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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
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| 篇名： | 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 |
| TITLE： | |
| 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（P＜0.05）。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（P＜0.05）；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（P＜0.05）。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： | OBJECTIVE： To establish special evaluation standard for antibiotics rational use in the inpatients with community-acquired pneumonia （called “CAP special evaluation standard” for short）， and to evaluate its effects. METHODS： Referring to related guideline， specification and drug package inserts， etc.， after consulting with physicians in infection related departments， clinical pharmacists established “CAP special evaluation standard” of our hospital from 7 aspects of drug selection， usage and dosage， medication duration， drug combination indications， drug combination compatibility， drug replacement and medication related examination. 50 CAP inpatients were selected from respiratory medicine department of our hospital by lot drawing method during Jan.-Jun. 2014 （before intervention group） and Jan.-Jun. 2015 （after intervention group）. Above standards were used as basis for special evaluation intervention， and the application of antibiotics and therapeutic efficacies were compared between 2 groups before and after intervention. RESULTS： After CAP special evaluation， rational rate of drug selection， medication duration， drug combination indications， drug combination compatibility， whole medication increased from 56.00％， 68.00％， 90.00％， 92.00％ and 30.00％ to 88.00％， 98.00％， 100％， 100％ and 84.00％. In the initial empirical treatment， the ratio of drug combination decreased from 64.00％ to 32.00％， and the utilization ratio of drug combination indications rose from 71.86％ before intervention to 100％ after intervention， with statistical significance（P＜0.05）. DDDs， AUD and average hospitalization cost of after intervention group were lower than those of before intervention group， but the ratio of average antibiotics cost in hospitalization cost was higher than before intervention group， with statistical significance （P＜0.05）. Total effective rate of 2 groups was 100％； the proportion of patients with “significant therapeutic efficacy” was increased significantly in after intervention group， but that of patients with “therapeutic efficacy improvement” was decreased significantly， with statistical significance （P＜0.05）. CONCLUSIONS： The special evaluation intervention based on “CAP special evaluation standard” can improve the use of antibiotics in the CAP inpatients， and it is a useful exploration for the evaluation mode of medication order. |
| 期刊： | 2017年第28卷第2期 |
| 作者： | 谢奕丹，吴晓玲，黄光鸿，符子艺 |
| AUTHORS： | XIE Yidan，WU Xiaoling，HUANG Guanghong，FU Ziyi |
| 关键字： | 社区获得性肺炎；住院患者；专项点评标准；临床药师；干预；抗菌药物；合理使用 |
| KEYWORDS： | Community-acquired pneumonia； Inpatients； Special evaluation standard； Clinical pharmacists；Intervention； Antibiotics； Rational use |
| 阅读数： | 450 次 |
| 本月下载数： | 10 次 |
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