的危险，长期局部应用尤其容易发生角膜的真菌感染。 (4)长期应用可能导致青光眼、视敏和视野的缺陷以及后囊下白内障的形成。 (5)如用药两天后症状体征无改善，应接受检查。 【禁忌证】结膜或角膜的病毒、真菌或支原体感染患者禁用。 【不良反应】(1)视物模糊、烧灼感、球结膜水肿、分泌物、干眼、溢泪、异物感、眼痒、刺痛、畏光等。 (2)结膜炎、角膜异常、眼睑发红角膜炎、巨乳头性结膜炎和葡萄膜炎等。 (3)眼外的不良反应包括头痛、鼻炎和咽炎。 【用法和用量】(1)0.2,(Alrex)滴眼，一次1滴，一日4次。 (2)0.5,(Lotemax)滴眼，一次1,2滴，一日4次，治疗的第,周，如果必要时，剂量可以增加到每小时,滴;用于手术后炎症的控制，滴入做过手术的眼结膜囊内，一次1,2滴，一日4次，在术后24小时就开始使用，并必需持续用到术后2周。 - 30 - 【制剂与規格】氯替泼诺滴眼液:(1)0.2,(Alrex)5ml:10mg;(2)0.5,(Lotemax)?2.5ml: 12.5mg;?5ml:25mg;?10ml:50mg。 1.3.2其他抗炎药 非甾体抗炎药物可以用于预防白内障手术时瞳孔缩小和术后炎症，在术前应用会获得更佳的效果。长期局部应用这类药物不会引起继发性青光眼、白内障、延缓伤口愈合、诱发感染等糖皮质激素那样的严重不良反应。 其他用于炎症和过敏性结膜炎治疗的制剂有抗组胺药依美斯汀、奥洛他定等。肥大细胞稳定剂色甘酸钠可以用于治疗春季结角膜炎及其他过敏性结膜炎。洛度沙胺滴眼液用于治疗过敏性结膜炎，包括季节性过敏性结膜炎。双氯芬酸滴眼液也可以治疗季节性过敏性结膜炎。 双氯芬酸钠DiclofenacSodium 【适应证】(1)用于治疗葡萄膜炎、角膜炎、巩膜炎、抑制角膜新生血管的形成。 (2)用于治疗眼内手术后、激光滤帘成形术后或各种眼部损伤的炎症反应，抑制白内障手术中缩瞳反应。 (3)用于准分子激光角膜切削术后止痛及消炎。 (4)用于春季过敏性眼病，预防和治疗白内障及人工晶体术后及黄斑 - 31 - 囊样水肿，以及青光眼滤过术后促进滤过泡形成等。 【注意事项】(1)孕妇慎用。 (2)本品可妨碍血小板聚集，有增加眼组织术中或术后出血的倾向。 【禁忌证】戴接触镜者禁用，但角膜屈光术后暂时配戴治疗性亲水软镜者除外。 【不良反应】滴眼后有短暂烧灼、刺痛、流泪等，极少数人可有结膜充血、视物模糊。少数人出现乏力、困倦、恶心等全身反应。 【用法和用量】(1)一般适应证滴眼，一次1滴，一日4,6次。 (2)眼科手术滴眼，一次1滴，术前3、2、1和0.5小时内各1次。 (3)白内障术滴眼，术后24小时开始用药，一次1滴，一日4次，持续2周。 (4)角膜屈光术滴眼，术后15分钟即可用药，一次1滴，一日4次，持续用药3天。 【制剂与規格】双氯芬酸钠滴眼液:(1)0.4ml:0.4mg;(2)1ml:1mg;(3)5ml:5mg。 氟比洛芬钠FlurbiprofenSodium 【适应证】(1)用于术后抗炎，治疗激光小梁成形术后炎症反应以及其他眼前段炎症。 (2)用于预防和治疗白内障人工晶状体植入术后的黄斑囊样水肿。 (3)用于治疗巨乳头性结膜炎。 (4)用于抑制内眼手术中的瞳孔缩小。 - 32 - 【注意事项】(1)不推荐妊娠及哺乳期妇女使用本品。 (2)有单纯疱疹病毒性角膜炎病史者，慎用本药。 (3)本品可能影响血小板聚集而延长出血时间，有出血倾向或服用其他使出血时间延长药物者慎用。 (4)对乙酰水杨酸或其他非甾体抗炎药过敏者，对本品也可能过敏。 (5)急性眼部感染疾病在局部使用抗炎药时，可能掩盖病情。 (6)本品无抗菌作用，对眼部感染性疾病，应同时应用抗生素。 【禁忌证】对本品过敏者禁用。 【不良反应】有短暂烧灼、刺痛或其他轻微刺激症状。 【用法和用量】(1)抑制内眼手术时的瞳孔缩小术前2小时开始滴眼，一次1滴，每半小时滴1滴，共4次。 (2)消炎和术后消炎滴眼，一次1滴，一日3,4次，连用2,3周。 (3)激光小梁成形术术后滴眼，一次1滴，一日3,4次，连用1,2周。 【制剂与規格】氟比洛芬钠滴眼液:(1)5ml:1.5mg;(2)10ml:3mg。 普拉洛芬Pranoprofen 【适应证】用于眼睑炎、结膜炎、角膜炎、巩膜炎、浅层巩膜炎、虹膜睫状体炎、术后炎症等外眼及眼前部炎症的对症治疗。 【注意事项】(1)本品只用于对症治疗而不是对因治疗。 (2)本品可掩盖眼部感染，对于感染引起的炎症使用本品时，一定要仔细观察，慎重使用。 - 33 - 【禁忌证】对本品的成分有过敏史的患者禁用。 【不良反应】刺激感、结膜充血、瘙痒感、眼睑发红、肿胀、眼睑炎、分泌物、流泪、弥漫性表层角膜炎、异物感、结膜水肿。 【用法和用量】滴眼一次1,2滴，一日4次，根据症状可以适当增减次数。 【制剂与規格】普拉洛芬滴眼液:5ml:5mg。 酮咯酸氨丁三醇KetorolacTromethamine 【适应证】(1)用于暂时缓解季节性过敏性结膜炎引起的眼痒。 (2)用于治疗内眼手术后(如白内障摘除术)的炎症反应。 【注意事项】(1)对阿司匹林、苯乙酸衍生物及其他非甾体抗炎药过敏者，对本品也可能过敏。 (2)慎用于有出血倾向的患者或避免合并应用可能延长出血时间的药物。 (3)使用本品感觉不适应立即停药。 (4)避免配带隐形眼镜等软性接触镜时用药。 【禁忌证】(1)患有活动性消化性溃疡近期出现过胃肠道出血或穿孔的病人或有消化性溃疡或胃肠道出血病史的患者禁用 (2)肾功能不全或因血容不足有肾衰竭危险的患者禁用 (3)临产分娩及产妇禁用 (4)对酮咯酸氨丁三醇有过敏史或对阿司匹林或其它非甾体抗炎药过敏的患者禁用 - 34 - (5)本品禁用于手术疼痛的预防或手术中镇痛 (6)可疑或确诊有脑血管出血不完全止血和高危出血的患者禁用 【不良反应】一过性刺痛或灼热感、过敏反应、眼刺激、浅层眼部感染及浅层角膜炎、角膜水肿，眼干、视力模糊、角膜溃疡、头痛、充血等。 【用法和用量】(1)过敏性结膜炎滴眼，一次1滴，一日3次。 (2)眼科术后炎症滴眼，手术前24小时开始滴用，一次1,2滴，一日3,4次，术后继续用2周。 【制剂与規格】酮咯酸氨丁三醇滴眼液:5ml:25mg。 富马酸依美斯汀EmedastineDifumarate 【适应证】用于治疗过敏性结膜炎。 【注意事项】(1)孕妇及哺乳期妇女慎用。 (2)使用本品时勿佩戴角膜接触镜。 【禁忌证】对本品所含成分过敏者禁用。 【不良反应】头痛、异梦、乏力、怪味、视物模糊、眼部灼热或刺痛、角膜浸润、角膜着染、皮炎、不适、眼干、异物感、充血、角膜炎、瘙痒、鼻炎、鼻窦炎和流泪。有些表现与疾病本身的症状相似。 【用法和用量】滴眼一次1滴，一日2次，必要时一日4次。 【制剂与規格】富马酸依美斯汀滴眼液:5ml:2.5mg。 洛度沙胺Lodoxamide - 35 - 【适应证】(1)用于各种过敏性眼病，如春季卡他性角结膜炎、卡他性结膜炎、巨大乳头性睑结膜炎、过敏性或特异反应性角结膜炎、包括那些病因不明，但一般由空气传播的抗原及隐形眼镜引起的过敏反应。 (2)用于由?型速发性变态反应(或肥大细胞)引起的炎症性眼病。 【注意事项】(1)用药物时勿配戴隐性眼镜，需等数小时后方可配戴。 (2)用药次数勿任意增加。 (3)孕妇及哺乳期妇女慎用。 (4)用药后症状改善(如不适、痒感、异物感、畏光、刺痛、流泪、发红及肿胀等)通常需数天，有时需持续治疗达4周。用药后若症状减轻，应坚持用药至进一步改善，必要时可与皮质激素类药物同用。 【禁忌证】对本品任何成分过敏者禁用。 【不良反应】轻微短暂的眼部不适感，如灼热、刺痛、眼痒、流泪。 【用法和用量】滴眼一次1,2滴，一日4次。 【制剂与規格】洛度沙胺滴眼液:5ml:5mg。 奥洛他定Olopatadine 【适应证】用于治疗过敏性结膜炎的体征和症状。 【注意事项】(1)孕妇及哺乳期妇女慎用。 (2)使用本品时，勿佩戴角膜接触镜。 【禁忌证】对本品所含成分过敏者禁用。 【不良反应】头痛、乏力、视力模糊、烧灼或刺痛感、感冒综合征、 - 36 - 眼干、异物感、充血、过敏、角膜炎、眼睑水肿、恶心、咽炎、瘙痒、鼻炎、鼻窦炎及味觉倒错。相当一部分的不良反应和疾病本身的症状相似。 【用法和用量】滴眼一次1,2滴，一日2次。 【制剂与規格】奥洛他定滴眼液:5ml:5mg。 吡嘧司特钾PemirolastPotassium 【适应证】用于过敏性结膜炎、春季卡他性结膜炎。 【注意事项】滴眼时如果药液粘到眼睑皮肤等处时，马上拭去。 【禁忌证】尚不明确。 【不良反应】眼刺激感、眼睑炎、眼部分泌物、结膜充血、眼睑痛痒感等。 【用法和用量】滴眼一次1滴，一日2次。 【制剂与規格】吡嘧司特钾滴眼液:5ml:5mg。 色甘酸钠SodiumCromoglicate 【适应证】用于预防春季过敏性结膜炎。 【注意事项】(1)过敏体质者慎用。 (2)严重肝肾功能不全患者慎用。 (3)用药前应清洁鼻腔。 (4)在春季结膜炎好发季节前2,3周使用。 【禁忌证】妊娠三个月以内的妇女禁用。 - 37 - 【不良反应】滴眼后偶有刺痛感和过敏反应。 【用法和用量】滴眼一次1,2滴，一日4次，必要时一日6次。 【制剂与規格】色甘酸钠滴眼液:(1)8ml:0.16g;(2)0.8ml:16mg。 马来酸非尼拉敏盐酸萘甲唑啉滴眼液 PheniramineMaleateNaphazolineHydrochlorideEyeDrops 【适应证】用于缓解因尘埃、感冒、过敏、揉眼、配戴角膜接触镜、游泳以及眼睛疲劳等引起的 眼睛充血、瘙痒、灼热感以及其他刺激症状。 【注意事项】(1)本品连用3,4日，症状未缓解者应停药就医。 (2)患有严重心血管疾病的老年患者、孕妇和哺乳期妇女以及未控制好的高血压、糖尿病患者慎用。 (3)在使用过程中，如发现眼红、疼痛等情况，应停药就医。 (4)佩戴隐形眼镜者滴药前摘下，滴入后15分钟再戴上。 (5)过敏体质者慎用。 【禁忌证】(1)对本品过敏者禁用。 (2)闭角型青光眼患者禁用。 【不良反应】(1)偶见滴眼后瞳孔散大，眼压升高。 (2)长期使用可能产生全身反应，如高血压、心律失常及高血糖等，停药后可恢复。 【用法和用量】滴眼一次1,2滴，每3,4小时1次。可根据症状缓解情况减少滴药次数。 - 38 - 【制剂与规格】马来酸非尼拉敏盐酸萘甲唑啉滴眼液:15ml:马来酸非尼拉敏45mg，盐酸萘甲唑啉3.75mg。 1.4散瞳药和睫状肌麻痹药 散大瞳孔是眼科常用的治疗。抗M胆碱类药物能够散大瞳孔，麻痹睫状肌。不同药物具有不同效能和作用持续时间。作用时间短、作用相对弱的散瞳剂，如0.5%托品酰胺滴眼液可以用于眼底检查。1,阿托品滴眼液可以引起睫状肌麻痹，适用于青少年的屈光检查。涂用眼膏可以减少药物的全身吸收，因此1,阿托品眼膏更适合于5岁以下儿童。具有较长作用时间的阿托品也可用于治疗前葡萄膜炎，主要是防止瞳孔缘虹膜后粘连。1,后马托品作用时间较短，可以作为治疗眼前节炎症的首选药物。 α肾上腺素受体激动剂去氧肾上腺素具有散大瞳孔的作用，但没有睫状肌麻痹作用。10,去氧肾上腺素滴眼液经常与1%阿托品滴眼液合用，以便增强散瞳作用。但10%去氧肾上腺素滴眼液禁用于新生儿、儿童及患有心脏病的老年人，只能用2.5,的浓度。 注意事项 (1)深色虹膜用药后瞳孔不易散大。要注意避免滴用的药物过量。(2)散瞳可以诱发少数患者发生急性闭角性青光眼，他们通常有浅前房。(3)去氧肾上腺素与全身给予的单胺氧化酶抑制剂有药物相互作用。(4)滴药后压迫泪囊部2,3分钟，以免经鼻腔吸收而中毒。(5)应当提醒开车的患者在散瞳后1,2小时内不要开车。 不良反应 (1)散瞳剂和睫状肌麻痹药剂的眼部不良反应包括一过性针刺感和眼压升高。(2)长时间用药会引起眼局部刺激、充血、 - 39 - 水肿和结膜炎。(3)应用抗M胆碱类散瞳剂，特别是阿托品，可以导致接触性睑皮肤炎。 长期应用阿托品会发生一些全身的不良反应，如皮肤和黏膜干燥、发热、激动和谵妄、心动过速、脸部潮红等。 散瞳药和睫状肌麻痹药包括三类:?抗胆碱药及抗毒蕈碱药(硫酸阿托品、环喷托酯、后马托品和托品酰胺);?拟交感神经药(去氧肾上腺素);?抗M胆碱药和拟交感神经药复合制剂(复方托吡卡胺)。 硫酸阿托品AtropineSulfate 【适应证】(1)用于眼底检查及验光前的散瞳，眼科手术术前散瞳，术后防止粘连。 (2)用于治疗角膜炎、虹膜睫状体炎。 【注意事项】(1)阿托品类扩瞳药对正常眼压无明显影响，但对眼压异常或窄角、浅前房眼患者，应用后可使眼压明显升高而有激发青光眼急性发作的危险。故对这类病例和40岁以上的病人不应用阿托品滴眼。 (2)滴眼后用手指压迫泪囊部1,2分钟，减少药液的全身吸收。 (3)孕妇慎用，哺乳期妇女应避免使用或停止哺乳。 (4)老年患者慎用。 【禁忌证】(1)对本品过敏者禁用。 (2)青光眼及前列腺肥大者禁用。 (3)儿童脑外伤者禁用。 - 40 - 【不良反应】(1)用药后可能产生皮肤、黏膜干燥，发热，面部潮红，心动过速等。 (2)少数人出现眼睑发痒、红肿，结膜充血等过敏表现。 【用法和用量】(1)滴眼液滴眼，一次1滴，一日3次，或病情需要时用。 (2)眼用凝胶滴眼，一次1滴，一日2次，或病情需要时用。 (3)眼膏涂于结膜囊内，一次适量，每晚l次，或病情需要时用。 【制剂与規格】硫酸阿托品滴眼液:10ml:100mg。 硫酸阿托品眼用凝胶:2.5g:25mg。 硫酸阿托品眼膏:2g:20mg。 氢溴酸后马托品HomatropineHydrobromide 【适应证】用于12岁以上40岁以下患者的散瞳验光和眼底检查。 【注意事项】(1)滴时按住内眦部，以免流入鼻腔，吸收中毒。 (2)前列腺肥大患者慎用。 (3)40岁以上患者慎用。 【禁忌证】对本品过敏和青光眼患者禁用。 【不良反应】不良反应主要由于滴眼后吸收入体内所致，因此滴眼时需压迫内眦以防止药物流入鼻腔而吸收。不良反应的表现为共济失调、兴奋不安、幻觉等。其余不良反应和注意事项同硫酸阿托品。 【用法和用量】滴眼一次1滴，每10分钟1次，连用1小时。 【制剂与規格】氢溴酸后马托品滴眼液:(1)10ml:100mg;(2)5ml: - 41 - 100mg。 环喷托酯Cyclopentolate 【适应证】用于滴眼散瞳和调节麻痹。 【注意事项】(1)婴幼儿和强直性麻痹或脑损伤患者使用本品后易出现全身不良反应，因此用药浓度应低于0.5%。 (2)不良反应主要由于滴眼后吸收入体内所致，因此滴眼时需压迫内眦以防止药物流入鼻腔而吸收。 (3)40岁以上患者慎用。 【禁忌证】青光眼患者禁用。 【不良反应】(1)眼部:用药后可产生烧灼感。可使青光眼患者的眼压升高。 (2)全身:滴眼后可能引起儿童中枢神经系统的紊乱，如运动失调、幻视和语无伦次。 【用法和用量】滴眼一次1滴，一日1次。 【制剂与規格】盐酸环喷托酯滴眼液:(1)5ml:25mg:(2)5ml:50mg;(3)15ml:150mg。 托吡卡胺滴眼液TropicamideEyeDrops 【适应证】用于滴眼散瞳和调节麻痹。 【注意事项】(1)为避免药物经鼻粘膜吸收，滴眼后应压迫泪囊部2,3分钟，。 - 42 - (2)如出现口干、颜面潮红等阿托品样毒性反应应立即停用，必要时给予拟胆碱类药物解毒。 (3)婴幼儿对本品的不良反应极为敏感，药物吸收后可引起眼局部皮肤潮红、口干等。 (4)老年患者容易产生类阿托品样毒性反应，也有可能诱发未经诊断的闭角型青光眼，一经发现应即停药。 【禁忌证】(1)闭角型青光眼患者禁用。 (2)婴幼儿有脑损伤、痉挛性麻痹及先天愚型综合征者反应强烈患者禁用。 【不良反应】(1)1%溶液可能产生暂时的刺激症状。 (2)散瞳期间视物模糊，可使闭角型青光眼眼压急剧升高，也可能激发未被诊断的闭角型青光眼。 【用法和用量】滴眼 一次1滴，间隔5分钟滴第2次。 【制剂与规格】托吡卡胺滴眼液:(1)6ml:15mg;(2)6ml:30mg。 复方托吡卡胺滴眼液CompoundTropicamideEyeDrops 【适应证】用于滴眼散瞳和调节麻痹。 【注意事项】(1)有眼压升高因素的前房角狭窄、浅前房者慎用，必要时测量眼压或用缩瞳药。 (2)高血压、动脉硬化、冠状动脉供血不足、糖尿病、甲状腺机能亢进者慎用。 (3)出现过敏症状或眼压升高应停用。 - 43 - (4)本品滴眼有作用强、起效快、持续时间短的特点，但瞳孔散大后约有5,10小时的畏光及近距离阅读困难的现象。 (5)滴眼后应压迫泪囊部2,3分钟，以防经鼻粘膜吸收过多引发全身不良反应。 (6)由于残余调节力的存在，不太适合于少年儿童散瞳验光。 (7)未成熟新生儿滴用可能发生心率减缓、呼吸停止。对儿童的安全性尚未确立，宜慎用。 【禁忌证】(1)未手术的闭角型青光眼患者禁用。 (2)婴幼儿有脑损伤、痉挛性麻痹及先天愚型综合征者反应强烈患者禁用。 【不良反应】(1)偶见眼局部刺激症状。 (2)亦可使开角型青光眼患者眼压暂时轻度升高，由于去氧肾上腺素本身具有降眼压的作用将不会造成视神经的损害。 【用法和用量】滴眼 (1)散瞳检查:本品滴入结膜囊，一次1滴，间隔5分钟再滴第2次。本品滴眼后5,10分钟开始散瞳，15,20分钟瞳孔散得最大。约维持一个半小时后开始缩瞳，5,10小时瞳孔恢复至滴药前水平。 (2)屈光检查:应用本品每5分钟滴眼一次，连续滴4次，20分钟后可作屈光检查。考虑残余调节力的存在，故不太适于12岁以下的少年儿童散瞳验光。 【制剂与规格】复方托吡卡胺滴眼液:(1)5ml:托吡卡胺25mg和盐酸去氧肾上腺素25mg;(2)10ml: - 44 - 托吡卡胺50mg和盐酸去氧肾上腺素50mg。 去氧肾上腺素Phenylephrine29 【适应证】散瞳，用于检查眼底及晶状体，鉴别闭角型或开角型青光眼(后者用此药后眼压不增高)。 【注意事项】(1)本品根据需要可配成2,,10,的溶液。 (2)儿童及老人应当避免使用10,浓度的溶液。 (3)心血管疾病患者应当避免使用，或只能使用2%浓度的溶液。 (4)心动过速、甲状腺机能亢进、糖尿病患者慎用。 【禁忌证】(1)对本品过敏和青光眼患者禁用。 (2)服用单胺氧化酶抑制剂，如异咪唑肼、硫酸苯乙肼、硫酸反苯环丙胺和三环抗抑郁药，如丙咪嗪、阿米替林、普罗替林、多虑平等时禁用本品滴眼。 (3)孕妇禁用。 (4)婴幼儿禁用。 【不良反应】(1)眼部:眼痛及针刺感、视力模糊、畏光。罕见诱发闭角型青光眼急性发作。 (2)全身:心律失常、冠状动脉痉挛、高血压等。 【用法和用量】滴眼一次1,2滴，一日1,5次。散瞳用时，常用浓度5%或10%，每隔5分钟滴1次，连续2次，于30分钟内即呈现散瞳。 【制剂与規格】盐酸去氧肾上腺素滴眼液:(1)25ml:0.1g;(2)5ml: - 45 - 0.25g;(3)5ml:0.5g。 1.5青光眼及其用药 青光眼(glaucoma)是一类严重的致盲眼病。到目前为止，只有降低眼压才能控制青光眼的病情。对于大多数原发性开角型青光眼患者来说，首选的是应用药物治疗来降低眼压。对于原发性闭角型青光眼，首要的问题是解除前房角关闭，可以进行激光或手术周边虹膜切除术，使后房水经过虹膜切除孔进入前房，消除或减轻周边部虹膜向前膨隆，开放前房角。但在进行周边部虹膜切除术之前，需要应用药物治疗来降低眼压和防止前房角关闭。一些原发性闭角型青光眼患者由 于治疗不及时或不合理，导致前房角粘连性关闭，单纯施行周边部虹膜切除术并不能降低眼压，需要施行眼外滤过术。虽然大多数患者能在手术后能满意地控制眼压，但是仍然有相当一部分患者需要加用药物来控制眼压。总之，通过药物治疗来降低眼压是处理青光眼的主要措施。 多种不同作用机制的药物可以降低眼压。眼部滴用的β肾上腺素受体拮抗剂或前列腺素类似物通常是首选的药物。在一些病例中，有必要联合应用这些药物，或者需要加用其他药物，如缩瞳药、交感神经兴奋剂及碳酸酐酶抑制剂等，以便控制眼压。 在一些高眼压或需要手术的病例中，需要紧急地降低眼压，可以应用20%甘露醇静脉滴注，用量可以大至500ml。 - 46 - 1.5.1 β肾上腺素受体拮抗药 眼部滴用β肾上腺素受体拮抗剂可以有效地降低眼压。口服β肾上腺素受体拮抗剂也可以降低眼压，但是这种给药方式有明显的不良反应，因此不再应用这种方式给药。 用于青光眼的β肾上腺素受体拮抗剂有卡替洛尔、左布诺洛尔、美替洛尔、噻吗洛尔和倍他洛尔。除了倍他洛尔是选择性的β肾上1腺素受体拮抗剂外，其余几种都是非选择性β和β肾上腺素受体拮12 抗剂，都有较好的降低眼压的作用，可以根据患者的情况选用。 注意事项、禁忌证和不良反应眼部给药后可以全身吸收，因此含有β肾上腺素受体拮抗剂的滴眼液禁用于心动过缓、房室传导阻滞或未控制的心衰患者。滴用β肾上腺素受体拮抗剂后眼部不良反应包括眼部针刺感、烧灼感、疼痛、眼痒、红斑、眼干及过敏反应(包括过敏性结膜炎和睑结膜炎)。偶有引起角膜病变的报道。 β肾上腺素受体拮抗剂，或者即使是心脏选择性的β肾上腺素1受体拮抗剂，也不能用于哮喘或有气道阻塞性病史的患者，除非没有其他药物可供选择。在可能诱发支气管痉挛风险的情况下，应用β肾上腺素受体拮抗剂应当格外谨慎。 β肾上腺受体拮抗剂可能掩盖急性低血糖症状，因此糖尿病患者使用β肾上腺素受体拮抗剂要特别注意，尤其是原发性低血糖患者、正在接受胰岛素治疗或口服降糖药物的患者。β肾上腺素受体拮抗剂会掩盖甲状腺功能亢进的临床体征，如心动过速。 妊娠及哺乳期妇女慎用β肾上腺素受体拮抗剂。 - 47 - 卡替洛尔Carteolol 【适应证】用于青光眼、高眼压症。 【注意事项】(1)对β肾上腺素受体阻滞剂有禁忌及过敏者慎用。 (2)肝功能低下者慎用。 (3)自发性低血糖患者及接受胰岛素或降糖药治疗的患者慎用。 (4)儿童慎用。 (5)孕妇及哺乳期妇女慎用，在确有应用指征时，应权衡利弊后决定是否使用。 (6)对明显心脏病患者，应用本品应检测心率。 (7)本品不宜单独用于治疗闭角型青光眼。 (8)与其他滴眼液合用时宜隔10分钟以上。 【禁忌证】(1)本品过敏者。 (2)支气管哮喘或有支气管哮喘史，严重慢性阻塞性肺部疾病。 (3)窦性心动过缓、?或?度房室传导阻滞、明显心衰、心源性休克。 【不良反应】(1)偶见局部不良反应，视物模糊、畏光、角膜着色、出现暂时性眼烧灼刺痛及流泪、结膜充血。全身不良反应心率减慢、呼吸困难、无力、头痛头晕。 (2)罕见不良反应恶心。 (3)长期连续用于无晶体眼或眼底病变者时，偶可发生黄斑部水肿、浑浊，故需定期测定视力和检查眼底。 【用法和用量】滴眼 一次1滴，一日2次。滴于结膜囊内，滴后用手指压迫内毗角泪囊部3,5分钟。效果不明显时，改用2%制剂，一 - 48 - 次1滴，一日2次。 【制剂与規格】盐酸卡替洛尔滴眼液:(1)5ml:50mg;(2)5ml:100mg。 左布诺洛尔Levobunolol 【适应证】(1)用于原发性开角型青光眼。 (2)用于某些继发性青光眼，高眼压症，手术后未完全控制的闭角型青光眼以及其他药物及手术无效的青光眼，加用本品滴眼可进一步增强降眼压效果。 【注意事项】(1)已知是全身β肾上腺能阻断剂禁忌的患者，包括异常心动过缓，I度以上房室传导阻滞患者慎用。 (2)先天性心衰患者应得到适当控制后，才能使用本品。 (3)对有明显心脏疾病患者应用本品应监测脉搏。 (4)对其他β肾上腺能阻断剂过敏者慎用。 (5)已有肺功能低下的患者慎用。 (6)自发性低血糖患者及接受胰岛素或降糖药治疗的患者慎用。 (7)本品不宜单独用于治疗闭角型青光眼。 (8)与其他滴眼液联合使用时，请间隔10分钟以上 (9)本品含氯化苯烷铵，戴软性角膜接触镜者不宜使用。 (10)使用中若出现脑供血不足症状时应立即停药。 (11)重症肌无力患者，用本品滴眼时需遵医嘱。 (12)定期复查眼压，根据眼压变化调整用药方案。 【禁忌证】(1)支气管哮喘或有支气管哮喘史、严重慢性阻塞性肺部 - 49 - 疾病患者禁用。 (2)窦性心动过缓、?或?度房室传导阻滞、明显的心衰及心源性休克患者禁用。 【不良反应】(1)1/3的患者出现暂时性眼烧灼及眼刺痛;5%的患者出现结膜炎;一些患者出现心率减慢及血压下降。 (2)其他少见不良反应，包括心律变化，呼吸困难，虹膜睫状体炎，头痛，头晕，一过性共济失调，嗜睡，瘙痒及荨麻疹。 (3)罕见不良反应，包括?全身症状:无力，胸痛;?心血管系统:心动过缓，心率失常，低血压，晕厥，心传导阻滞，脑血管意外，脑缺血，心衰，心绞痛，心悸，心搏停止;?消化系统:恶心，腹泻;?神经系统:抑郁，精神错乱，加重重症肌无力的症状，感觉异常;?皮肤:过敏反应如瘙痒及荨麻疹，脱发，Steven-Johnson综合征;?呼吸系统:支气管痉挛，呼吸衰竭，呼吸困难，鼻腔充血;?内分泌系统:掩盖糖尿病患者应用胰岛素或降糖药后的低血糖症状;?泌尿生殖器系统:阳萎。 