岭南地区某三甲医院呼吸道感染用药合理性分析

发布时间：2018-06-19 13:07

本文选题：岭南地区 + 呼吸道感染　；参考：《广州中医药大学》2017年博士论文

【摘要】：呼吸道感染是临床乃至日常生活常见病和多发病,具有多发性、易感性的发病特点。呼吸道感染不仅直接影响人们的日常工作和学习,可伴有严重并发症,严重者可出现多器官功能衰竭,威胁人类生命。呼吸道感染严重危害人类健康。岭南地区位于亚热带,濒临南海,河网密布,热带及亚热带气候,温暖湿润,雨量;岭南人嗜食肥甘厚腻谭亮,冷饮,容易出现在每年的炎热和潮湿的气候环境下脾胃功能失调,导致脾胃虚弱,酿痰生湿。岭南地区人群呼吸道感染常易"从化",从中医辨证常具有湿热特征。近年来,在呼吸道感染的治疗中滥用抗菌药物,随之产生大量耐药菌株,给临床治疗特别是对严重感染的治疗带来较大困难。可见在呼吸道感染的治疗中常存在不合理用药的情况。抗生素的不合理使用已成为全球性的公共卫生问题,是公共卫生领域关注的焦点。抗生素的不合理使用包括滥用抗菌药物,过量大处方复合给药、不遵照临床治疗指南给药以及患者不合理的自购药等。本研究拟采用对医疗机构的处方进行回顾性分析,进而了解岭南地区呼吸道感染的用药情况,为合理用药提供依据,规范医务人员的处方行为,提高合理用药水平,为岭南地区大综合医院合理用药现状提供了可靠、有代表性的参考数据。目的:本研究拟采用对医疗机构的处方进行回顾性分析,进而了解岭南地区呼吸道感染的用药情况,为合理用药提供依据,规范医务人员的处方行为,提高合理用药水平,为岭南地区大综合医院合理用药现状提供了可靠、有代表性的参考数据。方法:通过收集对岭南地区三甲医院2015年1月至2015年12月门诊呼吸道感染患者的电子处方信息,对岭南地区医院呼吸道感染处方用药情况进行分析。进入医院信息管理系统提取2015年1月至2015年12月所有呼吸道感染的门诊患者处方信息,主要内容包括患者年龄、性别、治疗时间、治疗部门,医院医生的工作,医生、疾病诊断、药物、药品编码通用名称、规格、数量及包装的包装单元、药物剂型、给药、剂量、用法及药物药品成本,数量,药品金额及付款方式。比较2项检验与t检验的差异,比较不同人口学特征、不同就诊方式、单次就诊次数、用药次数、抗菌药物使用情况、抗病毒药物的发放方式及单次费用等。结果:1门诊上呼吸感染用药分析1..1例上呼吸道感染门诊患者接受单药治疗2.27例,标准差为0.998。不同性别就诊的患者数为4以上者对比差距具有统计学意义(P0.05),单次访视男性患者高于4例或以上患者。不同年龄组患者数为4以上者对比差距具有统计学意义(P0.05),18岁以下、单次随访超过65岁的患者数均在4以上。不同职称的医生次就诊用药个数在4种及以上者对比空白有统计学意义(P0.05),当副主任医师处方时,患者的单次访访次数在4以上的比例较高。1.29786名上呼吸道感染患者处方中,含注射剂型处方数4034份,占比为41.22%。不同性别患者使用注射类给药方式差别具有统计学意义(P0.05),其中男性患者使用注射类给药方式的比例小于女性。不同年龄段患者使用注射类给药方式差别具有统计学意(P0.05)随着年龄的增加,注射药物的使用量增加。注射给药的使用是有统计学意义的差异不同职称医师开具处方时(P0.05),/副教授的处方使用比例较高的医师处方使用注射药物投递率低的可注射的药物传递副主任。1.3门诊上呼吸道感染患者单次就诊平均费用为271.68± 127.95元,不同性别患者单次就诊平均费用对比,差异有统计学意义(P0.05),单次访男性的平均费用高于女性。不同年龄段患者单次就诊平均费用对比,差异具有统计学意义(P0.05),门诊患者单次就诊费用有随年龄增大而增大的趋势。1.4对门诊上呼吸道感染患者抗菌药物使用情况进行分组分析,结果显示男性和女性患者抗菌药物使用率没有明显差别,P=0.833。不同年龄组患者抗菌药物使用率比较,差异具有统计学意义(P0.05),其中大于65岁上呼吸道感染患者抗菌药物使用率最高。1.59786名门诊上呼吸道感染患者中,1022例患者用抗病毒药物治疗,比例为10.45%。男性患者使用抗病毒药物的与女性相当,两者对比没有统计学意义(P0.05)。不同年龄组上呼吸道感染患者使用抗病毒药物使用情况对比,差异具有统计学意义(P0.05);18岁至65岁之间人群使用抗病毒药物的比例较高。1.6门诊上呼吸道感染患者中使用中成药者有9324人,中成药使用率为95.28%。不同性别的中成药使用率差异无显著性(P0.05)。男性患者中成药使用率与女性患者相似。不同年龄组中成药使用情况差异有统计学意义(P0.05),中成药使用率随年龄增长而降低。对门诊上呼吸道感染患者中成药使用个数情况进行分组分析,结果显示不同性别患者中成药使用个数情况对比,差异有统计学意义(P0.05),中成药在男性患者中的使用量大于女性患者2。不同年龄组患者中成药使用个数情况对比,差异具有统计学意义(P0.05),18～65岁患者中成药使用个数1个者最多,其中大于65岁人群使用2个中成药者有1338人,占40.10%。2门诊下呼吸感染用药分析2.1例门诊下呼吸道感染患者接受单药治疗2.18例,标准差为0.928。男性患者和女性在单次访问中差异无统计学意义(P0.05)。不同年龄组患者均为单就诊用药个数在4种及以上者对比差距具有统计学意义(P0.05)18岁以下的儿童,单次访问的年龄在65岁以下的儿童数低于。2.22568名下呼吸道感染患者处方中,含注射剂型处方数1513份,占比为58.92%。不同性别患者使用注射类给药方式差别具有统计学意义(P0.05),其中男性患者使用注射类给药方式的比例小于女性。不同年龄段患者使用注射类给药方式差别具有统计学意(P0.05)随着年龄的增加,注射药物的使用量增加。2.3门诊下呼吸道感染患者单次就诊平均费用为213.88±77.42元,不同性别患者单次就诊平均费用对比,差异无统计学意义(P0.05)。不同年龄段患者单次就诊平均费用对比,差异无统计学意义(P0.05)。2.42568名下呼吸道感染患者中,使用抗菌药物的有2130人,抗菌药物使用率为82.94%,男性和女性患者抗菌药物使用率没有明显差别,P=0.22。不同年龄组患者抗菌药物使用率比较,差异具有统计学意义(P0.05),其中18岁以下人群抗菌药物使用率最高。2.5门诊下呼吸道感染患者中使用中成药者有2042人,中成药使用率为79.52%,不同性别中成药使用率差异无显著性(P0.05)。男性患者中成药使用率与女性患者相似。不同年龄段中成药使用情况差异有统计学意义(P0.05),其中以18岁和65岁组中成药比例最高。对门诊下呼吸道感染患者中成药使用个数情况进行分组分析,结果显示不同性别患者中成药使用个数情况对比,差异有统计学意义(P0.05),女性更倾向于使用2种中成药比男性。不同年龄组患者中成药使用个数情况对比,差异具有统计学意义(P0.05),18～65岁患者中成药使用个数1个者最多,其中大于65岁人群使用2个中成药者有653人,占69.17%。结论:岭南地区呼吸道感染用药有其自身的特点,我院呼吸道感染用药具有普遍合理性,但门诊处方用药指标和合理的水平,推荐范围是有差距的一些方面,主要表现为平均处方数大于1.6-1.8,抗菌药物使用率高于国家卫生部的要求,喷射比例也略高。在上呼吸道感染患者的治疗中,抗生素的过度使用是上呼吸道感染的主要原因菌药物使用率远高于理论上上抗菌药物在呼吸道感染患者中的应用。本研究对三家三甲医院门诊处方信息进行全面抽样调查和综合分析,找出处方药的关键问题。为进一步了解医生的处方行为提供了新的思路和依据。
