100例肝移植患者用药分析及术后应用抗感染药物的调查与分析
发布时间：2018-09-04 13:06
【摘要】：肝移植术已成为目前公认的治疗终末期肝病的唯一有效手段,我国自上世纪70年代引进肝移植技术以来,取得了重大发展,挽救了成千上万肝病患者的生命,目前肝移植手术本身不再是制约肝移植发展的主要因素,而其术后相关并发症的高发生率却仍危及患者生命,其中免疫排斥反应和感染一直是影响肝移植术后患者生存率的关键。随着他克莫司(FK506)、吗替麦考酚酯等新型强效免疫抑制剂的应用,使机体的排斥反应对受体生存的威胁日益减少;而由于抗菌药物的不合理应用及细菌耐药性日益增加,感染却成为威胁患者生命及术后生存质量的一个主要因素。肝移植属于高风险,高耗费手术,患者需要承受沉重的经济负担。多年临床资料显示,肝移植患者术后常存在急、慢性排斥反应,术后感染,电解质紊乱,继发性糖尿病等并发症,使得术后需应用大量的治疗药物,对于一些药物,患者个体之间的药代动力学差异大,给临床用药的选择及科学合理的配伍带来一定的困难,另外,术后应用免疫抑制剂和急性排斥反应的冲击治疗,使肝移植患者在围手术期发生感染的概率远远高于其他外科手术的患者,因此肝移植患者临床用药多而复杂,用药的选择性、科学正确的合理性以及联合应用效果、药物之间的相互作用都是较为复杂的问题。本研究通过对我院肝移植患者住院期间医嘱用药统计分析,系统的了解肝移植患者药物利用和费用支出状况,以期进一步为肝移植患者在用药选择、给药途径、用药剂量等临床应用中提供依据。第一部分100例肝移植患者用药分析目的:分析统计我院100例肝移植患者药物利用以及费用支出情况,为肝移植患者在药物选择、给药途径、用药剂量等临床应用中提供依据。方法:通过调查2005年至2014年间我院肝移植患者的病例100份,对患者年龄、性别、住院天数、病因等基本信息进行记录;并对其用药种类、用药剂量、用药频率以及2005年至2014年患者住院费用进行汇总,用Excel做统计处理。结果:执行医嘱用药,涉及药物470种。其中,电解质平衡调节药,维生素与营养支持用药,免疫系统用药,循环系统用药,血液系统用药以及抗感染用药在医嘱中出现频率较高,占所用药物的80%以上;人血白蛋白,免疫球蛋白,他克莫司,吗替麦考酚酯,奥美拉唑,甲泼尼龙等单品中出现的频率以及用药人数均居于前列,显示该类患者的用药与其特殊人群的定位有密切关系。药物费用、住院总费用及两者之比的均值分别为:(11.94±5.49)万元、(24.51±11.05)万元、(48.68±9.12)%。影响住院费用的原因,主要与术前机体状况、术后重症监护依赖、感染等因素有关。结论:肝移植术后患者总住院费用无明显增长趋势,但药品费用占总费用比例较高。医院用药符合这一特殊人群的定位。第二部分肝移植患者应用抗感染药物的调查与分析目的:分析肝移植患者抗感染药物的应用情况,为肝移植患者围手术期合理使用抗感染药物提供依据。方法:回顾性调查2005年1月-2014年12月肝移植术后出院的100份病历,采用世界卫生组织(WHO)药物利用研究小组推荐的限定日剂量(DDD)、药物利用频度(DDDs)和药物利用指数(DUI)为指标,对所调查的患者用药情况用Excel进行统计分析。结果:100例肝移植患者抗感染药物使用率为100.0%,抗感染药物连续用药时间最长46 d、最短8 d、平均(18.2±1.8)d;其中2种以上抗感染药物联合连续用药时间最长38d、最短3d。单品种应用时间最长为34d、最短1 d。有61例患者采用过联合用药,应用频率为61.00%;其中二联43例,占43.00%,三联18例,占18.00%;统计应用例/次前10位的抗感染药物除头孢吡肟DUI=1.03外,其他药物DUI均1。结论:肝移植受者抗感染药物的使用频率、用药时间和联合用药例次均大于其他外科手术患者,这与其术后易感染的特殊性有关。本组61例联合应用抗感染药物的患者中,其联用品种均显示协同或相加的抗感染作用,属于合理配伍。
[Abstract]:Liver transplantation has been recognized as the only effective method to treat end-stage liver disease. Since the introduction of liver transplantation technology in China in the 1970s, great progress has been made, saving the lives of thousands of patients with liver diseases. At present, liver transplantation itself is no longer the main factor restricting the development of liver transplantation, and its postoperative complications. Immune rejection and infection are the key factors affecting the survival rate of patients after liver transplantation. With the application of new powerful immunosuppressive agents such as tacrolimus (FK506), mycophenolate mofetil and so on, the threat of rejection to the survival of recipients is decreasing day by day. Liver transplantation is a high-risk, high-cost operation, and patients need to bear a heavy economic burden. Many years of clinical data show that patients with liver transplantation often have acute, chronic rejection, postoperative infection, and electricity. Complications such as derangement, secondary diabetes mellitus and so on make it necessary to apply a large number of therapeutic drugs after operation. For some drugs, the pharmacokinetic differences between individual patients are great, which brings some difficulties to the choice of clinical medication and scientific and reasonable compatibility. In addition, the application of immunosuppressive agents and acute rejection shock therapy after operation makes the liver difficult. The probability of infection in the perioperative period of liver transplantation patients is much higher than that in other surgical patients. Therefore, the clinical use of drugs in liver transplantation patients is more and more complex, the choice of drugs, scientific and correct rationality, combined application effect and the interaction between drugs are more complex problems. Statistical analysis of prescribed drug use during the hospital period to systematically understand the utilization and expenditure of drugs in liver transplantation patients, with a view to providing further evidence for the clinical application of drug selection, route of administration and dosage of drugs in liver transplantation patients. Methods: 100 cases of liver transplantation patients in our hospital from 2005 to 2014 were investigated, and the basic information such as age, sex, hospitalization days, etiology and so on were recorded. Results: 470 kinds of drugs were involved in the execution of medical orders. Among them, electrolyte balance regulators, vitamin and nutritional support drugs, immune system drugs, circulatory system drugs, blood system drugs and anti-infective drugs were prescribed. The frequency and the number of drug users were in the front rank, indicating that the drug use of these patients was closely related to the location of the special population. The mean of the ratio was (1194 549) 000 yuan, (2451 1105) 000 yuan, (48.68 9.12)%. The main factors influencing the hospitalization expenses were preoperative body condition, postoperative intensive care dependence, infection and other factors. Objective: To analyze the application of anti-infective drugs in liver transplantation patients, and to provide evidence for rational use of anti-infective drugs during the perioperative period of liver transplantation. Methods: Retrospective investigation was carried out after liver transplantation from January 2005 to December 2014. 100 medical records of the hospital were analyzed by Excel with DDD recommended by the World Health Organization (WHO) Drug Utilization Research Group, DDDs and DUI as indicators. Results: 100 liver transplant patients were treated with anti-infective drugs and 100.0% with anti-infective drugs. The longest and shortest duration of continuous administration was 46 days and 8 days, with an average of (18.2 1.8) days, of which the longest and shortest duration of continuous administration of two or more anti-infective drugs was 38 days and the shortest was 3 days. CONCLUSION: The frequency, duration and frequency of antibiotics used in liver transplant recipients are longer than those in other surgical patients, which is related to the particularity of postoperative infection. All varieties showed synergistic or synergistic anti infective effects, which belonged to reasonable compatibility.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3