【用法和用量】滴眼一次1滴，一日1,2次。滴于结膜囊内，滴后用手指压迫内毗角泪囊部3,5分钟。 【制剂与規格】盐酸左布诺洛尔滴眼液:(1)5ml:25mg;(2)10ml:50mg。 美替洛尔Metipranolol 【适应证】(1)用于高眼压症、慢性开角型青光眼、无晶体性青光眼。 - 50 - (2)用于囊性青光眼、色素型青光眼、先天性和出血性青光眼。 【注意事项】(1)不宜与单胺氧化酶抑制剂合用。(2)本品剂量的个体差异较大，宜从小到大试用，以选择适宜的剂量。长期用药时不可突然停药。(3)充血性心力衰竭病人(继发于心动过速者除外)，须等心衰得到控制后始可用本品。(4)不宜与抑制心脏的麻醉药(如乙醚)合用。 【禁忌证】(1)窦性心动过缓、重度房室传导阻滞、心源性休克、低血压症患者禁用。 (2)有增加洋地黄毒性的作用，对已洋地黄化而心脏高度扩大、心率又较不平稳的患者禁用。 (3)哮喘及过敏性鼻炎患者禁用。 【不良反应】(1)睑结膜炎，一过性眼烧灼、刺激感、心率下降，偶有报道降低血压。 (2)罕见不良反应，包括呼吸困难、虹膜睫状体炎、额痛、头痛、肝酶活性升高、嗳气、一过性共济失调、嗜睡、头晕、瘙痒及荨麻疹。 【用法和用量】滴眼一次1滴，一日2次。从低浓度开始使用，如未能达到疗效或维持治疗，可改用较高浓度滴眼液。仅在0.3%浓度滴眼液治疗无效时，方可改用0.6%浓度滴眼液。 【制剂与規格】美替洛尔滴眼液:(1)5ml:5mg;(2)5ml:15mg;(3)5ml:30mg。 噻吗洛尔:用于:(1)用于原发性开角型青光眼。(2)用于某些继发性青光眼，高眼压症，部分原发性闭角型青光眼以及其他药物及手术无 - 51 - 效的青光眼，加用本品滴眼可进一步增强降眼压效果。 滴眼 一次1滴，一日1,2次，如眼压已控制，可改为一日1次。如原用其他药物，在改用本品治疗时，原药物不宜突然停用，应自滴用本品的第二天起逐渐停用。(其他见第4章-心血管系统疾病用药) 倍他洛尔Betaxolol 【适应证】用于慢性开角型青光眼和高眼压症。 【注意事项】糖尿病、甲亢、肌无力、肺功能不全患者慎用。 【禁忌证】窦性心动过缓、I度以上房室传导阻滞、有明显心衰患者禁用。 【不良反应】(1)视物模糊、点状角膜炎、异物感、畏光、流泪、痒、干燥、红斑、发炎、分泌物增多、视力敏锐度降低、过敏反应、水肿、角膜敏感性降低及瞳孔大小不一。 (2)心动过缓、心脏传导阻滞及充血性心力衰竭。 (3)可能会有因呼吸困难、支气管痉挛、气管分泌物浓稠、气喘或呼吸衰竭而产生肺压迫感、失眠、眩晕、头昏、头痛、忧郁、嗜睡、荨麻疹、中毒性表皮坏死、脱毛、舌炎等。 【用法和用量】滴眼一次1,2滴，一日2次。如本品尚不足以控制患者眼内压时，可并用毛果芸香碱、肾上腺素或服用碳酸酐酶抑制剂(如乙酰唑胺)等。 【制剂与規格】盐酸倍他洛尔滴眼液:5ml:12.5mg。 - 52 - 1.5.2前列腺素类似药 拉坦前列素和曲伏前列素是前列腺素类似药物，可以增加房水经脉络膜巩膜途径外流。比马前列素也是前列腺素类相关的药物。这些药物可以降低高眼压症或开角型青光眼患者的眼压，作用比β肾上腺受体拮抗剂要强，而且用药次数少，应用方便。 拉坦前列素Latanoprost 【适应证】用于治疗青光眼和高眼压症，以及各种眼内压增高的情况。 【注意事项】(1)使用含硫柳汞制剂后5分钟之内者不得使用本品。 (2)治疗前，告知患者用药后虹膜颜色可能会加深，在用药过程中应当注意虹膜颜色的改变。 (3)在无晶体眼、伴有晶状体后囊膜撕裂的人工晶状体眼或前房型人工晶状体眼、具有发生葡萄膜炎和黄斑囊样水肿危险因素的患者慎用。 (4)哮喘患者慎用。 (5)孕妇不宜使用;哺乳期妇女不宜使用，或停止哺乳。 (6)儿童不宜使用。 【禁忌证】角膜接触镜佩戴者禁用。 【不良反应】(1)虹膜颜色加深、睑缘炎、眼部刺激症状和疼痛;眼睫毛变黑增粗增长;结膜充血、暂时点状角膜上皮糜烂、眼睑水肿和红斑;皮疹。 (2)罕见呼吸障碍、哮喘加重、虹膜炎、葡萄膜炎、眼睑皮肤变黑。 - 53 - (3)极罕见胸痛、咽炎。 【用法和用量】滴眼一次1滴，一日1次。晚间使用效果较好。 【制剂与規格】拉坦前列素滴眼液:(1)1ml:50μg;(2)2.5ml:125μg。 曲伏前列素Travoprost 【适应证】用于降低开角型青光眼或高眼压症患者升高的眼压。 【注意事项】(1)患者虹膜棕色素可能逐步增加，这些改变可能在几个月或几年都不被发现(警告)。通常棕色素从受影响眼的瞳孔周围向外周呈向心性分布，但整个虹膜或部分虹膜颜色会变深。患者应根据情况定期进行检查，直到加深逐渐明显。如果色素沉着发生应停止治疗。 (2)具有眼部感染史(虹膜炎/葡萄膜炎)患者慎用。 (3)无晶体患者，晶体后囊膜破裂的假晶体患者或有黄斑水肿危险因素的患者慎用。 (4)在佩戴接触性镜片期间禁止使用。使用本品前应将接触性镜片摘除。在滴入本品15分钟后再重新戴入镜片。 (5)本品的降眼压作用大约在用药2小时后开始出现，在12小时达到最大。本品可以和其它眼局部用药一起用于降眼压。同时使用不止一种眼药时，每种药物的滴用时间至少间隔5分钟。 【禁忌证】急性眼部感染的患者禁用。 【不良反应】(1)35%,50%的患者眼充血。大约3%的患者因结膜充 - 54 - 血停止用药。 (2)5,,10%的眼部不良反应包括视力下降，眼部不适，异物感，疼痛，瘙痒。 (3)1,,4%的眼部不良反应包括视力异常、眼睑炎、视力模糊、白内障、炎性细胞、结膜炎、干眼、眼部不适、房闪、虹膜异色、角膜炎、睑缘结痂、畏光、结膜下出血和流泪。 (4)非眼部不良反应占1~5%，包括外伤、心绞痛、焦虑、关节炎、背痛、心动过缓、气管炎、胸痛、感冒综合征、抑郁、消化不良、胃肠功能紊乱、头痛、高胆固醇血症、高血压、低血压、感染、疼痛、前列腺功能紊乱、窦炎、尿失禁和尿道感染。 【用法和用量】滴入患眼每晚1次，每次1滴。剂量不能超过每天1次，因为频繁使用会降低药物的降眼压效应。 【制剂与規格】曲伏前列素滴眼液:2.5ml:0.1mg。 比马前列素Bimatoprost 【适应证】(1)用于开角型青光眼。 (2)用于其他降眼压药物无效(多次测量后不能达到预定的眼内压水平)或不能耐受的眼压升高患者。 【注意事项】(1)使用含硫柳汞制剂后5分钟之内者不得使用本品。 (2)治疗前，告知患者用药后虹膜颜色可能会加深，在用药过程中应当注意虹膜颜色的改变。 (3)在无晶体眼、伴有晶状体后囊膜撕裂的人工晶状体眼或前房型人 - 55 - 工晶状体眼、具有发生葡萄膜炎和黄斑囊样水肿危险因素的患者慎用。 (4)哮喘患者慎用。 (5)孕妇不宜使用;哺乳期妇女不宜使用，或停止哺乳。 (6)儿童和18岁以下青少年不宜使用。 (7)每晚于病眼内滴入本品l滴。频繁使用可降低本品的降眼压作用。首次用药约4小时后眼压开始降低，最大效果出现在8,12小时内。如不慎过量使用本品，应进行对症治疗。 (8)本品可与其他降眼压的局部眼用药联用。如使用1种以上的降眼压药，应至少间隔5分钟使用。 【禁忌证】对本品中任何成分过敏者。 【不良反应】(1)虹膜颜色加深、睑缘炎、眼部刺激症状和疼痛;眼睫毛变黑增粗增长;结膜充血、暂时点状角膜上皮糜烂、眼睑水肿和红斑;皮疹。 (2)罕见呼吸障碍、哮喘加重、虹膜炎、葡萄膜炎、眼睑皮肤变黑。 (3)极罕见胸痛、咽炎。 (4)眼痒、过敏性结膜炎、白内障、结膜水肿、分泌物、畏光、浅层点状角膜炎，头痛，高血压。 【用法和用量】滴眼一次1滴，一日1次，夜间使用。 【制剂与規格】比马前列素滴眼液:1ml:0.3mg。 1.5.3肾上腺素受体激动药 - 56 - 肾上腺素通过减少房水生成和增加房水经小梁网的外流来发挥药效。由于肾上腺素具有散瞳作用，因此在有发生原发性闭角型青光眼倾向的人中应用时必须谨慎，除非这些人已经做过周边虹膜切除术。肾上腺素的不良反应包括眼部剧烈刺痛、眼红。肾上腺素用于高血压和心脏病患者时应当格外小心。滴入药物后用手指压迫内毗角泪囊部3,5分钟。 地匹福林是肾上腺素的前体药，它比肾上腺素更快速地透过角膜，然后转化为活性成分而发挥药物作用。 溴莫尼定为选择性α肾上腺素受体兴奋剂。在单用β肾上腺素2 受体拮抗药不能满意地降低眼压的开角型青光眼或高眼压症患者中，应用溴莫尼定降低眼压是合理的。当其他降眼压药物不能满意地控制眼压时，溴莫尼定可以作为辅助治疗。 溴莫尼定Brimonidine 【适应证】用于降低开角型青光眼和高眼压症患者的眼压。 【注意事项】(1)用药后困倦会影响到熟练工作的完成，例如驾驶车辆。 (2)滴用本品至少15分钟后才可配戴接触镜。 (3)同时使用其他滴眼液时，每种药物的滴用时间至少间隔5分钟。 【禁忌证】(1)严重心血管疾病、脑或冠状动脉供血不足、肢端动脉痉挛综合征、直立性低血压、抑郁症、肝肾功能不全患者禁用。 (2)孕妇及哺乳期妇女禁用。 - 57 - (2)使用单胺氧化酶抑制剂治疗的患者禁用。 【不良反应】眼部反应包括结膜充血、灼烧、刺痛、眼痒、过敏、结膜滤泡增生、视觉障碍、睑缘炎、流泪、角膜糜烂、浅层点状角膜炎、眼痛、分泌物、眼干、眼部刺激、眼睑炎症、结膜炎、畏光。此外还有高血压、头痛、抑郁、口干、疲劳、困倦。较少见的不良反应有味觉障碍、心悸、头昏、晕厥、鼻炎、鼻干。 【用法和用量】滴眼 一次1滴，一日2次。对眼内压在下午达高峰的患者或需要额外控制眼压者，下午可增加1滴。 【制剂与規格】溴莫尼定滴眼液:5ml:10mg。 地匹福林Dipivefrine 【适应证】(1)用于降低开角型青光眼和高眼压症患者的眼压。 (2)用于对闭角型青光眼虹膜切除后的残余性青光眼。 【注意事项】(1)孕妇及哺乳期妇女慎用，在确有应用指征时，应权衡利弊后决定是否使用。 (2)无晶状体青光眼、高血压、心功能不全、甲状腺机能亢进患者慎用。 【禁忌证】未经手术的闭角型青光眼、甲状腺机能亢进、高血压、冠状动脉供血不全、心律失常及糖尿病等患者禁用。 【不良反应】(1)滴眼后可出现轻微眼部灼烧、刺痛感，结膜滤泡增生、结膜充血、视物模糊、额痛、结膜角膜色素沉着。 (2)偶有枕部疼痛、心律失常、心率增快、血压增高、脸色苍白、发 - 58 - 抖和出汗等。 (3)有引起散大瞳孔和无晶状体黄斑病变的可能。 【用法和用量】滴眼 一次1滴，一日1,2次。 【制剂与規格】地匹福林滴眼液:(1)5ml:5mg;(2)8ml:8mg。 1.5.4碳酸酐酶抑制药 碳酸酐酶抑制剂，如乙酰唑胺、布林佐胺可以通过减少房水生成来降低眼压。当全身使用碳酸酐酶抑制剂时可以减少尿量。 乙酰唑胺可以通过口服和静脉注射给药，可作为降眼压治疗的辅助用药。乙酰唑胺是硫胺类药，偶尔能引起血液病、皮疹及与硫胺类药物有关的不良反应。一般不推荐长期使用。 布林佐胺是眼部滴用的碳酸酐酶抑制剂，应用于β肾上腺素受体拮抗药疗效差的患者或那些禁用β肾上腺素受体拮抗药的患者。它可以单独使用或作为眼部滴用β受体阻滞药的辅助用药。使用后很少全身吸收，因此很少会引起磺胺药的不良反应。但如果发生严重的不良反应，则需要停药。 乙酰唑胺Acetazolamide 【适应证】(1)用于治疗各种类型的青光眼，对各种类型青光眼急性发作时的短期控制是一种有效的降低眼压的辅助药物:?开角型(慢性单纯性)青光眼，如用药物不能控制眼压，并用本品治疗可使其中大部分病例的眼压得到控制，作为术前短期辅助药物;?闭角型青光 - 59 - 眼，急性期应用本品降压后，上应根据房角及眼压描记情况选择适宜的抗青光眼手术;?本品也用于抗青光眼及某些内眼手术前降低眼压，抗青光眼术后眼压控制不满意者，仍可应用本品控制眼压。(2)用于继发性青光眼降低眼压。 【注意事项】(1)肺功能障碍(酸中毒危险)、糖尿病、肝功能不全及肾功能不全患者慎用。 (2)老年患者慎用。 (3)孕妇慎用。 (4)一般不推荐长期使用。如要长期使用，则需要监控血细胞数、血浆电解质浓度。 (5)避免注射部位外渗，否则会发生组织坏死的危险。 【禁忌证】(1)对本品或磺胺药过敏者禁用。 (2)肝肾功能不全所致低钾血症、低钠血症、高氯性酸中毒者禁用; (3)肝昏迷者禁用。 (4)肾上腺衰竭及肾上腺皮质机能减退(阿狄森病)者禁用。 【不良反应】恶心、呕吐、腹泻、味觉失调、食欲缺乏、感觉异常、面部潮红、头痛、眩晕、疲劳、易激动、抑郁、性欲降低、代谢性酸中毒和电解质紊乱、嗜睡、意识模糊、听力障碍、荨麻疹、皲裂、尿糖增加、血尿、肾结石、血液病(包括粒细胞缺乏症和血小板减少症)、皮疹(包括多形性红斑和中毒性表皮坏死松解症)、光过敏、肝功能损害、迟缓性瘫痪、惊厥、暂时性近视。 【用法和用量】口服成人常用量(1)开角型青光眼，首量250mg，每 - 60 - 日l,3次，维持量应根据病人对药物的反应决定，尽量使用较小的剂量使眼压得到控制;一般一次250mg，一日2次，就可使眼压控制在正常范围。 (2)继发性青光眼和手术前降眼压，一次250mg，每4,8小时1次，一般每日2,3次。(3)急性病例，首次药量500mg，以后用维持量，一次125,250mg，一日2,3次。 【制剂与規格】乙酰唑胺片:250mg。 乙酰唑胺胶囊:250mg。 布林佐胺Brinzolamide 【适应证】用于开角型青光眼和高眼压症。可以作为对β肾上腺素受体阻滞剂无效，或者有使用禁忌证的患者单独的治疗药物，或者作为β肾上腺素受体阻滞剂的协同治疗药物。 【注意事项】(1)肝损伤、妊娠者应慎用。 (2)不推荐儿童使用。 (3)滴用后应当注意有无全身不良反应。 【禁忌证】(1)对本品或磺胺过敏者禁用。 (2)严重肾功能不全(肌酐清除率低于30ml/min)和高氯性酸中毒者禁用。 (3)妇女哺乳期禁用。 【不良反应】滴药后可有局部刺激症状、味觉障碍、异物感和眼部充血;少见眼干、眼疼、眼分泌物增多、角膜炎、流泪、眼疲劳、视力 - 61 - 异常、角膜糜烂等。 【用法和用量】滴眼 一次1滴，一日2次，必要时一日3次。与其他抗青光眼药物合用时，至少间隔5分钟。 【制剂与規格】布林佐胺滴眼液:5ml:50mg。 1.5.5拟M胆碱药 滴用缩瞳剂后可使瞳孔缩小。对于闭角型青光眼来说，瞳孔缩小可以拉紧虹膜，使周边部虹膜从房角前壁拉开，从而使前房角开放而降低眼压。对于开角型青光眼来说，缩瞳剂通过收缩睫状肌而引起小梁网眼张开，促使房水外流管道开放，增加房水外流，从而降低眼压。 毛果芸香碱Pilocarpine 【适应证】(1)用于急性闭角型青光眼，慢性闭角型青光眼，开角型青光眼，继发性青光眼等。本品可与其他缩瞳剂、β受体阻滞剂、碳酸酐酶抑制剂、拟交感神经药物或高渗脱水剂联合用于治疗青光眼。 (2)用于检眼镜检查后，用本品滴眼缩瞳以抵消睫状肌麻痹剂或扩瞳药的作用。 【注意事项】(1)瞳孔缩小常引起暗适应困难，应告知需在夜间开车或从事照明不好的危险职业的患者特别小心。 (2)定期检查眼压。如出现视力改变，需查视力、视野、眼压描记及房角等，根据病情变化改变用药及治疗方案。 (3)为避免吸收过多引起全身不良反应，滴眼后需用手指压迫泪囊部 - 62 - 1,2分钟。JVS、用(4)如意外服用，需给予催吐或洗胃;如过多吸收出现全身中毒反应，应使用阿托品类抗胆碱药进行对抗治疗。 (5)哮喘，急性角膜炎患者慎用。 (6)孕妇及哺乳期妇女慎用。 (7)儿童慎用。因患儿体重轻，易用药过量引起全身中毒。 【禁忌证】任何不应缩瞳的眼病患者，如虹膜睫状体炎和继发性青光眼等患者禁用。 【不良反应】(1)缩瞳剂引起的睫状肌痉挛会导致头痛和偏头痛，在滴用缩瞳剂的最初2,4周较为严重。 (2)眼部不良反应包括眼部灼烧感、眼痒、刺痛、视力模糊、结膜充血、近视、晶状体变化、玻璃体积血、瞳孔阻滞。 (3)流涎、出汗、胃肠道反应和支气管痉挛等全身性不良反应罕见。 【用法和用量】(1)滴眼液滴眼。?慢性青光眼:0.5%,4%溶液，一次1滴，一日1,4次。?急性闭角型青光眼急性发作期:l%,2%溶液，一次1滴，每5,l0分钟1次，3,6次后每l,3小时1次，直至眼压下降(注意:对侧眼每6,8小时滴眼1次，以防对侧眼闭角型青光的发作)。 ?缩瞳:对抗散瞳作用，1%溶液滴眼1滴，2,3次;先天性青光眼房角切开或外路小梁切开术前，1%溶液，一般滴眼1,2次;虹膜切除术前，2%溶液，一次1滴。 (2)眼膏点眼，每晚涂擦,次。 【制剂与規格】硝酸毛果芸香碱滴眼液:(1)10ml:50mg;(2)10ml: - 63 - 100mg;(3)10ml:200mg。 硝酸毛果芸香碱眼膏:2g:40mg。 1.5.6高渗药 高渗药，如静脉注射的甘露醇，口服的甘油盐水，都是快速有效的短期降眼压药物，常用于降低急性闭角型青光眼和一些继发性青光眼的眼压。高渗剂也用于内眼手术前减少玻璃体容积。静脉给药的高渗剂的降眼压作用比口服高渗剂强，起效快。 甘露醇:用于降低眼内压，其他降眼内压药无效时或眼内手术前备用。(其他见第1章-神经与精神疾病用药)。 甘油氯化钠注射液GlycerolandSodiumChlorideInjection 【适应证】降低眼压，用于其他降眼压药无效时或眼内手术前准备。 【注意事项】(1)甘油与甘露醇同样具有强烈的脱水作用，但两者药理性能不同。甘露醇是渗透性利尿剂，注射后能增加血溶量，对心脏负担较重，又不能被机体代谢吸收，只能由肾脏排出体外，形成大量排尿导致明显的电解质丢失，如长时期反复使用，极易造成脱水及电解质丢失。而本品可被机体全部代谢并氧化成营养物质，不出现大量排尿现象。 (2)甘露醇制品常有结晶现象，临床使用需保温。而本品则无此弊病。 (3)本品为甘露醇注射液的优良替代品，可避免甘露醇注射液引起的?水和电解质紊乱;?心力衰竭，稀释性低钠血症及偶然的高钾血症; - 64 - ?不适当的过度利尿导致的血容量减少，加重少尿。 【禁忌证】心力衰竭、高钠血症、严重脱水、无尿者、对其成分过敏者。 【不良反应】可能出现血红蛋白尿或血尿，发生率与滴注速度过快有关，故应严格控制滴注速度(每分钟2,3ml)。一旦发生血尿或血红蛋白尿，应及时停药，2日内即可消失。 【用法和用量】静脉滴注一次500ml，一日1,2次，滴注速度应缓慢，每分钟不超过3ml。 【制剂与规格】甘油氯化钠注射液:(1)250ml:甘油25g，氯化钠2.25g;(2)500ml:甘油50g，氯化钠4.5g。 甘油氯化钠GlycerolandSodiumChloride 【适应证】用于青光眼及脑水肿。 【注意事项】(1)糖尿病患者慎用。 (2)急性青光眼患者本身伴有恶心、呕吐者，不宜服用。 【禁忌证】心力衰竭、高钠血症、严重脱水、无尿者。 【不良反应】一般有头疼、眩晕、恶心、呕吐。 【用法和用量】口服一次100,200ml，一日1,2次。 【规格】甘油氯化钠:500ml。 1.6眼用局部麻醉药 对于眼科来说，局部麻醉是最常用的麻醉方法。眼科的局部麻醉 - 65 - 包括表面麻醉、浸润麻醉和传导阻滞麻醉等。 丁卡因和奥布卡因是广泛使用的局部麻醉药。丙美卡因刺激小，因此多用于儿童。奥布卡因或利多卡因和荧光素的混合制剂可以用于眼压测量。丁卡因可以产生深度麻醉，适合用于眼科小手术前麻醉，例如角膜缝线的拆除。利多卡因单独或与肾上腺素合用，可以注入眼睑后施行小手术，进行球后或球周注射后可以施行眼球的手术。 局部麻醉药不能单纯作为镇痛剂来解除眼部症状。也不能交与患者自行滴用。 丁卡因Tetracaine 【适应证】用于眼科表面麻醉，测量眼压、眼部手术、角膜异物剔除等麻醉。 【不良反应】(1)滴眼后有短暂烧灼感。 (2)对角膜上皮有轻度损伤，影响创伤角膜上皮再生。 (3)有发生过敏的可能。 (4)大剂量使用可致心脏传导系统和中枢神经系统抑制。 【用法和用量】滴眼 一次1,2滴。 【制剂与規格】盐酸丁卡因滴眼液:(1)5ml:25mg;(2)5ml:50mg。 (其他见第17章-麻醉用药)。 盐酸利多卡因注射液:用于眼用局部麻醉。(其他见第17章-麻醉用药)。 - 66 - 奥布卡因Oxybuprocaine 【适应证】用于眼科表面麻醉。 【注意事项】本品对瞳孔无影响，但反复多次使用可导致角膜炎和角膜严重损害。 【禁忌证】对本品的成分或对安息香酸酯(除可卡因外)类局部麻醉药有过敏史者禁用。 【不良反应】(1)可有休克、过敏样症状。 (2)频繁使用有可能引起角膜损伤。 【用法和用量】滴眼一次1,4滴，可以根据年龄、体质适当增减。 【制剂与規格】盐酸奥布卡因滴眼液:(1)1ml:4mg;(1)5ml:20mg;(3)20ml:80mg。 丙美卡因Proparacaine 【适应证】用于各种眼科手术及眼科检查的表面麻醉。 【注意事项】(1)甲状腺功能亢进或心脏病患者慎用。 (2)表面麻醉剂不宜长期使用，以免引起角膜损伤、视力减退或伤口愈合延迟。 (3)使用本品时防止异物进入眼内，并禁止揉搓眼睛。 【禁忌证】对本品过敏者禁用。 【不良反应】长期频繁使用可能引起角膜损伤、视力减退或伤口愈合延迟。 【用法和用量】滴眼(1)短时间麻醉，操作前一般为1,2滴。必要时 - 67 - 可追加1滴。 (2)取异物或缝线拆除等小手术，一次1,2滴，间隔5,10分钟，使用1,3次。 (3)白内障摘除等长时间手术，一次1,2滴，间隔5,10分钟，使用3,5次。 【制剂与規格】盐酸丙美卡因滴眼液:15ml:75mg。 1.7眼科其他用药 1.7.1人工泪液、眼润滑剂和收敛药 由眼泪分泌减少或异常所引起慢性眼部不适(例如Sjgren's综合征)，通常采用泪液补偿疗法,即滴用人工泪液有较好的反应。眼部不适的严重程度和患者的喜好，常常影响患者对人工泪液的选择。 羟丙甲基纤维素是治疗泪液不足的传统治疗方法。需要频繁滴药(例如每小时1次)，才能使症状获得充分缓解。卡波姆具有粘附于眼表的特性，有助于减少用药频次至一日4次。聚乙烯醇可以增加泪膜持续时间，当眼表黏蛋白减少时可以起到积极的作用。聚维酮滴眼液也可以用于泪液缺乏症的治疗。0.9,氯化钠滴眼液有时对泪液缺乏症有用，滴用后也可以使角膜接触镜佩戴者感到舒适。0.9,氯化钠溶液和其他冲洗液常规地应用于内眼手术。 含有石蜡的眼膏可以润滑眼表，尤其适用于复发性角膜上皮糜烂的患者，但可能引起短暂的视觉障碍，因此最好在睡前使用。在佩戴接触镜时不应当使用眼膏。 - 68 - 硫酸锌是一种传统的收敛剂。 羟丙甲基纤维素Hypromellose 【适应证】用于诱增泪液分泌，舒缓由于长期阅读、使用计算机或置身于空调环境中而导致的眼睛过度使用、疲倦和干涩。 【注意事项】(1)使用后如眼部持续刺激，则停止使用。 (2)本产品含有氯化苄烷胺，配戴软性隐形眼镜时不宜使用。 【禁忌证】对羟丙甲纤维素及其他辅料如苯扎氯铵等过敏者禁用。 【不良反应】在极少数人中可能会引起眼部不适，如眼睛疼痛，视力模糊，眼球持续发红或出现刺激。如使用后眼部的上述症状持续超过3天，则应停止使用该药，必要时去医院检查。 【用法和用量】滴眼一次1,2滴，一日3次，或根据病情需要滴用。 【制剂与規格】羟丙基甲基纤维素滴眼液:(1)9ml:27mg;(2)18ml:54mg。 羧甲基纤维素钠CarboxymethylcelluloseSodium 【适应证】(1)用于缓解眼部干燥，或因暴露于阳光、风沙所引起的眼部烧灼、刺痛等不适感。 (2)用于保护眼睛，避免受到不良环境的进一步刺激。 【注意事项】(1)为防止污染，勿将瓶嘴触及任何物体表面。不可重复使用，用后即弃。 (2)瓶嘴不得接触眼睛。 - 69 - (3)如果应用时感觉眼痛、视力改变、眼睛持续充血或刺激感、症状加重或症状持续72小时以上，则应停止用药并就医。 (4)孕妇、哺乳期妇女、老年人和儿童应在医师指导下使用。 (5)包装完好的滴眼液方可使用。 (6)过敏体质者慎用。 【禁忌证】对本品过敏者禁用。 【不良反应】尚不明确。 【用法和用量】滴眼一次1,2滴，或根据病情需要滴用。 【制剂与規格】羧甲基纤维素钠滴眼液:(1)0.4ml:2mg;(2)0.4ml:4mg。 卡波姆Carbomer 【适应证】用于干眼症泪液缺乏的替代治疗。 【注意事项】(1)驾车或操纵机器时慎用。 (2)戴隐形眼镜时不宜使用。 【禁忌证】对本品任何成分过敏者禁用。 【不良反应】用药后可能引起短暂的视物模糊。 【用法和用量】滴眼 一次1滴，一日3,5次，或更多，于白天和睡觉前使用。 【制剂与規格】卡波姆滴眼液:10ml:20mg。 玻璃酸钠滴眼液SodiumHyaluronateEyeDrops - 70 - 【适应证】(1)用于眼睛疲劳、眼干燥症、眼干燥综合征、斯-约二氏综合征等内因性疾患。 (2)用于手术后药物性、外伤、光线对眼造成的刺激及戴隐形眼镜等引起的外因性疾病。 【注意事项】(1)不要在佩戴角膜接触镜或隐形眼镜时使用。 (2)用后立即密封，2,8度保存。 【禁忌证】青光眼或眼部有剧痛感者禁用。 【不良反应】可能引起短暂的视物模糊、刺激感、眼痒、结膜充血、睑皮肤炎等。 