万古霉素临床应用合理性分析

发布时间：2018-03-04 22:09

本文选题：万古霉素　切入点：不良反应　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本研究调查乌鲁木齐市某三级甲等医院使用万古霉素的住院患者,了解和评价该药的使用情况,评估其合理性,以指导临床合理用药。方法：对该院2012年1月至2013年12月期间使用万古霉素的住院患者经电子病历系统(electronic medical record, EMR)和医院信息系统(hospital information system, HIS)调取入选研究对象病历资料,调查患者基本情况,临床诊断,临床治疗方案,联合用药情况,各项生化检查指标结果,既往药物过敏史,痰、脓液以及分泌物病原学检查,药敏和病原学检查结果,血药浓度监测结果。综合分析万古霉素临床疗效及使用合理性的评价。结果：入选研究患者212例,共检出五种细菌,包括葡萄球菌119株、大肠埃希菌28株、肺炎克雷伯菌23株、铜绿假单胞菌21株、不动杆菌21株。其中119株葡萄球菌包括金黄色葡萄球菌39株、表皮葡萄球菌33株、耐甲氧西林金黄色葡萄球菌(MRSA)25株、耐甲氧西林表皮葡萄球菌(MRSE)22株。所检出的五种细菌对万古霉素均未表现出耐药性。212例患者中发生万古霉素不良反应31例,占14.62%。万古霉素的DUI值小于1,平均用药天数小于10天。调查期间住院患者使用万古霉素的总费用为667296元,人均为3147.62元,平均用药时间为8.37天,有效率为81.40%。结论：所调查的医院万古霉素临床应用较好,不存在滥用现象,但患者使用万古霉素后发生不良反应比例仍较高,值得临床关注。万古霉素血药浓度监测,有助于制定个体化给药方案,为临床合理应用提供参考。
[Abstract]:Objective: to investigate the inpatients who used vancomycin in a Grade 3A hospital in Urumqi, to understand and evaluate the use of vancomycin, and to evaluate the rationality of the use of vancomycin. Methods: from January 2012 to December 2013, the medical records of the patients who were enrolled in the study were collected by electronic medical record (EMRs) and hospital information system (HIS), which were treated with vancomycin during the period from January 2012 to December 2013. To investigate the patients' basic condition, clinical diagnosis, clinical treatment plan, combined use of drugs, the results of various biochemical indicators, the past history of drug hypersensitivity, the etiological examination of sputum, pus and secretions, the results of drug sensitivity and etiology, Results: the clinical efficacy and rationality of vancomycin were comprehensively analyzed. Results: five kinds of bacteria including 119 strains of Staphylococcus, 28 strains of Escherichia coli and 23 strains of Klebsiella pneumoniae were detected in 212 patients. Among the 21 strains of Pseudomonas aeruginosa and 21 strains of Acinetobacter, 119 strains of Staphylococcus aureus included 39 strains of Staphylococcus aureus, 33 strains of Staphylococcus epidermidis and 25 strains of methicillin-resistant Staphylococcus aureus. There were 22 strains of methicillin-resistant Staphylococcus epidermidis. None of the 5 strains detected showed resistance to vancomycin. Among 212 patients, 31 had adverse reactions to vancomycin. The DUI value of vancomycin was less than 1, the average days of using vancomycin was less than 10 days. The total cost of using vancomycin in inpatients during the investigation was 667296 yuan, the average cost of vancomycin was 3147.62 yuan, and the average time of taking vancomycin was 8.37 days. Conclusion: the clinical application of vancomycin in the investigated hospital is good and there is no abuse, but the adverse reaction rate of patients with vancomycin is still high, which is worthy of clinical attention. It is helpful to make individualized drug administration plan and provide reference for rational clinical application.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R969.3

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