[Abstract]:Respiratory tract infection is a common and frequently occurring disease in clinical and daily life. It has the characteristics of multiple incidence and susceptibility. Respiratory tract infection not only directly affects people's daily work and learning, but also has serious complications. The serious people can appear multiple organ failure and threaten human life. Respiratory infection seriously endangers human health. The respiratory infection is serious harm to human health. South of the Five Ridges The region is located in the subtropics, on the brink of the South China Sea, the dense river network, the tropical and subtropical climate, warm humid, rainfall; south of the Five Ridges people are fat, sweet and greasy Tan Liang, cold drink, easy to appear in the heat and humid climate of each year in the spleen and stomach dysfunction, resulting in the weakness of the spleen and stomach, and the moisture of the phlegm. The respiratory infection in south of the Five Ridges area is often easy to "Conghua", from traditional Chinese medicine, from traditional Chinese Medicine Syndrome differentiation often has the characteristics of damp and hot. In recent years, antibiotics are abused in the treatment of respiratory tract infection, and a large number of drug-resistant strains are produced, which brings great difficulties to clinical treatment, especially for the treatment of severe infection. It is obvious that irrational use of antibiotics often exists in the treatment of respiratory tract infection. The irrational use of antibiotics has become the world. The problem of public health is the focus of public health. The irrational use of antibiotics includes the abuse of antibiotics, overdose of the prescription, non compliance with the clinical treatment guidelines and the irrational self purchase of the patients. This study intends to use a retrospective analysis of the prescriptions of medical institutions to understand the south of the Five Ridges area. The use of drug use in the area of respiratory tract infection provides a basis for rational use of drugs, standardizing prescription behavior of medical personnel, improving the level of rational use of drugs, providing reliable and representative reference data for the rational use of drugs in south of the Five Ridges general hospital. Objective: This study intends to adopt a retrospective analysis of the prescription of medical institutions and then to solve the mountain range. The drug use of respiratory tract infection in southern China provides a basis for rational use of drugs, standardizing prescription behavior of medical personnel, raising the level of rational use of drugs, providing reliable and representative reference data for the rational use of drugs in south of the Five Ridges general hospital. Method: through collecting the outpatient clinic from January 2015 to December 2015 in the third one hospital in south of the Five Ridges The electronic prescription information of the patients with respiratory tract infection was analyzed in the prescription drug use of respiratory tract infection in south of the Five Ridges hospital. The hospital information management system was entered to extract all the outpatient patients' prescription information from January 2015 to December 2015. The main contents included patient's age, sex, treatment time, treatment department, hospital doctor. Work, doctor, disease diagnosis, medicine, drug code general name, specification, quantity and packing unit, drug dosage form, dosage, dosage, usage and drug and drug cost, quantity, drug amount and t test. Compare the difference of the 2 test and the difference of the demography, the different methods of medical treatment, the number of medical treatment, the use of Medicine The number of times, the use of antibacterials, the distribution of antiviral drugs and the single cost and so on. Results: 1 1..1 cases of outpatient respiratory infection were analyzed by single drug treatment in 2.27 cases, the standard deviation of the standard deviation was more than 4 of