【用法和用量】滴眼 一次1滴，一日5,6次，或根据症状适当增减。 【制剂与规格】玻璃酸钠滴眼液:(1)0.4ml:1.2mg;(2)5ml:5mg。 聚乙烯醇PolyvinylAlcohol 【适应证】用于预防或治疗眼部干涩、异物感等刺激症状，或改善眼干燥症状。 【注意事项】(1)使用本品后如有眼痛、视物模糊、持续充血及刺激感加重，应当停用本品，及时就医。 (2)不要在佩戴角膜接触镜时使用。 (3)过敏体质者慎用。 【禁忌证】对本品过敏者禁用。 【不良反应】用药后偶有眼部刺激症状和过敏反应。 - 71 - 【用法和用量】滴眼一次1滴，一日5,6次，或根据症状适当增减。 【制剂与規格】聚乙烯醇滴眼液:(1)0.8ml:11.2mg(以聚乙烯醇计);(2)10ml:140mg(以聚乙烯醇计)。 重组牛碱性成纤维细胞生长因子 Recombinantbovinebasicfibroblastgrowthfactor(rb-bFGF) 【适应证】(1)用于角膜上皮缺损和点状角膜病变，轻中度干眼症，大泡性角膜炎，角膜擦伤，轻中度化学烧伤，角膜手术及术后愈合不良。 (2)用于地图状(或营养性)单泡性角膜溃疡。 【注意事项】(1)本品为蛋白类药物，应避免高温或冰冻环境，2,8度冷藏。 (2)对感染性或急性炎症期角膜病者，须同时局部或全身使用抗生素或抗炎药。 【禁忌证】尚不明确。 【不良反应】个别患者用药时可能出现刺痛感。 【用法和用量】(1)滴眼液滴眼，一次1,2滴，一日4,6次。 (2)凝胶剂涂入结膜囊内，一日2次，早晚各1次。 【制剂与規格】重组牛碱性成纤维细胞生长因子滴眼液:5ml:12000U。 凝胶剂:5g:21000U - 72 - 氯化钠SodiumChloride 【适应证】用于暂时性缓解眼部干涩症状。 【注意事项】(1)使用本品后如有眼部充血、红肿、眼痒，应及时就医。 (2)不能作为角膜接触镜冲洗液使用。 (3)使用2周后症状未缓解，应停药就医。 【禁忌证】尚不明确。 【不良反应】尚无不良反应的报道。 【用法和用量】滴眼 一次1,2滴，一日5,6次。 【制剂与規格】氯化钠滴眼液:10ml:55mg。 复方硫酸锌滴眼液CompoundZincSulfateEyeDrops 【适应证】用于治疗结膜炎、沙眼等眼部感染。 【注意事项】偶有轻微痒感，短时间内可消失。 【禁忌证】葡萄糖-6磷酸脱氢酶缺乏(有溶血性贫血倾向)者禁用。 【不良反应】用药后偶有轻微痒感、皮疹和发热。 【用法和用量】滴眼一次1滴，一日3,4次。或遵医嘱。 【制剂与规格】复方硫酸锌滴眼液:1ml:盐酸小檗碱1mg，硫酸锌3mg，硼酸20mg。塑料瓶装，每瓶5ml;8ml;10ml。 1.7.2眼部诊断药 荧光素钠可用于眼表染色，检测眼表损伤和异物，或在Goldmann - 73 - 压平眼压计测量眼压时进行眼表染色。荧光素钠可用于静脉注射，用于诊断性眼底和虹膜血管的荧光素血管造影。注射用吲哚菁绿在眼科中用于脉络膜血管造影，确定脉络膜疾患的位置。 荧光素钠FluoresceinSodium 【适应证】用于诊断性眼底和虹膜血管的荧光素血管造影检查。 【注意事项】(1)有过敏或支气管哮喘者使用静脉注射荧光素钠应特别注意，使用时应备有急救物品，以备注射荧光素钠后发生反应时用。 (2)注射荧光素钠前需做过敏试验。 (3)孕妇，特别是孕期头3个月的孕妇，应避免进行荧光素血管造影。哺乳期妇女慎用。 (4)静脉注射荧光素钠后皮肤会暂时发黄，可在6,12h消退。尿液也呈黄色，可在24,36h后恢复正常。 (5)静脉注射荧光素钠时应避免药液外渗。如有外渗可发生皮肤坏死脱落、浅层静脉炎、皮下肉芽肿、肘前区域的中毒性神经炎，并可引起长达数小时的手臂剧烈疼痛。如有药液外渗，应及时停止注射，采取措施治疗损伤组织，解除疼痛。 (6)不要在注射器内与其他溶液或药物混合或稀释。 【禁忌证】对本品任何成分过敏者禁用。 【不良反应】静脉注射后可发生恶心、头痛、胃肠道不适、晕厥、呕吐、低血压以及过敏反应。已有使用本品后心搏停止、基底动脉缺血、严重休克、抽搐、注射部位发生血栓性静脉炎和注射侧手臂的钝痛、 - 74 - 荨麻疹、瘙痒、支气管痉挛和过敏反应的。注射本品后可发生强烈的味觉改变。 【用法和用量】(1)滴眼?眼表染色，滴眼液(1%,2%)滴入结膜囊内，一次1滴;?测量眼压时眼表染色，滴眼液(0.25%,0.5%)，滴入结膜囊内。 (2)静脉注射血管造影，5%荧光素钠注射液一次10ml，或10%荧光素钠注射液一次5ml，缓慢静脉注射。 【制剂与規格】荧光素钠滴眼液:2ml:0.4g。 荧光素钠注射液:(1)5ml:0.5g;(2)3ml:0.3g。 吲哚菁绿IndocyanineGreen 【适应证】(1)用于诊断各种肝脏疾病，了解肝脏的损害程度及其储备功能，用于诊断肝硬化、肝纤维化、韧性肝炎、职业和药物中毒性肝病。 (2)用于脉络膜血管造影，确定脉络膜疾患的位置。 【注意事项】(1)有过敏性体质者慎用。用药前应预先备置抗休克急救药和器具。 (2)用灭菌注射用水溶解吲哚菁绿，并使其完全溶解。 (3)临用前调配注射液。如必须保存，应尽量选择阴凉处避光保存，并不得超过4小时。(4)病人早晨空腹、仰卧位、安静状态下进到该项试验检查。 (5)胆囊造影剂、利胆剂、利福平、抗痛风药可造成本试验误差。 - 75 - (6)尚无孕妇用药经验。哺乳期妇女需要使用时应停止哺乳。 【禁忌证】对本品和碘有过敏史者禁用。 【不良反应】(1)可能引起休克、过敏样症状。 (2)本品不完全溶解时，可能发生恶心、发热、休克等反应。 (3)其他不良反应:恶心、呕吐、打嗝、荨麻疹、发热等。 【用法和用量】脉络膜血管造影时，25mg吲哚菁绿用灭菌注射用水2ml溶解，迅速地肘静脉注射。 【制剂与規格】注射用吲哚菁绿:25mg。 1.7.3眼科围手术期用药 眼科围手术期用药包括用于准备眼科手术的药物、手术时注入前房的药物、手术后使用的药物。 多种抗菌滴眼液可用于眼科围手术期的无菌化治疗。非甾体抗炎药物滴眼液，如双氯酚酸钠、氟比洛芬、普拉洛芬、酮咯酸氨丁三醇已用于预防和治疗眼部手术和激光治疗相关的炎症、疼痛和其他症状。双氯酚酸钠、氟比洛芬也可用于预防眼科手术时瞳孔缩小。内眼使用的玻璃酸钠在眼部手术期间使用。卡巴胆碱能迅速缩小瞳孔，持续约20min。如果需要延长缩瞳时间，可以再次用药。平衡盐溶液在内眼手术时常规使用。 卡巴胆碱Carbachol 【适应证】用于人工晶状体植入、白内障摘除、角膜移植术等需要缩 - 76 - 小瞳孔的手术。 【注意事项】本品不能用于口服、肌内和静脉注射。 【禁忌证】心血管疾患病(包括心律不齐、心动过缓、低血压)、迷走神经兴奋、癫痫、甲亢、帕金森病、支气管哮喘、消化性溃疡和尿路梗塞患者禁用。 【不良反应】(1)常见视力模糊、眼痛、眼刺激或烧灼感。 (2)偶见头痛、眼部充血、眼睑抽搐。 【用法和用量】前房内注射一次0.2,0.5ml。 【制剂与規格】卡巴胆碱注射剂:1ml:0.1mg。 玻璃酸钠注射液SodiumHyaluronateInjection 【适应证】眼科手术辅助用品，主要用于白内障摘除、人工晶状体植入术、青光眼手术及角膜移植术等。 【注意事项】(1)本品使用前必须先和室温平衡。 (2)避免向眼内注射过多的透明质酸钠。 (3)手术结束时，可采用注洗法或抽吸法清除残留于眼内的透明质酸钠。 (4)本品必须一次性使用。 【禁忌证】尚不明确。 【不良反应】可出现一过性眼压升高。 【用法和用量】根据手术方式选择用量，前房内注射，一次约0.2ml。 【制剂与规格】玻璃酸钠注射:(1)0.5ml:5mg;(2)1ml:17mg。 - 77 - 1.7.4眼用抑制新生血管药 眼部新生血管，特别是脉络膜新生血管膜是一种重要的眼部病变，可以导致不可逆的视力丧失。对于脉络膜新生血管膜可以采用激光视网膜光凝治疗，但对于黄斑中心凹下的脉络膜新生血管膜不能采用这种治疗，因为对黄斑中心凹的激光凝治疗将会破坏中心视力。采用维替泊芬进行光动力疗法治疗黄斑中心凹下新生血管膜取得了较好的效果。玻璃体腔内注射糖皮质激素和抑制新生血管的药物也取得了较好的效果，但在我国尚未批准上市。 维替泊芬可以用于年龄相关性黄斑变性伴有典型型黄斑中心凹下脉络膜新生血管膜，或病理性近视的黄斑中心凹下新生血管膜的光动力治疗。静脉输注维替泊芬后，通过非热性的红色激光局部照射，激活维替泊芬，产生细胞毒性诱导剂，破坏新生血管膜。只有有经验的专家才可以使用这种疗法。 维替泊芬Verteporfin 【适应证】用于继发于年龄相关性黄斑变性、病理性近视或可疑眼组织胞浆菌病，以典型性为主型中心凹下脉络膜新生血管形成的患者。对于隐匿性中心凹下脉络新生血管为主的患者，尚无充分证据支持维替泊芬治疗。 【注意事项】(1)对严重肝功能损害、胆道阻塞者避免使用。 (2)避免在妊娠期使用。 (3)配制好的溶液应当无沉淀和变色，避光保存，且在4小时内使用。 - 78 - (4)避免选用手背小静脉，注射时避免药液外渗。一旦在输注过程中出现药液外渗，外渗的局部必须完全避光并局部冷敷，直至局部肿胀和变色完全消失，否则会出现严重的局部灼伤。 (5)输注后5天内，应适当采取防护措施，避免将皮肤和眼睛直接暴露于阳光直射或强的室内光源，以免发生光敏反应。 【禁忌证】卟啉症患者及已知对本品制剂中任何成分过敏者禁用。 【不良反应】(1)视力障碍(包括视力模糊，闪光，视野缺损)、恶心、背痛、无力、瘙痒、高胆固醇血症、发烧等。 (2)罕见流泪、视网膜下或玻璃体积血、过敏反应(包括胸痛、晕厥、出汗、血压和心率改变)。 (3)注药部位的反应包括疼痛、水肿、发炎、出血、变色等。 【用法和用量】静脉滴注。临用前，将本品15mg用灭菌注射用水7ml 2溶解，制成浓度为2mg/ml的溶液;然后按体表面积6mg/m的剂量，取上述溶液用5%葡萄糖注射液适量稀释制成30ml的溶液，以每分钟3ml的速度静脉滴注。在药液滴注开始后15分钟，用波长689?3nm、 2 剂量50J/cm的激光照射病灶局部，照射时间83秒。 【制剂与規格】注射用维替泊芬:15mg。 - 79 - (英文版 ) Two regulations promulgated for implementation is in the party in power for a long time and the rule of law conditions, the implementation of comprehensive strictly strategic plan, implementation in accordance with the rules and discipline to manage the party, strengthen inner-party supervision of major initiatives. The two regulations supporting each other, the < code > adhere to a positive advocate, focusing on morality is of Party members and Party leading cadres can see, enough to get a high standard; < rule > around the party discipline, disciplinary ruler requirements, listed as "negative list, focusing on vertical gauge, draw the party organizations and Party members do not touch the" bottom line ". Here, the main from four square face two party rules of interpretation: the first part introduces two party Revised regulations the necessity and the revision process; the second part is the interpretation of the two fundamental principles of the revision of laws and regulations in the party; the third part introduces two party regulations modified the main changes and needs to grasp several key problems; the fourth part on how to grasp the implementation of the two regulations of the party. < code > and < Regulations > revised the necessity and revised history of the CPC Central Committee the amendment to the Chinese Communist Party members and leading cadres honest politics several guidelines > and < Chinese Communist Party discipline and Punishment Regulations > column 1 by 2015 to strengthen 80 party laws and regulations focus. Two party regulations revision work lasted a Years, pooling the wisdom of the whole party, ideological consensus, draw historical experience, respect for the wisdom of our predecessors, which reflects the unity of inheritance and innovation; follow the correct direction, grasp the limited goals, adhere to the party's leadership, to solve the masses of the people reflect a focus on the problem. The new revision of the < code > and < rule >, reflects the party's 18 and the eighth session of the third, the spirit of the fourth plenary session, reflecting the experience of studying and implementing the General Secretary Xi Jinping series of important speech, reflects the party's eighteen years comprehensive strictly practice. (a) revised two regulations of the party need of < the ICAC guidelines > in < in 1997 Leaders as members of the Communist Party of China clean politics certain criteria (Trial) > based on revised, the promulgation and implementation of January 2010, to strengthen the construction of the contingent of leading cadres play an important role. But with the party to manage the party strictly administering the deepening, has not been able to fully meet the actual needs. Content is too complicated, "eight prohibition, 52 are not allowed to" hard to remember, and also difficult to put into practice; the second is concisely positive advocated by the lack of prohibited provisions excessive, no autonomy requirements; the third is banned terms and discipline law, both with the party discipline, disciplinary regulations 81 repeat and Criminal law and other laws and regulations repeat; the fourth is to "clean" the theme is not prominent, not for the existing problems, and is narrow, only needle of county-level leading cadres above. < rule > is in 1997 < Chinese Communist Party disciplinary cases (Trial) > based on revision, in December 2003 the promulgation and implementation, to strengthen the construction of the party play very important role. Along with the development of the situation, which many provisions have been unable to fully meet the comprehensive strictly administering the practice needs. One is Ji law, more than half of the provisions and criminal law and other countries laws and regulations Repetition; two is the political discipline regulations is not prominent, not specific, for violation of the party constitution, damage the authority of Party Constitution of misconduct lack necessary and serious responsibility to pursue; third is the main discipline for the leading cadres, does not cover all Party members. Based on the above situation, need to < the criterion of a clean and honest administration > and < rule > the two is likely to be more relevant regulations first amendment. By revising, really put the authority of Party discipline, the seriousness in the party tree and call up the majority of Party members and cadres of the party constitution of party compasses party consciousness. (II) two party regulations revision process the Central Committee of the Communist Party of China attaches great importance to two regulations revision . Xi Jinping, general books recorded in the Fifth 82 Plenary Session of the eighth session of the Central Commission for Discipline Inspection, on the revised regulations < > made clear instructions. According to the central deployment, the Central Commission for Discipline Inspection from 2014 under six months begin study two regulations revision. The Standing Committee of the Central Commission for Discipline Inspection 4 review revised. Comrade Wang Qishan 14 times held a special meeting to study two regulations revision, amendment clarifies the direction, major issues of principle, path and target, respectively held a forum will listen to part of the province (area) secretary of the Party committee, Secretary of the Discipline Inspection Commission, part of the central ministries and state organs Department The first party committee is mainly responsible for people, views of experts and scholars and grassroots party organizations and Party members. Approved by the Central Committee of the Communist Party of China, on 7 September 2015, the general office of the Central Committee of the Party issued a notice to solicit the provinces (autonomous regions, municipalities) Party, the central ministries and commissions, state ministries and commissions of the Party (party), the General Political Department of the military, every 3 people organization of Party of two regulations revision opinion. Central Commission for Discipline Inspection of extensive solicitation