摘要
目的:了解我院万古霉素的用药现状及存在的问题,以期提出改进意见并为临床合理使用万古霉素提供参考。方法:采用回顾性研究方法参照《万古霉素/去甲万古霉素病例点评指南(试行)》和相关指南及专家共识,抽取我院2016年1月–2017年12月使用万古霉素进行治疗的住院患者病历,根据纳入排除标准,双人录入并核对,采用Excel软件进行数据处理与分析。结果:共纳入341例患者,分布于19个科室,其中男性205例(60.1%),女性136例(39.9%),年龄覆盖新生儿至老年患者(出生15 min^96岁)。分析结果显示,不存在医生越权开药现象,17例(5.0%)患者无相关病程记录;预防用药2例(0.6%),治疗用药339例(99.4%),其中经验用药268例(79.1%),目标用药71例(20.9%);治疗用药前病原学送检260例(76.7%),其中痰液标本最多,共107例次(37.5%)。存在的主要问题包括:部分患者药物起点选择过高(20例,5.9%),药物配制浓度过高(104例,30.5%),患者的用药疗程过长(1例,0.3%);不良反应方面,共32例(9.4%)患者发生了肾毒性,所有患者均未进行治疗药物监测。结论:我院万古霉素整体使用情况基本合理,但在规范病原学送检、药物的选择、浓度的配制以及治疗药物监测的开展等方面仍需改进,应加强万古霉素的专项点评和用药分析,不断促进其在临床的合理使用。
Objective:To investigate the present situation and existing problems of the use of vancomycin in our hospital by the method of retrospective drug analysis,in order to provide improvements suggestion and reference for clinical use of vancomycin.Methods:Inpatient cases using vancomycin from January 2016 to December 2017 were chosen.The Guidelines for the Evaluation of Vancomycin/Norvancomycin Cases(for Trial Implementation)and other relevant guidelines and expert consensus were used for evaluation.Cases were analyzed with Excel software by two pharmacists according to the inclusion and exclusion criteria.Results:Totally,341 cases were included,there were 205 male cases(60.1%)and 136 female cases(39.9%),distributing in 19 departments.The age ranged from newborns to elderly patients(15 minutes to 96 years old).There was no excess of authority for prescription of vancomycin,while 17 cases(5.0%)didn't have the related case records.There were 2 cases(0.6%)of prophylactic drug use and 339 cases(99.4%)of therapeutic drug use,including 268 cases(79.1%)of empiric therapy and 71 cases(20.9%)of target therapy.Etiological testings were examined in 260 cases(76.7%)before the use of vancomycin,and the most of specimens were sputum specimens(107 cases,37.5%).The main problems included selection of higher-level antibiotics(20 cases,5.9%),the excessive drug concentration(104 cases,30.5%),the long duration of treatment(1 case,0.3%).As for the adverse drug reaction,there were 32 cases of nephrotoxicity(9.4%).None of them conducted therapeutic drug monitoring.Conclusion:The overall use of vancomycin in our hospital was basically reasonable in recent two years,while the standardization of pathogens examination,the choice of drugs,the drug concentration and the monitoring of therapeutic drugs still needed to be improved.The special review and medication analysis of vancomycin should be strengthened to promote its rational use in clinic.
作者
王震寰
侯嘉娜
万里燕
魏建英
WANG Zhen-huan;HOU Jia-na;WAN Li-yan;WEI Jian-ying(Department of Pharmacy,First Hospital of Tsinghua University,Beijing 100016,China;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Sciences,Peking University,Beijing 100191,China)
出处
《中国药物应用与监测》
CAS
2018年第4期230-235,共6页
Chinese Journal of Drug Application and Monitoring
关键词
万古霉素
用药分析
合理用药
Vancomycin
Medication analysis
Rational drug use
