头孢菌素注射剂皮试的经济学分析及其评估量表的制定

发布时间：2018-05-11 11:22

  本文选题：头孢菌素 + 皮试　； 参考：《郑州大学》2017年硕士论文

【摘要】：背景由于头孢菌素在临床上应用广泛,是否对其进行皮肤过敏试验目前在临床上争论不休,但国内外并没有直接证据支持其是否进行皮试。我院头孢菌素的使用量极大,尤其在外科病区,且对我院及其他几家市级医院的初步调查发现,各个医院对于头孢菌素皮试的要求各不相同,院内各科室对其要求不尽相同,有的科室采用原药皮试,有的科室采用头孢唑林钠替代皮试,有些采用青霉素替代皮试,甚至有些科室不进行皮试,且其皮试液的配置浓度要求也各不相同,国内各对各种头孢菌素的皮试要求也不同,头孢菌素皮试问题亟待我们重视及出台相应的策略规范化其管理。目的1、对我院头孢菌素注射剂皮试情况及皮试成本进行调查分析,初步判断我院头孢菌素皮试的基本情况。2、制定头孢菌素类药物临床皮肤过敏试验评估量表初表,为后期应用于临床奠定基础。方法1、采用回顾性分析的方法,统计出我院常用的8种头孢菌素注射剂[头孢硫脒(1.0 g)、头孢硫脒(0.5 g)、头孢替安(1.0 g)、头孢替安(0.5 g)、头孢他啶(0.5 g)、头孢米诺(0.5 g)、头孢米诺(1.0 g)、头孢曲松钠(1.0 g)]皮试情况,皮试相关费用,以及由于头孢菌素过敏反应所产生的相关费用,并对头孢菌素皮试费用与过敏反应的相关费用进行比较。2、以前期文献研究及临床经验作为基础,按患者自身因素及药物因素两方面设定调查指标,制定调查问卷,运用德尔菲法对20名专家进行问卷调查。结果1、我院100 330例使用这8种头孢菌素注射剂患者的皮试率为82.49%,原药皮试阳性率为6.27%,直接成本为3 434 411.72元,间接成本为141 985.12元,医保承担的费用为259 096.28元,全社会承担的费用为3 576 396.84元;从全社会角度分析,头孢菌素注射剂皮试成本为(447 049.61±247 395.07)元,皮试所减少的过敏反应成本为(298 545.76±263 160.29)元,皮试成本明显高于通过皮试所减少的过敏反应成本,差异有统计学意义(P0.05)。2、两轮专家积极系数分别为100%及90.0%,专家权威程度为0.763,协调系数分别为0.56及0.617,专家意见趋于一致,最终确定患者自身因素13个指标,药物因素5个指标。
[Abstract]:Background because cephalosporins are widely used in clinical practice, whether to conduct skin allergy tests is controversial in clinical practice, but there is no direct evidence at home and abroad to support their skin tests. The use of cephalosporins in our hospital is very great, especially in the surgical area, and the preliminary investigation of our hospital and several other municipal hospitals shows that the requirements for cephalosporin skin test are different in each hospital, and the requirements for the cephalosporin skin test are different in different departments and departments of the hospital. Some departments use raw drug skin test, some departments use cefazolin sodium instead of skin test, some use penicillin instead of skin test, and even some departments do not carry out skin test, and the concentration requirements of skin test solution are different. All kinds of cephalosporins have different skin test requirements in our country. The problem of cephalosporin skin test is urgent for us to pay attention to and make corresponding strategies to standardize the management of cephalosporins. Objective 1. To investigate and analyze the skin test of cephalosporin injection and the cost of skin test in our hospital, to judge the basic condition of cephalosporin skin test in our hospital, and to make a preliminary scale for evaluating the clinical skin allergy test of cephalosporins. To lay the foundation for clinical application in later stage. Method 1. Retrospective analysis was used. Eight commonly used cephalosporin injections [cefathiramidine 1.0 g, cefathiraz 0.5 g, ceftiamil 1.0 g, ceftiamil 0.5 g, ceftazidime 0.5 g, cefminox 0.5 g, cefmino 1.0 g, ceftriaxone 1.0 g) were recorded. The related expenses of skin test and related expenses caused by cephalosporin allergic reaction were compared with those of allergic reaction. 2. Based on the previous literature research and clinical experience, the cost of skin test was compared with that of anaphylaxis. According to the patients' own factors and drug factors, the questionnaire was established, and 20 experts were investigated by Delphi method. Results 1. The skin test rate was 82.49, the positive rate of the original drug was 6.27, the direct cost was 3 434 411.72 yuan, the indirect cost was 141 985.12 yuan, the cost of medical insurance was 259 096.28 yuan. The cost of skin test of cephalosporin injection was 447 049.61 卤247,395.07 yuan, and the cost of allergic reaction reduced by skin test was 298 545.76 卤263 160.29 yuan. The cost of skin test was significantly higher than that of allergic reaction reduced by skin test. The difference was statistically significant (P 0.05). The positive coefficient of two rounds of experts was 100% and 90.0%, the degree of expert authority was 0.763, and the coordination coefficient was 0.56 and 0.617 respectively. Finally, 13 indexes of patients' own factors and 5 indexes of drug factors were determined.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R956
，

本文编号：1873744