of opinions, careful study, attracting, formed a revised sent reviewers. In October 8 and October 12, Central Committee Political 83 Bureau Standing Committee and the Political Bureau of the Central Committee After consideration of the two regulations revised draft. On October 18, the Central Committee of the Communist Party of China formally issued two regulations. Can say, two laws amendment concentrated the wisdom of the whole party, embodies the party. Second, < code > and < Regulations > revision of the basic principles of two party regulations revision work and implement the party's eighteen, ten eight plenary, the spirit of the Fourth Plenary Session of the Eleventh Central Committee and General Secretary Xi Jinping important instructions on the revised < low political criterion > and < Regulations >, highlighting the ruling party characteristics, serious discipline, the discipline quite in front of the law, based on the current, a long-term, advance as a whole, with Bu Xiuding independent < rule > and < rule >. Main principle is: first, adhere to the party constitution to follow. The constitution about discipline and self-discipline required specific, awaken the party constitution of party compasses party consciousness, maintaining the authority of the constitution. General Secretary Xi Jinping pointed out that "no rules, no side round. Party constitution is the fundamental law, the party must follow the general rules. In early 2015 held the eighth session of the Central Commission for Discipline Inspection Fifth Plenary Session of the 16th Central Committee, Xi Jinping again pointed out that constitution is the party must follow the general rules, but also the general rules." the revision 84 of the < code > and < rule > is Method in adhere to the regulations established for the purpose of combining rule of virtue is to adhere to the party constitution as a fundamental to follow, the constitution authority set up, wake up the party constitution and party rules the sense of discipline, the party constitution about discipline and self-discipline specific requirements. 4 second is to adhere to in accordance with the regulations governing the party and the party. The Party of rule of virtue "de", mainly refers to the party's ideals and beliefs, excellent traditional style. The revised the < code > closely linked to the "self-discipline", insisting on the positive initiative, for all members, highlight the "vital few", emphasized self-discipline, focusing on the morality, and the majority of Party members and the ideological and moral standards. The revised < > Ji method separately, Ji, Ji Yan to Method, as a "negative list", emphasizing the heteronomy, focusing on vertical gauge. Is this one high and one low, a positive reaction, the strict party discipline and practice results transformation for the integration of the whole party to observe moral and discipline requirements, for the majority of Party members and cadres provides benchmarking and ruler. Third, insist on to. In view of the problems existing in the party at the present stage, the main problems of Party members and cadres in the aspect of self-discipline and abide by the discipline to make clearly defined, especially the party's eighteen years strict political discipline and political rules, organization and discipline and 85 to implement the central eight provisions of the spirit against the four winds and other requirements into Disciplinary provisions. Not one pace reachs the designated position, focusing on in line with reality, pragmatic and effective. After the revision of major changes, major changes in the < code > and < rule > modified and needs to grasp several key problems (a) < code > < code > adhere to according to regulations governing the party and party with morals in combination, for at the present stage, the leadership of the party members and cadres and Party members in existing main problems of self-discipline, put forward principles, requirements and specifications, showing Communists noble moral pursuit, reflected at all times and in all over the world ethics from high from low 5 common requirements. One is closely linked to the "self-discipline", removal and no direct relation to the provisions of . the second is adhere to a positive advocate, "eight prohibition" 52 are not allowed to "about the content of the" negative list moved into synchronization amendment < cases >. Three is for all the party members, will apply object from the leadership of the party members and cadres to expand to all Party members, fully embodies the comprehensive strictly required. The fourth is prominent key minority, seize the leadership of the party members and cadres is the key, and put forward higher requirements than the ordinary Party members. Five is to simplify, and strive to achieve concise, easy to understand, easy to remember. The revised < code > is the ruling Party since the first insists on 86 a positive advocate forAll Party members and the self-discipline norms, moral declaration issued to all members of the party and the National People's solemn commitment. > < criterion of a clean and honest administration consists of 4 parts, 18, more than 3600 words. After the revision of the < code >, a total of eight, 281 words, including lead, specification and Party member cadre clean fingered self-discipline norms, etc. Part 3 members low-cost clean and self-discipline, the main contents can be summarized as "four must" "eight code". Lead part, reiterated on ideal and faith, fundamental purpose, the fine traditions and work style, noble sentiments, such as "four must" the principle of requirements, strong tone of self-discipline, The higher request for 6 and supervised tenet, the foothold in permanent Bao the party's advanced nature and purity, to reflect the revised standards requirements. Members of self-discipline norms around the party members how to correctly treat and deal with the "public and private", "cheap and rot" thrifty and extravagance "bitter music", put forward the "four norms". Party leader cadre clean fingered self-discipline norms for the leadership of the party members and cadres of the "vital few", around the "clean politics", from civil servant of the color, the exercise of power, moral integrity, a good family tradition and other aspects of the leadership of the party members and cadres of the "four norms" < > < norm norm. "The Party member's self-discipline norms" and "party members and leading cadre clean fingered self-discipline norms," a 87 total of eight, collectively referred to as the "eight". "Four must" and "eight" of the content from the party constitution and Party's several generation of leaders, especially Xi Jinping, general secretary of the important discussion, refer to the "three discipline and eight points for attention" statements, and reference some embody the Chinese nation excellent traditional culture essence of epigrams. (2) the revised regulations, the main changes in the revised Regulations > to fully adapt to the strictly requirements, reflects the according to the regulations governing the law of recognition of deepening, the realization of the discipline construction and Jin Ju. < rule > is party a ruler, members of the basic line and follow. And the majority of Party members and cadres of Party organizations at all levels should adhere to the bottom line of thinking, fear discipline, hold the bottom line, as a preventive measure, to keep the party's advanced nature and purity. 1, respect for the constitution, refinement and discipline. Revised < rule > from comprehensive comb physical constitution began, the party constitution and other regulations of the Party of Party organizations and Party discipline requirements refinement, clearly defined in violation of the party constitution will be in accordance with regulations to give the corresponding disciplinary action. The original 10 categories of misconduct, integration specification for political discipline, discipline, honesty and discipline masses Ji Law and discipline and discipline and other six categories, the content of < rule > 88 real return to Party discipline, for the majority of Party members and listed a "negative list. 7 2, highlighting the political discipline and political rules. > < Regulations according to the stage of the discipline of outstanding performance, emphasizing political discipline and political rules, organization and discipline, in opposition to the party's leadership and the party's basic theory, basic line, basic program and basic experience, the basic requirement of behavior made prescribed punishment, increase the cliques, against the organization such as violation of the provisions, to ensure that the central government decrees and the Party of centralized and unified. 3, adhere to strict discipline in the law and discipline In front, Ji separated. Revised < Regulations > adhere to the problem oriented, do Ji separated. Any national law existing content, will not repeat the provisions, the total removal of 79 and criminal law, repeat the content of the public security management punishment law, and other laws and regulations. In the general reiterated that party organizations and Party members must conscientiously accept the party's discipline, die van comply with national laws and regulations; at the same time, to investigate violations of Party members and even criminal behavior of Party discipline and responsibility, > < Regulations distinguish five different conditions, with special provisions were made provisions, so as to realize the connection of Party discipline and state law. 4, reflect Wind building and anti-corruption struggle of the latest achievements. < rule > the party's eighteen years 89 implement the spirit of the central provisions of the eight, against the requirements of the "four winds" and transformation for disciplinary provisions, reflecting the style construction is always on the road, not a gust of wind. In the fight against corruption out of new problems, increase the trading rights, the use of authority relatives profit and other disciplinary terms. Prominent discipline of the masses, the new against the interests of the masses and ignore the demands of the masses and other disciplinary terms and make provisions of the disposition and the destruction of the party's close ties with the masses. Discipline to protect the party's purpose. 