碳青霉烯类抗菌药物临床应用评价体系的建立与实践

发布时间：2018-01-20 11:46

本文关键词： 碳青霉烯类抗菌药物临床应用评价体系评价指标药物利用评价　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的碳青霉烯类抗菌药物被誉为治疗革兰阴性菌感染的最后一道防线,为使碳青霉烯类抗菌药物能够更加持久地在治疗革兰阴性菌感染中发挥作用,延缓革兰阴性菌对碳青霉烯类抗菌药物耐药性的增长,需要严格管理、合理应用碳青霉烯类抗菌药物。本文建立碳青霉烯类抗菌药物临床应用评价体系并应用于临床,旨在加强碳青霉烯类抗菌药物的临床应用管理,促进碳青霉烯类抗菌药物的合理应用。研究方法应用药物利用评价(Drug use evaluation, DUE)方法,建立碳青霉烯类抗菌药物临床应用评价体系。依据碳青霉烯类抗菌药物临床应用评价体系,自行设计碳青霉烯类抗菌药物评价工作表,主要内容包括患者信息、诊断、用药信息、实验室检查、用药指征评价、用药过程评价、用药结果评价和管理指标评价八项。对2013年9月27日一2013年12月31日应用碳青霉烯类抗菌药物的全部病例52例进行横断面调查。应用SPSS17.0软件建立数据库,对评价结果进行数据统计、分析。研究结果碳青霉烯类抗菌药物临床应用评价体系包括评价指标、评价标准、评价依据和预期目标。评价指标分为四个一级指标和十七个二级指标,四个一级指标依次为用药指征、用药过程、用药结果和管理指标；十七个二级指标依次为适应症、禁忌症、实验室指标、药物选择、给药途径、给药剂量及间隔时间、特殊人群、溶媒剂量及选择、静脉滴注时间、疗程、联合用药、相互作用、药品不良反应、症状好转或治愈、特殊使用类抗菌药物申请单、病程记录、处方 52例病例中,8例完全符合评价标准,符合率为15.4%。其中适应症(符合率96.2%)、禁忌症(符合率1.9%)、生命体征监测(符合率100.0%)、药物选择(符合率100.0%)、给药途径(符合率100.0%)、滴注时间(符合率100.0%)、相互作用(符合率98.1%)、ADR(符合率100.0%)、填写“特殊使用类抗菌药物申请单”(符合率100.0%)达到预期目标；用药前进行病原学检查(符合率80.8%)、血象监测(符合率53.9%)、肝肾功能监测(符合率94.2%)、给药剂量及间隔时间(符合率84.6%)、特殊人群(符合率88.9%)、溶媒用量及选择(符合率17.3%)、疗程(符合率73.1%)、联合用药(符合率86.4%)、症状好转或治愈(符合率65.4%)、特殊情况下越级用药小于等于24h并于24h内补充“特殊使用类抗菌药物申请单”(符合率46.2%)、病历记录用药指征(符合率84.6%)及联合用药指征(符合率63.6%)、处方权(符合率69.2%)未达到预期目标。 52例病例共送检病原学标本189份,其中痰标本61份,占32.3%；血液标本118份(包括PCT标本和血培养标本),占62.4%。分离出革兰阴性菌8株,占72.7%；革兰阳性菌1株,占9.1%；真菌2株,占18.2%。52例病例全部进行病原学监测,占100.0%。52例病例全部进行PCT试验,占100.0%；7例病例进行痰涂片(检测细菌),占13.5%；23例病例进行痰涂片(检测真菌),占44.2%；29例病例进行痰培养,占55.8%；18例病例进行血培养,占34.6%。结论 1.本文制订的碳青霉烯类抗菌药物评价指标包括四个一级指标,十七个二级指标,具有科学性、代表性、实用性。 2.本文建立的碳青霉烯类抗菌药物临床应用评价体系具有可行性。应用碳青霉烯类抗菌药物临床应用评价体系对某医院碳青霉烯类抗菌药物进行评价,有利于发现该医院碳青霉烯类抗菌药物临床应用过程中的问题与不足。 3.某医院碳青霉烯类抗菌药物临床应用过程中,尚存在一些问题亟待解决。如：溶媒用量及选择、给药剂量及间隔时间、管理指标、实验室指标、特殊人群、疗程、联合用药未达到预期目标。
[Abstract]:research objective
Carbopenems leather treatment known as the last line of defense of Gram-negative bacteria infection, the carbapenem antibiotics can be more persistent in the treatment of leather to play the role of Gram-negative bacteria infection, delaying the gram negative bacteria antibiotic resistance to carbapenems growth, the need for strict management and the rational use of carbapenem antibiotics. The establishment of carbapenem antibiotics clinical application evaluation and clinical application, to strengthen the management of clinical application of carbapenem antibiotics, promote the reasonable application of carbapenem antibiotics.
research method
The application of drug utilization evaluation (Drug use evaluation, DUE) method, the establishment of carbopenems system evaluation of clinical application of antibacterial drugs. On the basis of carbapenem antibiotics clinical application evaluation system, designed to carbopenems evaluation table, including main contents of patient information, diagnosis, drug information, laboratory examination. The indications of drug use medication evaluation, process evaluation, outcome evaluation and medication management index evaluation of eight. On September 27, 2013 December 31, 2013, the use of carbapenem antibacterial drugs in all cases in 52 cases. A cross-sectional survey was conducted using SPSS17.0 software to establish database, analysis of the results of the evaluation of statistical data.
Research results
