中国医药
中國醫藥
중국의약
China Medicine
2015年
9期
1372-1376
,共5页
张晋萍%张海霞%徐航%吴青
張晉萍%張海霞%徐航%吳青
장진평%장해하%서항%오청
社区获得性肺炎%抗菌药物%回顾性分析%用药评价
社區穫得性肺炎%抗菌藥物%迴顧性分析%用藥評價
사구획득성폐염%항균약물%회고성분석%용약평개
Community acquired pneumonia%Antimicrobials%Retrospective analysis%Medication evaluation
目的 评价社区获得性肺炎(CAP)患者抗菌药物用药合理性.方法 回顾性查阅2012年7月至2014年6月于南京大学医学院附属鼓楼医院住院并进入CAP临床路径的485例患者病历资料,将患者按年龄分为青年组(91例)、中年组(172例)、老年组(222例).记录患者基本资料及抗菌药物使用情况,分析患者用药合理性.结果 青年组、中年组的平均住院时间明显短于老年组[(9±5)、(12±6)d比(15 ±12)d,P＜0.05],青年组平均住院时间明显短于中年组(P＜0.05).青年组、中年组和老年组患者联合用药比例分别为39.6％ (36/91)、50.0％ (86/172)及55.9％ (124/222).痰、血、胸腔积液及灌洗液病原学检查阳性共118例,其中真菌、革兰阳性菌及革兰阴性菌阳性者分别占74.6％(88例)、5.9％(7例)及19.5％(23例),青年、中年及老年患者分别占8.5％(10例)、23.7％ (28例)及67.8％(80例).中年组、老年组人均用药频度居前3位的药物为氟喹诺酮类、头孢菌素类以及碳青霉烯类,青年组人均用药频度居前3位的药物为氟喹诺酮类、头孢菌素类以及含β内酰胺酶抑制剂的β内酰胺类.3组患者中,用药频度排名第1位药物均为莫西沙星.有10种药物的药物利用指数(DUI)＞1,其中,头孢地嗪、青霉素、伊曲康唑、头孢吡肟的DUI等于或接近2.0,超过限定日剂量将近1倍.结论 本院CAP患者的治疗能根据指南要求合理选择抗菌药物品种,并根据病原学检查结果进行目标治疗.但在某些患者治疗过程中,抗菌药物给药剂量、给药频次等仍存在不合理之处,需进一步改进.
目的 評價社區穫得性肺炎(CAP)患者抗菌藥物用藥閤理性.方法 迴顧性查閱2012年7月至2014年6月于南京大學醫學院附屬鼓樓醫院住院併進入CAP臨床路徑的485例患者病歷資料,將患者按年齡分為青年組(91例)、中年組(172例)、老年組(222例).記錄患者基本資料及抗菌藥物使用情況,分析患者用藥閤理性.結果 青年組、中年組的平均住院時間明顯短于老年組[(9±5)、(12±6)d比(15 ±12)d,P＜0.05],青年組平均住院時間明顯短于中年組(P＜0.05).青年組、中年組和老年組患者聯閤用藥比例分彆為39.6％ (36/91)、50.0％ (86/172)及55.9％ (124/222).痰、血、胸腔積液及灌洗液病原學檢查暘性共118例,其中真菌、革蘭暘性菌及革蘭陰性菌暘性者分彆佔74.6％(88例)、5.9％(7例)及19.5％(23例),青年、中年及老年患者分彆佔8.5％(10例)、23.7％ (28例)及67.8％(80例).中年組、老年組人均用藥頻度居前3位的藥物為氟喹諾酮類、頭孢菌素類以及碳青黴烯類,青年組人均用藥頻度居前3位的藥物為氟喹諾酮類、頭孢菌素類以及含β內酰胺酶抑製劑的β內酰胺類.3組患者中,用藥頻度排名第1位藥物均為莫西沙星.有10種藥物的藥物利用指數(DUI)＞1,其中,頭孢地嗪、青黴素、伊麯康唑、頭孢吡肟的DUI等于或接近2.0,超過限定日劑量將近1倍.結論 本院CAP患者的治療能根據指南要求閤理選擇抗菌藥物品種,併根據病原學檢查結果進行目標治療.但在某些患者治療過程中,抗菌藥物給藥劑量、給藥頻次等仍存在不閤理之處,需進一步改進.