8 of these regulations, a total of three series, Chapter 15, 178, more than 24000 words, after the revision of the regulations a total of 3 series, Chapter 11, 133, 17000 words, divided into "general" and "special provisions" and "Supplementary Provisions" Part 3. Among them, add, delete, modify the provisions of the proportion of up to nearly 90%. 1, the general general is divided into five chapters. The first chapter to the regulations of the guiding ideology, principles and scope of application of the provisions, highlight the strengthening of the party constitution consciousness, maintenance the authority of Party Constitution, increase the party organizations and Party members must abide by the party constitution, Yan Centralized centralized, would examine at all levels of the amended provisions implementing and maintaining Party discipline, and consciously accept the party discipline, 90 exemplary compliance with national laws and regulations. The second chapter of discipline concept, disciplinary action types and effects of the regulations, will be a serious warning from the original a year for a year and a half; increase the Party Congress representative, by leaving the party above (including leave probation) punishment, the party organization should be terminated its representative qualification provisions. The third chapter of the disciplinary rules of use prescribed in the discipline rectifying process, non convergence, not close hand classified as severely or heavier punishment. "Discipline straighten "At least eighteen years of five years, these five years is to pay close attention to the provisions of the central eight implementation and anti -" four winds ". The fourth chapter on suspicion of illegal party disciplinary distinguish five different conditions, with special provisions were made provisions, to achieve effective convergence of Party and country 9 method. < rule > the provisions of Article 27, Party organizations in the disciplinary review found that party members have committed embezzlement, bribery, dereliction of duty dereliction of duty and other criminal law act is suspected of committing a crime shall give cancel party posts, probation or expelled from the party. The second is < Regulations > Article 28 the provisions of Party organizations in the disciplinary review But found that party members are stipulated in the criminal law, although not involved in a crime shall be investigated for Party discipline and responsibility should 91 be depending on the specific circumstances shall be given a warning until expelled punishment. This situation and a difference is that the former regulation behavior has been suspected of a crime, the feeling is quite strict, and the latter for the behavior not involving crime, only the objective performance of the provisions of the criminal code of behavior, but the plot is a crime to slightly. < Regulations > the 29 provisions, Party organizations in the discipline review found that party members and other illegal behavior, affect the party's image, the damage to the party, the state and the people's interests, we should depend on the situation Seriousness given disciplinary action. The loss of Party members, seriously damaging the party's image of behavior, should be given expelled from the party. At this article is party member is in violation of the criminal law outside the other illegal acts, such as violates the public security administration punishment law, customs law, financial laws and regulations behavior. The fourth is < cases > Article 32 stipulates, minor party members and the circumstances of the crime, the people's Procuratorate shall make a decision not to initiate a prosecution, or the people's court shall make a conviction and exempted from criminal punishment shall be given within the party is removed from his post, probation or expelled from the party. Party members and crime, sheets were fined in accordance with For acts; the principal Ordinance amended the provisions of the preceding paragraph. This is the new content, in order to achieve Ji method effective 92 convergence. Five is < > the thirty third article 10 of the provisions, the Party member due to an intentional crime is sentenced to criminal law (including probation) sheets or additional deprivation of political rights; due to negligence crime and was sentenced to three years or more (excluding three years) a penalty, shall give expelled punishment. Due to negligence crime is convicted and sentenced to three years (including three years) in prison or be sentenced to public surveillance, detention, shall in general be expelled from the party. For the individual may not be expelled from the party, should control Approval. This is followed and retained the original > < Regulations the provisions of punishment party authorization rules and report to a level party organizations. For is "party members with criminal acts, and by the criminal punishment, generally should be expelled from the party". The fifth chapter of probationary Party member of the discipline and discipline after missing members of the treatment and punishment decisions, such as the implementation of the provisions, clear the related party discipline and punishment decision made after, for duties, wages and other relevant alteration formalities for the longest time. 2, sub sub section will the original regulations of 10 categories of acts of violation of discipline integration revised into 6 categories, respectively, in violation of the punishments for acts of political discipline "in violation of discipline behavior of punishment" in violation of integrity of disciplinary action points "of violation punishments for acts 93 of mass discipline" "the violation of work discipline, punishment" in violation of discipline of life behavior punishment "6 chapters. 3, annex" Supplementary Provisions "clear authority making supplementary provisions of, cases of interpretative organ, as well as regulations implementation time and retroactivity etc.. 11 (3) learning understanding > < regulations needs to grasp several key problems The first problem -- about the violation of political discipline behavior > < new ordinance chapter 6 the political discipline column for the six disciplines, that is the main opposition to Party leadership and the opposition of the basic theory, basic line, basic program and basic experience, basic requirements of misconduct made provisions of the disposition, especially the eighteen since the CPC Central Committee put forward the Yan Mingzheng treatment of discipline and political rules requirements and practical achievements transformation for Discipline article, increase the false debate central policies, cliques, against the organization review, make no discipline of the principle of harmony terms. These are the party's eighteen years in comprehensive strictly Process combined with the practice of rich content. (1) false debate the central policies and undermine the Party of centralized and unified the problem is made in accordance with the provisions of the party constitution. Constitution in general programme requirements adhere to democratic centralism is one of the requirements of the construction of the party must adhere to the four cardinal. Application 94 of this principle is not only the party the basic organization principle and is also the mass line in party life, it requires that we must fully develop inner-party democracy, respect for the dominant position of Party members, safeguarding the Party member democratic rights, give full play to the enthusiasm and creativity of the party organizations at all levels and Party members, at the same time, also must implement the right concentration, ensure the party's mission < the chaos in unity and concerted action to ensure that the party's decision to get quickly and effectively implementing. The Party Central Committee formulated the major principles and policies, through different channels and ways, fully listen to the party organizations and Party members of the opinions and suggestions, but 12 is some people face to face not to say back blather "" will not say, after the meeting said, "" Taiwan does not say, and nonsense ", in fact, not only disrupt the people thought, some causing serious consequences, the damage to the Party of the centralized and unified, hinder the central policy implementation, but also a serious violation of the democratic system of principles. There is no doubt that shall, in accordance with the Regulations > 4 Specified in Article 6 to give the appropriate punishment. For did not cause serious consequences, to give criticism and education or the corresponding tissue processing. (2) about the destruction of the party's unity < New Regulations > the forty eighth to fifty second article, to damage Party's unity unified and violation of political discipline, punishment situation 95 made explicit provisions. Article 52 of the new "in the party get round group, gangs seek private gain, cliques, cultivate private forces or through the exchange of interests, for their own to create momentum and other activities to gain political capital, given a serious warning or withdraw from their party posts disposition; if the circumstances are serious, to give Leave a party to observation or expelled from the party. (3) on against the organization review of the provisions of the constitution, party loyalty honesty is party members must comply with the obligations. Members must obey the organization decision, shall not violate the organization decided encounters by asking questions to find organization, rely on the organization, shall not deceive the organization, against the organization. For example, after the investigation does not take the initiative to explain the situation, but to engage in offensive and defensive alliance, hiding the stolen money is against survey organization, is a violation of the behavior of political discipline. Article 24 of the original > < Regulations, although the provisions of the interference, hinder group review the behavior of the fabric can be severely or 13 Aggravated punishment, but did not put this kind of behavior alone as a discipline for qualitative amount of discipline. > < new regulations increase the Article 57, "anti organization review, one