the patients with different sex of 0.998. (P0.05), a single visit. The male patients were more than 4 or more patients. The contrast gap was statistically significant (P0.05), under 18 years old, and the number of patients over 65 years old was more than 4. The number of doctors with different titles was statistically significant (P0.05) in 4 or more cases (P0.05). When the number of patients visited more than 4, the number of patients with upper respiratory tract infection was higher than 4, including 4034 prescriptions of injection type, which accounted for the difference in the use of injection mode in patients with different sex of 41.22%. (P0.05), and the proportion of male patients using injection method was less than that of women (P0.05). The difference in the way of injection in different age groups was statistically significant (P0.05) with the increase of age, the use of injectable drugs increased. The use of the injection was statistically significant (P0.05) when different professional titles were prescribed (P0.05). The average cost of a single visit to the.1.3 outpatient was 271.68 + 127.95 yuan. The average cost of the single visit for different sex patients was statistically significant (P0.05). The average cost of the single visit to the male was higher than that of the female. The difference was statistically significant (P0.05). The single visit cost of outpatients had a trend of.1.4 increasing with age. The use of antimicrobial agents in outpatients with upper respiratory tract infection was analyzed. The results showed that there was no significant difference in the use of antibacterial drugs between male and female patients, and the antibacterials in different age groups of P=0.833. were antibacterials. The difference was statistically significant (P0.05). Among the patients older than 65 years old, the highest use rate of Antibacterials in the upper respiratory tract was.1.59786 in the patients with upper respiratory tract infection, and 1022 patients were treated with antiviral drugs, and the proportion of the male patients with 10.45%. was equivalent to that of the women, and there was no statistical difference between the two. Significance (P0.05). The use of antiviral drugs in patients with upper respiratory infection in different age groups was compared, the difference was statistically significant (P0.05); the proportion of people aged 18 to 65 years old with antiviral drugs was higher in.1.6 outpatient patients with upper respiratory tract infection by 9324 people, and the use rate of Chinese patent medicine was 95.28%. different sex. The use rate of Chinese patent medicine was not significant (P0.05). The use rate of Chinese patent medicine was similar to that of female patients. The use of Chinese patent medicine in different age groups was statistically significant (P0.05), and the use rate of Chinese patent medicine decreased with age. The difference was statistically significant (P0.05). The use of Chinese patent medicine in male patients was greater than that of female patients in 2. different age groups. The difference was statistically significant (P0.05). The number of Chinese patent medicines in 18~65 years old was the most, of which more than 65 were more than 65. 