목적 평개사구획득성폐염(CAP)환자항균약물용약합이성.방법 회고성사열2012년7월지2014년6월우남경대학의학원부속고루의원주원병진입CAP림상로경적485례환자병력자료,장환자안년령분위청년조(91례)、중년조(172례)、노년조(222례).기록환자기본자료급항균약물사용정황,분석환자용약합이성.결과 청년조、중년조적평균주원시간명현단우노년조[(9±5)、(12±6)d비(15 ±12)d,P＜0.05],청년조평균주원시간명현단우중년조(P＜0.05).청년조、중년조화노년조환자연합용약비례분별위39.6％ (36/91)、50.0％ (86/172)급55.9％ (124/222).담、혈、흉강적액급관세액병원학검사양성공118례,기중진균、혁란양성균급혁란음성균양성자분별점74.6％(88례)、5.9％(7례)급19.5％(23례),청년、중년급노년환자분별점8.5％(10례)、23.7％ (28례)급67.8％(80례).중년조、노년조인균용약빈도거전3위적약물위불규낙동류、두포균소류이급탄청매희류,청년조인균용약빈도거전3위적약물위불규낙동류、두포균소류이급함β내선알매억제제적β내선알류.3조환자중,용약빈도배명제1위약물균위막서사성.유10충약물적약물이용지수(DUI)＞1,기중,두포지진、청매소、이곡강서、두포필우적DUI등우혹접근2.0,초과한정일제량장근1배.결론 본원CAP환자적치료능근거지남요구합리선택항균약물품충,병근거병원학검사결과진행목표치료.단재모사환자치료과정중,항균약물급약제량、급약빈차등잉존재불합리지처,수진일보개진.
Objective To evaluate the rationality of the antimicrobials utilization in patients with community acquired pneumonia (CAP).Methods Clinical data of 485 patients in the CAP clinical pathway in Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University from July 2012 to June 2014 were retrospectively analyzed.The patients were divided into youth group (91 cases),middle-aged group (172 cases) and elderly group (222 group).The general data of antimicrobial drugs were recorded and the reasonability of antimicrobials was analyzed.Results The average length of stay in hospital was significantly shorter in youth group and middle-aged group,compared with that in elderly group [(9 ± 5),(12 ± 6) d vs (15 ± 12) d] ; it was significantly shorter in youth group compared with that in middle-aged group (P ＜ 0.05).The proportion of patients receiving combination use of antimicrobials was 39.6％ (36/91),50.0％ (86/172) and 55.9％ (124/222) in youth group,middle-aged group and elderly group.The bacterial culture of the samples including sputum,blood,pleural fluid and lavage showed that 1 18 cases were positive; among them fungi,gram-positive bacteria and gram-negative bacteria accounted for 74.6％ (88/118),5.9％ (7/118) and 19.5％ (23/118),respectively; in young patients,middle-aged patients and elderly patients it accounted for 8.5％ (10/118),23.7％ (28/118) and 67.8％ (80/118).Fluoroquinolones,cephalosporins and carbapenems had the top three frequency of drug use (DDDs) per person in middle-aged group and elderly group; fluoroquinolones,cephalosporins and β-1actam/β-1actamase inhibitors had the top three DDDs per person in youth group.In all the three groups,the DDDs of moxifloxacin ranked the first.There were 10 kinds of drugs with drug utilization index (DUI) =or ＞ 1 ; among them,the DUI of cefodizime,penicillin,itraconazole and cefepime was close to 2.Conclusions The antibiotics therapy in our hospital is applied according to the guidelines,and adjusted along with the results of bacterial culture in patients with CAP.However,there are some unreasonable use including irrational dose and frequency of administration; a further improvement is still needed.