of the following acts, given a warning or serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, give 96 expelled from the party: (a) on supply or forged, destroyed, transfer, conceal evidence; (II) to prevent others expose, providing evidence Material; (III) harboring co personnel; (4) to the organization to provide false information, to hide the fact; (5) the him against the acts of the organization review. "< rule > add this clause to the Constitution requires more specific, the previous no punishment in accordance with the definite list and put forward clear punishment in accordance with. (4) about organizing or participating in superstitious activities as < Regulations > about engage in activities of feudal superstition obstruction of social management order" violations of Article 164 the provisions, but according to the original < rule > only in disrupting production, work, social life order The case to be disciplinary treatment, in other words, alone make the feudal superstition, organize or participate in the activities of feudal superstition of, does not constitute a violation. Which is not consistent with the requirements of our party's political party. > < new regulations in this change is, superstitious activities on the political discipline, increase the Article 58, is the organization of Party members, in superstitious activities included in violation of the negative list of political discipline deserves punishment, which and Party members should adhere to the correct political principle, political standpoint and viewpoint is consistent. 14 the second question about organization and discipline violation behavior of democratic centralism is our The party's fundamental 97 organizational system. < New Regulations > Chapter 7 "in violation of the behavior of organizational discipline punishment" mainly for violation of democratic centralism, contrary to the "four obey the discipline behavior for source classification rules. Increased not in accordance with the relevant provisions or requirements to the organization for instructions to report on major issues; do not report truthfully report about personal matters; falsify personal archives; hide before joining the party serious mistakes; leading cadres in violation of the relevant provisions of the organization, will participate in the spontaneous formation of the old Xiang, Alumni Association, comrades in arms; to obtain illegal country residence abroad or foreign nationality, illegal for private frontier Documents such as discipline terms. (1) on the report truthfully report personal matters in 2010 the Central Committee of the Communist Party of China office, office of the State Council introduced < provisions on issues related to the leading cadres to report personal >, is clear about the request, deputy division level and above leading cadres should truthfully report changes in my marriage and spouse, children, moved to the country (territory), practitioners, income, real estate, investment and other matters, for failing to report, do not report, concealed and unreported, according to the seriousness of the case, giving criticism and education, and to make a correction within a time limit, shall be ordered to make a check, the commandment Jiemian conversation, informed criticism or jobs, free Post 98 processing, constitute violations, in accordance with the relevant provisions shall be given a disciplinary sanction. But since the original < Regulations > and there is no corresponding specific terms, the violation of the regulations, do not report, as a false report about personal matters, there is no corresponding disciplinary action terms, in practice it is difficult to operate. In this regard, in order to solve is not reported, as a false report about personal matters 15 asked censure, the new < Regulations > add the Article 67 of violation of personal matters related to reporting requirements, report truthfully report the clear punishment basis, making this kind of violation behavior is no longer free drilling for Exhibition on matters of personal checks to verify and supervision of cadres, discipline review provides a powerful discipline guarantee. (2) about the illegal organization, to fellow, alumni, friends of the war will < regulations stipulated in Article 68 of >, leading cadres of the party in violation of relevant provisions of the organization, will participate in the spontaneous formation of fellow, Alumni Association, comrade in arms to give the punishment according to the seriousness of the case. Here special needs note is three points: this provision for only the leading cadres ", reflecting the high requirements of leading cadres; second violation in 2002, the Central Commission for Discipline Inspection, the central Organization Department and the The relevant provisions of the General Political Department jointly issued the < off in leading cadres not to participate in 99 the initiative to set up "the villagers would be" alumni "" comrades in arms organization notice >. That is to say, to the spontaneous formation of fellow, Alumni Association, comrades in arms will constitute the premise of discipline is a violation of the provisions of this. The notification specified, leading cadres are not allowed to participate in the spontaneous incorporation of fellow, alumni, between comrades association would like the organization and shall not bear the sorority Human and the organizer shall not hold the corresponding position in the sorority; shall not borrow machine woven "network" and engage in kiss sparsely, round and round the gangs, but not "align" "Jieyi Gold Orchid" behavior. The third is to emphasize here that shall be organized to participate in the initiative to set up the villager, Alumni Association, comrades in arms. The so-called 16 spontaneous was established mainly means without registration. Therefore, Party members include leading cadres in the normal range of fellow, alumni, comrades in the party is not a violation of the rules of Party discipline. The three problem about integrity violations discipline Lian Jie discipline has been eighteen years clean government and anti The focus of the work of corruption. This Ordinance to amend, honesty and discipline this biggest adjustment, the new content, most of which prescribed by the original < criterion of a clean and honest administration > 8 ban and 52 are not allowed into the basic this part. (1) the central eight provisions of the spirit and requirements into < New > in 100 the regulations of the party's eighteen years, central resolutely implement the provisions of the eight and pay close attention to the node and intensive briefing, on public funds, private bus, public funds tourism, gifts of public funds, the big parade and lavish weddings and festive, illegal payment allowances and subsidies, illegal construction of buildings such as the original masses reflects the relatively strong, "four winds" problem of the Resolute rectification. But original < Regulations > to eat and drink, super standard reception and no clear and specific expression, new < rule > will implement eight Central provisions of the spirit of the problem increased to "clean cheap self-discipline" chapter, clear to exceed the standard, beyond the scope of the reception or borrow machine eating and drinking etc. some in violation of the provisions of the spirit of the eight central relevant persons responsible for punishment, once the violation will be according to the < rule > severely punished, binding, enhanced significantly. One is to add Article 87, about to obtain illegal, hold, and the actual use of the sports card, golf ball cards and other consumer card. Illegal access to private clubs made the punishment provisions. The second is increase the Article 97, has made provisions of the disposition of illegal self pay or 17 spamming allowances, subsidies and bonuses. The third is added to the Article 99, on violation of super standard, beyond the scope of the reception or borrow machine eat and drink to make the provisions of punishment. The fourth is to increase the Article 101, on the management 101 of conference activities in violation of the provisions made sanctions regulations. The fifth is the increased Article 102, for violation of office space management provisions made the punishment provisions. Six is to split the original < rule > Article 78, formed article 98, Article 100 of public Models of tourism, violate the provisions on the administration of the use of discipline of the bus through the list of made a more detailed provisions, apply more operational. Seven is increased the article 96, in violation of the relevant provisions of the, to participate in public funds to pay for dinner, high consumption of entertainment, fitness activities and public funds to buy gift, send gifts to make the provisions of the disposition. On the violation of the central provisions of the spirit of the eight, in addition to > < new regulations into "violation of honesty and self-discipline" misconduct outside, is different with the original < Regulations >, revised < rule > clearly defined not only to disposition of the directly responsible persons, but also dispose of collar Guide responsibilities. (2) increased trading rights, use of authority or position influence as relatives and close to profit violation of the terms of the < New Regulations > absorption < clean politics several guidelines > the relevant provisions spirit, increase the "negative list, including trading rights, the functions and powers or duties of influence as relatives and staff around profit. Increase Article 81" mutual use of office or authority ring for each other and their spouses, children and their spouses and other relatives, 102 around 18 personnel and other specific relationship between the people to seek benefits engage in trading rights, given a warning or serious warning Sanctions; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, shall be expelled from the party. Increase Article 82 "connivance, acquiescence to the spouse, children and spouse etc. relatives and staff around the effect of Party members and cadres personal authority or position for personal gain, if the circumstances are relatively minor, given a warning or a serious warning; if the circumstances are relatively serious, giving removed from or placed on probation within the party post; if the circumstances are serious, the given Expelled from the party. Party members and cadres of the spouses, children and their spouses does the actual work and get salary or although the actual work but to receive significantly beyond the same rank salary standard, Party members and cadres informed fails to correct, in accordance with the provisions of the preceding paragraph. "(3) about the gifts, gifts misconduct from handling practices in recent years, engaged in official cadres received gifts, gifts problems more prominent. This has seriously affected the image of Party members and cadres, damaged the relations between the party and the masses, and is a hotbed of corruption, is really necessary for this kind of behavior to be disciplined. < rule > no on accepting gifts, gifts, Card consumption behavior to engage in simple "one 103 size fits all", but the difference between the different separately. One is in accordance with the provisions of Article 83, accepting may affect the impartial enforcement of the official gifts, gifts, consumer cards to depending on the seriousness of the case shall be given disciplinary sanctions. That is to say, for may affect the fair execution of business gifts, gifts, consumer cards are not allowed to accept. 