2 Chinese traditional Chinese medicines were used in 1338 people, accounting for 2.1 cases of lower respiratory tract infection in 40.10%.2 outpatient clinic, 2.1 cases of lower respiratory tract infection were treated with single drug treatment in 2.18 cases. The difference was not statistically significant (P0.05) in the single visit of 0.928. male patients and women (P0.05). The contrast gap is statistically significant (P0.05) children under 18 years of age, the number of children under the age of 65 years under the age of one visit is lower than that of the.2.22568 patients with lower respiratory tract infection, with 1513 injectable prescriptions, and the difference is statistically significant (P0.05) in the use of injections in different sexes of 58.92%.. The proportion of injecting drug delivery in male patients is less than that of women. The difference of the use of injection methods in different age groups is statistically significant (P0.05) with the increase of age and the increase in the use of injection drugs in.2.3 outpatient patients with lower respiratory tract infection, the average cost of the single visit is 213.88 + 77.42 yuan. There was no significant difference in the average cost of diagnosis (P0.05). There was no significant difference in the average cost of medical treatment in different age groups (P0.05) among the patients with.2.42568 lower respiratory tract infection, 2130 people used antibiotics, the use rate of antibiotics was 82.94%, and there was no significant difference in the use of antibiotics in men and women. The difference of the use rate of P=0.22. in different age groups was statistically significant (P0.05). Among the patients under 18 years old, 2042 of the patients with lower respiratory tract infection in.2.5 outpatients were used with Chinese patent medicine, the use rate of Chinese patent medicine was 79.52%, and there was no significant difference in the use rate of Chinese traditional Chinese medicine (P0.05). The use rate of Chinese patent medicine was similar to that of female patients. There was a significant difference in the use of Chinese patent medicine in different age groups (P0.05), among which the proportion of Chinese patent medicine was the highest in 18 and 65 years old. The number of Chinese patent medicine in the patients with lower respiratory tract infection was analyzed. The results showed the number of use of Chinese patent medicine in different sex patients. The difference was statistically significant (P0.05), and women were more inclined to use 2 kinds of Chinese patent medicine than men. The difference was statistically significant (P0.05). The number of 18~65 year old Chinese patent medicines used the largest number of 1, of which 65 years old people used 2 Chinese patent medicines in 653, accounting for 69.17%. conclusion: The drug use of respiratory tract infection in south of the Five Ridges area has its own characteristics. The drug use of respiratory tract infection in our hospital is generally reasonable, but the drug use index and reasonable level of the outpatient prescription are in some aspects, the main manifestation is that the average number of prescriptions is greater than 1.6-1.8, the use rate of antibacterials is higher than that of the national Ministry of health, and the injection ratio is higher than that of the national Department of health. In the treatment of patients with upper respiratory tract infection, the overuse of antibiotics is the main cause of upper respiratory infection and the use of antibiotics is far higher than the application of the theoretical upper antimicrobial agents in the patients with respiratory infection. This study conducted a comprehensive sampling survey and comprehensive analysis on the outpatient prescription information of three three A hospitals to find out the prescriptions. The key questions of medicine provide a new idea and basis for further understanding the prescribing behavior of doctors.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R95

【参考文献】