社区获得性肺炎住院患者抗菌药物合理使用专项点评标准的建立与应用效果评价

发布时间：2019-03-31 00:14

【摘要】：目的:建立社区获得性肺炎(CAP)住院患者抗菌药物合理使用专项点评标准(以下简称"CAP专项点评标准"),评价其应用效果。方法:临床药师参照相关指南、规范和药品说明书等资料,与感染相关科室医师共同协商后,从药物选择、用法用量、用药疗程、联合用药指征、联合用药配伍、药物更换与用药相关的检查等7个方面入手,建立我院"CAP专项点评标准"。采用抽签法选取2014年1-6月(干预前组)和2015年1-6月(干预后组)我院呼吸内科CAP住院患者各50例,以上述标准为依据进行专项点评干预,比较干预前后两组患者抗菌药物的使用情况及疗效。结果:经CAP专项点评后,干预后组患者药物选择、用药疗程、联合用药指征、联合用药配伍和总体用药合理率分别由干预前的56.00%、68.00%、90.00%、92.00%和30.00%上升至88.00%、98.00%、100%、100%和84.00%,初始经验治疗抗菌药物联合用药的比例由干预前的64.00%下降至32.00%,具指征联合用药的比例由干预前的71.88%上升至100%,差异均有统计学意义(P0.05)。干预后组患者抗菌药物用药频度、使用强度和平均住院药物费用均低于干预前组,而平均抗菌药物费用占住院药物费用的比例高于干预前组,差异均有统计学意义(P0.05);两组患者治疗总有效率均为100%,但干预后组疗效判定为"显效"的患者比例显著上升,而疗效判定为"进步"的患者比例显著下降,差异均有统计学意义(P0.05)。结论:以"CAP专项点评标准"为依据的专项点评干预可改善CAP住院患者抗菌药物的使用情况,是针对其用药医嘱点评模式的有益探索。
[Abstract]:Aim: to establish a special evaluation standard for rational use of antibacterial drugs in (CAP) patients with community acquired pneumonia (hereinafter referred to as "CAP specific evaluation standard") and evaluate its application effect. Methods: clinical pharmacists consult the related guidelines, specifications and drug instructions. After consultation with doctors in the departments concerned with infection, the drug selection, dosage, course of treatment, indication of combined use and compatibility of combined use were carried out by the clinical pharmacists, and after consultation with the doctors of the departments concerned with infection, the clinical pharmacists were given the indication of combined use. Seven aspects of drug exchange and drug use related inspection were established to establish the CAP special evaluation standard in our hospital. 50 CAP patients from January to June 2014 (pre-intervention group) and from January to June 2015 (post-intervention group) in our hospital were selected by drawing lots. To compare the use and curative effect of antibacterial drugs in two groups before and after intervention. Results: after special evaluation of CAP, the rate of drug selection, course of treatment, indication of combination of drugs, combination of drugs and overall drug use were 56.0%, 68.00%, 90.00%, respectively, in the post-intervention group, which were compared with those in the pre-intervention group (56.0%, 68.00%, 90.00%, respectively). 92.00% and 30.00% rose to 88.00%, 98.00%, 100%, 100%, and 84.00%, and the proportion of initial experience combined use of antibiotics decreased to 32.00% from 64.00% before intervention. The proportion of indicative combination drugs increased from 71.88% before intervention to 100%, the difference was statistically significant (P0.05). The frequency, intensity and average cost of antibacterials in the intervention group were lower than those in the pre-intervention group, while the percentage of the average antibacterial cost in the in-hospital drug cost was higher than that in the pre-intervention group, the difference was statistically significant (P0.05). The total effective rate of the two groups was 100%, but the proportion of the patients whose curative effect was determined as "significant effect" increased significantly after intervention, while the proportion of the patients whose curative effect was "progressive" decreased significantly (P0.05). Conclusion: the special evaluation intervention based on "CAP special evaluation standard" can improve the use of antibacterial drugs in patients with CAP, and it is a beneficial exploration for the evaluation mode of medical orders of CAP patients.
【作者单位】：广东省中西医结合医院药学部;广东省中西医结合医院消化内科;广东省中西医结合医院呼吸内科;
【基金】：佛山市卫生局医学科研立项课题(No.2014258)
【分类号】：R563.1

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