19 is in accordance with the provisions of Article 83, accepting was significantly higher than normal ceremony is still exchanges of gifts, gifts, consumer card to disciplinary action. This is new regulations that daily life is purely reciprocity, accepting the same thing, boys , fellow friends gifts, gifts, shopping cards, although and fair execution of business has nothing to do, also want to as the case shall be dealt with, the situation is obviously beyond normal reciprocity ". The so-called" reciprocity ", one is emphasizes the reciprocal in protocol. In other words is you to me how, I to you how, not only does not go. The second is to significantly exceeded the normal local economy level, customs and habits, economic capacity of individual gifts, gift value. Specific sanctions to according to the processing of a variety of factors to consider, as appropriate. The third is the root according to the provisions of Article 84," to Engaged in public service personnel and their spouses and children, children's spouses and other relatives and other specific relationship presented Ming Xianchao normal reciprocity of gifts, gifts, consumer card, if the circumstances are 104 relatively serious, given a warning until probation. "In accordance with the above provisions, gift giving significantly beyond the normal reciprocity, giver constitute the discipline. (4) on illegal trading of stocks or of other regulations of securities investment < > Article 88 is engaged in punishment regulation of camp and activity in violation of the relevant provisions on. Among them, 3 will" buying and selling stocks or in other securities investment "column as one of disciplinary cases Out. First need to be clear, > < regulations did not change the provisions of the Ordinance. The ordinance of the provisions of the second paragraph of Article 77 provisions "who, in violation of the provisions of the sale of stocks" is one of the violation, and at the beginning of the first paragraph of this article "violation of 20 against the relevant provisions of the" textual representation of the repeat revision. In, just from the legislative technique removed the "personal" in violation of the provisions, content and not to change the original provisions. Need to clear is, "buy or sell a stock or of other securities investment" refers to violation of the relevant provisions refers to in April 2001, the Party Central Committee, the State Council promulgated the On the work of the party and government organs staff's personal investment in securities if dry provisions >. According to the provisions of Article 3, use of work time, office facilities, the sale of stocks and securities investment fund belongs to illegal behavior. The fourth question, about the violation of the masses of the disciplinary actions < 105 new regulations > would violate public discipline behavior of a single set of a class of restored "three rules of discipline and eight note" in the discipline of the masses of excellent traditional. < New Regulations > Chapter 9 "to violate the masses of disciplinary action", mainly the destruction of the party's close ties with the masses of misconduct made provisions on disciplinary; enrich and perfect the super standard, beyond the scope of Xiang Qun < All to raise fund and labor, in for involving the public affairs deliberately, chinakayao, in social security, policy support, disaster relief funds and materials and other matters assigned any kind and affectionate friends, obviously unfair acts against the interests of the masses of the disciplinary terms; increase the terms not in accordance with the provisions of the public party provided, government, factory and village (neighborhood) provided etc. violation of the people's right to know the behavior of the discipline. The fifth issue, on the violation of work discipline violation of work discipline added "negative list, including Party organizations carry out strictly Main responsibility for poor discipline terms. (1) the new party organization comprehensive strictly the main responsibility of the party does not fulfill the 21 or perform poor disciplinary terms < New Regulations > has a lead people to pay attention to the new terms, that is, in chapter ten "on the violation of work discipline behavior punishment" increase in the one hundred and fourteenth "party fail to perform 106 comprehensive strictly the main responsibility of the party or to perform comprehensive strictly the main responsibility for administering the ineffective, resulting in serious damage or serious adverse effects, to the person directly responsible and the responsibility of leadership and give a warning or serious warning. The situation is serious, giving removed from their party posts or on probation Punishment. "Here the changes. For the first time, the main responsibility write < rule >. (2) new shall report does not report or false reporting discipline shall increase the 117 bar" in the higher level units to check to inspect the work or report to the parent unit, work report of shall report the matters do not report or do not report, cause serious damage or serious adverse effects of, to the person directly responsible and the responsibility of leadership, to give warning or a serious warning; if the circumstances are serious, giving removed from their party posts or placed on probation. "For example, during the tour visits to the region, the unit Members the obligation to the inspection teams to reflect the true situation, to conceal not reported or intentionally to the inspection teams to provide false information, causing serious damage or serious adverse effects of, the person directly responsible and the responsibility of leadership should be in accordance with the provisions of < rule > Article 117 to give the appropriate punishment. (3) the new not granted in accordance with the provisions of punishment, not according to the provisions of the implementation of disciplinary measures 22 violation 107 of the provisions of Article 115 "Party organizations have one of the following circumstances, the direct leadership responsibility. Probation: members were sentenced punished, in accordance with the provisions give disciplinary action or in violation of state law Rules of behavior should be given disciplinary punishment and dispose of; disciplinary punishment by decision or complaint review the decision made, not in accordance with the provisions of the implementation decisions on punishment of the party, position, rank, and the treatment of the matters; Party members subject to disciplinary action, not in accordance with the cadre management authority and organizational relationships of by dispose of Party members to carry out education and supervision of daily management. "What needs to be pointed out is," cliff "demoted with cars, housing, secretary problem, implementation is not a discipline and party posts and ranks treatment by the organization department is responsible for the implementation, with cars, housing by the logistics department is responsible for the implementation of, Ji Commission responsible oversight responsibilities. The six questions, about the acts violating the discipline of life "in violation of discipline of life behavior punishment", mainly to "four winds" problems and a serious violation of social morality, family virtue acts of misconduct made provisions on disciplinary, an increase of extravagant life, contrary to the social public order and good customs disciplinary terms. Worth mentioning is, > < Regulations in Article 150 108 about "adultery" "mistress (Cardiff) formulation in the new < rule > is removed, to expand the scope of Article 127 provisions" and others hair improper sexual relations, let face disciplinary action Wider more strict. Four, and earnestly do a good job in the < code > and < rule > implement system of life lies in execution. < code > and < Regulations > is 23 Party organizations at all levels of a strong constraint and all Party members follow. Learning and implementing the < code > and < rule > is party committees (party), commission for discipline, discipline inspection group), the majority of Party members and cadres of the common responsibility, must party caught together, the party one execution. () Party committees (party) and play and implement comprehensive strictly the main responsibility, pays special attention to the two party regulations learning cross penetration. One is to Adhere to the party constitution is fundamental to follow, and resolutely safeguard the authority of the Party Chapter. The second is to adhere to the problem oriented, to strictly political discipline and political rule moments in the first place. The third is to adhere to the discipline and rules quite in front must not allow the bottom line to break the discipline. The fourth is to seriously organize the study of propaganda and education, in the city party members to create a disciplined, about the rules of the strong atmosphere. (II) Commission for Discipline Inspection at all levels (Discipline Inspection Group) to