摘要
目的:对复旦大学附属中山医院老年患者临床应用利奈唑胺的合理性进行分析,并统计不良反应的发生情况,为老年患者安全合理用药提供参考。方法:运用回顾性研究方法,选取2018年8月至2020年8月在复旦大学附属中山医院使用利奈唑胺治疗的老年患者,收集患者的基本信息、感染部位、病原菌的种类、实验室检查指标、合并疾病和合并用药等情况,根据药品的说明书和相关指南设计调查表,对老年患者中利奈唑胺的使用情况进行合理性评价,评估其疗效和不良反应,并对血药浓度监测情况进行统计分析。结果:共纳入有效病例329例,利奈唑胺临床应用的合理率为81.8%,不合理原因主要有无指征用药、疗程不当、选药起点过高以及联用药物不适宜等。临床治疗有效率为69.3%,病原菌清除率为59.6%。利奈唑胺用药期间主要的不良反应为血小板减少(20.4%)和血红蛋白减少(11.9%)。31名老年患者进行利奈唑胺的血药浓度监测,血药浓度的监测率为9.4%,谷浓度维持在2~8 mg·L^(-1)的有11例(35.5%),谷浓度>8 mg·L^(-1)的有18例(58.1%),谷浓度<2 mg·L^(-1)的有2例(6.4%)。结论:利奈唑胺临床应用的合理性有待提高,临床医师应严格把握用药适应证及合并用药的合理性来促进其临床使用。此外,临床用药期间还应加强利奈唑胺的血药浓度监测来提高老年患者用药的安全性。
OBJECTIVE To explore the rationality of linezolid and count the occurrence of drug adverse reactions so as to provide rationales for the safe and reasonable clinical use of linezolid in elderly patients.METHODS A retrospective study was conducted for elderly patients treated with linezolid from August 2018 to August 2020.Their demographic profiles,site of infection,pathogen type,laboratory tests,concomitant diseases and combined medication were reviewed.According to drug instructions and the relevant guidelines,a questionnaire was designed for evaluating the rationality,efficacy and adverse reactions and plasmatic concentration of linezolid was monitored.RESULTS A total of 329 cases were included and the reasonable rate of linezolid was 81.8%in clinical use.The major irrational reasons were non-indicated medication,improper course of treatment,high starting point for drug selection and unsuitable drug combination.The effective rate of clinical treatment was 69.3%and the pathogen clearance rate 59.6%.The major adverse reactions were thrombocytopenia(20.4%)and hemoglobin reduction(11.9%).For 31 elders,serum concentration of linezolid was monitored with a detection rate of 9.4%.The trough concentration was maintained at 2-8 mg·L^(-1)(n=11),>8 mg·L^(-1)(n=18)and<2 mg·L^(-1)(n=2).CONCLUSION The rationality of clinical application of linezolid should be further improved.Clinicians should pay more attention to the indications before prescribing to promote its rational use.In addition,monitoring of serum concentration during linezolid treatment should be strengthened to improve the safety of clinical application in elderly patients.
作者
秦艳
李虹霞
沈赟
陈喆
戴佩芳
叶岩荣
QIN Yan;LI Hong-xia;SHEN Yun;CHEN Zhe;DAI Pei-fang;YE Yan-rong(Department of Pharmacy,Affiliated Zhongshan Hospital,Fudan University,Shanghai 200032,China;School of Pharmacy,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)
出处
《中国医院药学杂志》
CAS
北大核心
2021年第9期929-935,共7页
Chinese Journal of Hospital Pharmacy
基金
复旦大学附属中山医院青年基金(编号:2020ZSQN53)。
关键词
利奈唑胺
老年患者
合理用药
不良反应
linezolid
elderly patients
rationality
adverse drug reactions
