摘要
目的描述抗菌药物潜在的药物相互作用(pDAAIs)在重症监护室(ICU)的流行情况,分析临床药师的药学干预对提高ICU患者抗菌药物使用安全性和有效性的作用。方法前瞻性选取西安交通大学第二附属医院2021年1—12月有临床药师审核医嘱的ICU患者作为干预组,同时回顾性选取2019年1—12月未进行药学干预的该院ICU感染患者病历资料作为对照组,对比有无临床药师干预的感染患者的ICU住院天数、抗菌药物相关肝肾损伤发生率。干预组采用Micromedex数据库鉴别确定pDAAIs,并对其严重程度及临床意义进行分析。结果共纳入778例患者,其中干预组406例,临床药师审核了3619条药物医嘱,发现30种药物相互作用组合,286对pDAAIs,其中10种组合占所观察到pDAAIs的60.5%。干预组中已发生和未发生pDDIs的患者,在抗菌药物类别、平均使用药物品种数之间差异有统计学意义(P<0.01)。临床药师药学干预pDAAIs 537条,医师接受503条,总接受率为93.7%。与对照组相比,干预组患者ICU住院时间明显缩短,抗菌药物相关肝、肾损伤发生率明显下降(P<0.05)。结论ICU感染患者pDAAIs发生率较高,药物治疗易受药物相互作用影响。临床药师的药学干预可预防或处置pDAAIs,提高ICU患者抗菌药物使用的安全性和有效性。
Objective To describe the prevalence of potential drug-drug interactions(pDDIs)involving antimicrobial agents in the ICU and analyze the role of clinical pharmacist interventions in improving the safety and effectiveness of antimicrobial agents use in ICU patients.Methods A prospective study was conducted to select ICU patients whose medical prescriptions were reviewed by clinical pharmacists in The Second Affiliated Hospital of Xi'an Jiaotong University from January to December 2021,as the intervention group,and the patients with ICU infections in this hospital who did not undergo pharmacy intervention from January to December 2019,were retrospectively selected as the control group.The hospital stay in ICU and the incidence of antimicrobial drug-associated hepatic and renal injuries of the patients with infections with or without the intervention of clinical pharmacists were compared.The intervention group utilized the Micromedex database to identify and analyze the severity and clinical significance of pDDIs.Results A total of 778 patients were included,with 406 patients in the intervention group.Clinical pharmacists reviewed 3619 medication orders and identified 30 combinations of drug interactions,resulting in 286 pDDIs,with 10 combinations accounting for 60.5%of observed pDDIs.According to statistical analysis,there was a statistically significant difference between the categories of antimicrobial drugs and the average number of drug varieties used(P<0.01).Clinical pharmacists intervened in 537 cases of pDDIs,of which 503 were accepted by physicians,resulting in an overall acceptance rate of 93.7%.Compared to the control group,patients in the intervention group had significantly shorter ICU stays and a decreased incidence of antimicrobial-related hepatic and renal injuries(P<0.05).Conclusion The occurrence of pDDIs is relatively high among ICU infection patients,and drug therapy is susceptible to the influence of drug interactions.Clinical pharmacist interventions can prevent or manage pDDIs,thereby improvin
作者
王海涛
张抗怀
谢姣
王娜
杨乾婷
蔡艳
李友佳
张莉
王岩
Hai-Tao WANG;Kang-Huai ZHANG;Jiao XIE;Na WANG;Qian-Ting YANG;Yan CAI;You-Jia LI;Li ZHANG;Yan WANG(Department of Pharmacy,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)
出处
《中国药师》
CAS
2023年第10期125-131,共7页
China Pharmacist
基金
国家自然科学基金面上项目(72274153)。
关键词
抗菌药物
抗菌药物潜在的药物相互作用
重症监护室
药学干预
Antimicrobial agents
Potential drug-antimicrobial agent interactions
Intensive care unit
Pharmaceutical intervention