Carbapenem antibacterial drug clinical application evaluation system including evaluation index, evaluation criteria, evaluation criteria and expectations. Evaluation index is divided into four indexes and seventeen level two indexes, four level indicators are the indications of drug use, drug use, drug results and management index; seventeen level two index were indications, contraindications, laboratory index, drug selection, route of administration, dosage and time interval, special populations, and selection of solvent dosage, infusion time, treatment, drug combination, interaction, adverse drug reactions, symptoms improved or cured, special use of antimicrobial drugs for single disease record, prescription
In 52 cases, 8 cases were fully consistent with the evaluation criteria, the coincidence rate is 15.4%. the indications (coincidence rate 96.2%), contraindications (coincidence rate 1.9%), monitoring of vital signs (coincidence rate 100%), drug selection (coincidence rate 100%), route of Administration (coincidence rate 100%), infusion time (coincidence rate 100%), interaction (coincidence rate 98.1%), ADR (coincidence rate 100%), fill in the "special use of antimicrobial agents application form" (in line with the rate of 100%) to achieve the desired objectives before treatment; etiology examination (coincidence rate 80.8%), blood monitoring (coincidence rate 53.9%), liver and kidney function monitoring (coincidence rate 94.2%), the dosage and time interval (coincidence rate 84.6%), special populations (coincidence rate 88.9%), and the amount of solvent selection (with the rate of 17.3%), treatment (coincidence rate 73.1%), combination (coincidence rate 86.4%), the symptoms improved or cured (coincidence rate 65.4%), the special case of leapfrog medication less than or equal to 24h and in 24h. Supplementation of the "special application antimicrobial drug application form" (coincidence rate 46.2%), medication record indications (coincidence rate 84.6%) and combined medication indications (coincidence rate 63.6%), prescription rights (coincidence rate 69.2%) failed to achieve the expected goal.
A total of 52 cases from pathogens from 189 samples including 61 sputum samples, accounting for 32.3%; 118 blood specimens (including PCT specimens and blood culture specimens), accounted for 62.4%. isolated from 8 strains of gram negative bacteria, accounting for 72.7%; 1 strains of gram positive bacteria, accounting for 9.1%; 2 strains of fungi, accounting for 18.2%.52 all cases of pathogen monitoring, accounting for 100.0%.52 cases were carried out PCT test, accounting for 100%; 7 cases of sputum smear (detection of bacteria), accounting for 13.5%; 23 cases of sputum smear (detection of fungal), accounting for 44.2%; 29 cases of sputum culture, accounting for 55.8%; 18 cases of blood culture, accounting for 34.6%.
conclusion
1. the evaluation indexes of carbapenems include four first grade indexes and seventeen two grade indexes, which are scientific, representative and practical.
The feasibility of this 2. carbapenem antibacterial drug clinical application evaluation system. The application of carbapenem antibiotics clinical application evaluation system of a hospital to carbopenems were evaluated, the hospital for the discovery of carbapenem antibiotics should be used in the process of clinical problems.
3., there are still some problems to be solved in the clinical application of carbapenem antibiotics in a hospital. For example, dosage and selection of solvents, dosage and interval time, management indicators, laboratory indicators, special populations, and course of treatment did not achieve the desired goal.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R95

【参考文献】