本文编号：2222190
[Abstract]:Liver transplantation has been recognized as the only effective method to treat end-stage liver disease. Since the introduction of liver transplantation technology in China in the 1970s, great progress has been made, saving the lives of thousands of patients with liver diseases. At present, liver transplantation itself is no longer the main factor restricting the development of liver transplantation, and its postoperative complications. Immune rejection and infection are the key factors affecting the survival rate of patients after liver transplantation. With the application of new powerful immunosuppressive agents such as tacrolimus (FK506), mycophenolate mofetil and so on, the threat of rejection to the survival of recipients is decreasing day by day. Liver transplantation is a high-risk, high-cost operation, and patients need to bear a heavy economic burden. Many years of clinical data show that patients with liver transplantation often have acute, chronic rejection, postoperative infection, and electricity. Complications such as derangement, secondary diabetes mellitus and so on make it necessary to apply a large number of therapeutic drugs after operation. For some drugs, the pharmacokinetic differences between individual patients are great, which brings some difficulties to the choice of clinical medication and scientific and reasonable compatibility. In addition, the application of immunosuppressive agents and acute rejection shock therapy after operation makes the liver difficult. The probability of infection in the perioperative period of liver transplantation patients is much higher than that in other surgical patients. Therefore, the clinical use of drugs in liver transplantation patients is more and more complex, the choice of drugs, scientific and correct rationality, combined application effect and the interaction between drugs are more complex problems. Statistical analysis of prescribed drug use during the hospital period to systematically understand the utilization and expenditure of drugs in liver transplantation patients, with a view to providing further evidence for the clinical application of drug selection, route of administration and dosage of drugs in liver transplantation patients. Methods: 100 cases of liver transplantation patients in our hospital from 2005 to 2014 were investigated, and the basic information such as age, sex, hospitalization days, etiology and so on were recorded. Results: 470 kinds of drugs were involved in the execution of medical orders. Among them, electrolyte balance regulators, vitamin and nutritional support drugs, immune system drugs, circulatory system drugs, blood system drugs and anti-infective drugs were prescribed. The frequency and the number of drug users were in the front rank, indicating that the drug use of these patients was closely related to the location of the special population. The mean of the ratio was (1194 549) 000 yuan, (2451 1105) 000 yuan, (48.68 9.12)%. The main factors influencing the hospitalization expenses were preoperative body condition, postoperative intensive care dependence, infection and other factors. Objective: To analyze the application of anti-infective drugs in liver transplantation patients, and to provide evidence for rational use of anti-infective drugs during the perioperative period of liver transplantation. Methods: Retrospective investigation was carried out after liver transplantation from January 2005 to December 2014. 100 medical records of the hospital were analyzed by Excel with DDD recommended by the World Health Organization (WHO) Drug Utilization Research Group, DDDs and DUI as indicators. Results: 100 liver transplant patients were treated with anti-infective drugs and 100.0% with anti-infective drugs. The longest and shortest duration of continuous administration was 46 days and 8 days, with an average of (18.2 1.8) days, of which the longest and shortest duration of continuous administration of two or more anti-infective drugs was 38 days and the shortest was 3 days. CONCLUSION: The frequency, duration and frequency of antibiotics used in liver transplant recipients are longer than those in other surgical patients, which is related to the particularity of postoperative infection. All varieties showed synergistic or synergistic anti infective effects, which belonged to reasonable compatibility.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3
【共引文献】
相关博士学位论文 前1条
1 邰沁文;自体肝移植的临床和相关实验研究[D];新疆医科大学;2013年
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