an important basis for the revised two party regulations as, adhere to easily 109 blame, strengthen supervision and enforcement And early method in combining Ji, increase accountability efforts. One is to two regulations within the party important basis, adhere to the party constitution duties, with strict discipline to maintain the constitution authority. The second is to adhere to high standards and keep the bottom line, adhere to Ji Yan in law and discipline, the discipline and rules quite in front, grasping grasping small, easily blame, comprehensive use of supervision and discipline of "four kinds of form" in the discipline embodies the strict requirements and care for the discipline, tighten up, Yan. According to discipline in accordance with regulations to carry out disciplinary review. Increase the violations punishment, clues can initiate an investigation on the trial of cases According to the discipline on the provisions of the proportion of processing and control manager maintains discipline. To focus on investigating non convergence, don't accept hand serious disciplinary violations at the same time, pay more attention to the general review of discipline 24 behavior, and gradually increase the lighter punishment. Four is to illuminate two party regulations, combined with the local district of the Department of party conduct Lianzheng to relevant laws and regulations system clean, timely research proposes to establish, change, waste release opinion, avoid conflict, and the fasten system of cage, and gradually formed not rot, not rot, not want to rot system and working mechanism. (3) the leadership of the party members and cadres 110 should play an exemplary role. The rate of higher consciousness of the front of the Ordinance to lead practice self-discipline norms, leading to maintain discipline of seriousness and authority. One is the above rate, demonstration and guidance, take the lead in learning and mastering the < code > and < > the requirements and regulations, do the deep understanding, learning to use. The second is to play an exemplary role in abiding by discipline rate, take the lead in practicing self-discipline norms, firmly establish before the discipline are equal, the system has no privilege, discipline is no exception, and consciously do standards, require more strict measures more practical. Third is to consciously accept supervision, conscientiously participate in the democratic life and debriefing honesty responsibility, such as Real to the party organization to report personal matters, and to accept the supervision of the work and life of the normal, habits under the supervision of the exercise of power, to carry out the work. The fourth is to set an example for the strict enforcement of discipline. Leading cadres should take the lead in the maintenance of discipline of seriousness and authority, to dare to seriously, dare to struggle, dare to offend people, for misconduct not laissez faire, but do not indulge, not tolerate to ensure the party constitution of party compasses party put in place. (4) the majority of Party members and cadres to set high standards and hold the bottom line, consciously abide by the < code > and < rule >. One is to control the < standard > and < 25 cases >, tight Close connection 111 with their own thoughts, practical work and life, efforts to solve the problems, to enhance the study and implement of the effectiveness and pertinence. The second is to establish a high standard and hold the bottom line, consciously in the self-discipline pursuit of high standards, strictly in the party away from the red line discipline, discipline, about the rules and know fear, distrust, the formation of the honor system, comply with the system, safeguard system of good habits. Regulations and discipline regulations of < < New Revision of the Communist Party of China clean fingered self-discipline criterion > and < Chinese Communist Party Disciplinary Regulations > is the Party Central Committee in the new situation to promote the comprehensive strictly root of the lift, the regulations of the party construction of keeping pace with the times. We should study and implement the Standards > and < > as the primary political task, adhere to the party constitution duties, adhere to the discipline of, Ji Yan in law, the full implementation of supervision and discipline accountability responsibilities for coordination and promotion "four overall" strategic layout in XX District vivid practice to provide a strong guarantee. - Si Jian Wu, and effectively enhance the implementation of the implementation of the < code > < > The consciousness of General Secretary Xi pointed out that the party is in charge of the party, to manage the party; strictly, it can cure good party. Criterion > and < rule > keep pace 112 with the times is our party to form a new potential strictly rules, to deepen understanding of the ruling law, is a comprehensive strictly, and strengthen the supervision within the party important grasper. Criterion > closely linked to the theme of self-discipline, self-discipline intensity-modulated, focusing on morality, for the majority of Party members and cadres set to see, feel the high standard, show the Communists noble moral sentiment; District Ordinance < < rule > the constitution of discipline integration into a political discipline, organization and discipline, honesty and discipline, discipline of the masses, work discipline, discipline, emphasize discipline, focusing on established rules, to draw the party organizations and Party members do not touch the bottom line. Party committees (party) to effectively strengthen the study and publicize the implementation of the < code > and < rule > the organization and leadership of criterion > and < > a full range, multi angle, deep publicity, the formation of study and publicize and implement the boom, in order to consolidate the development of good political environment to create a positive environment and atmosphere. The majority of Party members and cadres to strict requirements, the < rule > and < Ordinance cases > as a guide to action and behavior criterion, adhere to the moral standards and discipline of the bottom line, to maintain the discipline of worship and awe, learning, compliance, and maintain party discipline and rules of the model. The discipline inspection and supervision organs and cadres to the < code > and < > as the deepening of 113 the "three", and strengthen supervision and discipline of accountability is important to follow correctly grasp the use of supervision and discipline of "four types", promote the comprehensive strictly in new roots. Strict discipline, adhere to the discipline and rules quite in front of the enterprise in the implementation of expensive to implement to execute. The discipline inspection and supervision organs to implement the < code > and < Efforts to investigate cases > as an opportunity, adhere to the party should manage the party strictly, serious performance of their duties to promote two regulations implementation. Change discipline concept. From the simple "investigation of illegal" to a comprehensive "stare at violate discipline"; from the business case to prosecute the big cases and timely solve the signs of tilt to. From the orientation to the normal supervision; from the tube "minority" to resist the "most". Guide Party members and cadres to seriously implement the < code > and < rule >, consciously abide by the political, organizational, honest people, work, life six discipline. Urge the leadership cadres sent to play an exemplary role, take the lead in strictly enforced. Relaxation and rest Strong wind is Su Ji, closely linked to the "four winds" prone to multiple, the masses reflect the strong important nodes and, glued to the four winds "new form, new trends, seriously investigate and deal with violations of the central eight provisions of the spirit, to increase the bulletin exposure intensity, the formation of Chajiu" four winds "loudly, continue to release and discipline 114 must be strict signal. At the same time, extended supervision tentacles, through the development of the rural and fishery party conduct Lianzheng construction inspection, issued in a timely manner, Chajiu occurred in grassroots side of corruption and unhealthy, and earnestly safeguard the interests of the masses and social stability. The creativity and discipline. Grasp and make good use of the supervision and discipline of" four types ", to ensure the Promoting clues to lots of discipline and the law of the vacuum tube, strict together. Not only to the "less" and "very few" thorough investigation severely punished, but also the "most" to maintain zero tolerance trend through layers of conductive pressure, let the discipline about the rules for each party members and cadres consciously follow. At present, it is necessary to implement the "list" management, strictly follow the clues to the disposal of five standards, make the classification of disposal, dynamic cleanup. Zadok Party committees at all levels to implement the main responsibility, comprehensive use of disciplinary action and tissue processing and other means to effectively curb the commonplace, used to see do not blame the "small problem", not because of "practice" and "exception". Prominent Discipline characteristics, the problems of violation of discipline and rules into the focus of supervision and discipline and disciplinary review. At the same time, increase case double check the intensity, the serious problems of discipline violations or "four winds" ban but not absolutely, not only to be 115 held directly responsible, but also held leadership responsibility; not only to pursue studies the main responsibility of the Party committee, and to pursue Commission for Discipline Inspection and supervision responsibilities and promote accountability to become the new norm. The implementation of supervisory responsibility. Maintain < code > and < rule > the seriousness and authority of the discipline and rules and truly become the party's ruler. Discipline as supervision within the party the specialized agency, we must strengthen the responsibility to act, adhere to the Impartial discipline accountability, earnestly will be strict discipline, discipline must be punished, and severely punish the acts in violation of rules and regulations. 116