本文選題：嶺南地區(qū) + 呼吸道感染��； 參考：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：呼吸道感染是臨床乃至日常生活常見病和多發(fā)病,具有多發(fā)性、易感性的發(fā)病特點。呼吸道感染不僅直接影響人們的日常工作和學(xué)習(xí),可伴有嚴(yán)重并發(fā)癥,嚴(yán)重者可出現(xiàn)多器官功能衰竭,威脅人類生命。呼吸道感染嚴(yán)重危害人類健康。嶺南地區(qū)位于亞熱帶,瀕臨南海,河網(wǎng)密布,熱帶及亞熱帶氣候,溫暖濕潤,雨量;嶺南人嗜食肥甘厚膩譚亮,冷飲,容易出現(xiàn)在每年的炎熱和潮濕的氣候環(huán)境下脾胃功能失調(diào),導(dǎo)致脾胃虛弱,釀痰生濕。嶺南地區(qū)人群呼吸道感染常易"從化",從中醫(yī)辨證常具有濕熱特征。近年來,在呼吸道感染的治療中濫用抗菌藥物,隨之產(chǎn)生大量耐藥菌株,給臨床治療特別是對嚴(yán)重感染的治療帶來較大困難。可見在呼吸道感染的治療中常存在不合理用藥的情況�？股氐牟缓侠硎褂靡殉蔀槿蛐缘墓残l(wèi)生問題,是公共衛(wèi)生領(lǐng)域關(guān)注的焦點。抗生素的不合理使用包括濫用抗菌藥物,過量大處方復(fù)合給藥、不遵照臨床治療指南給藥以及患者不合理的自購藥等。本研究擬采用對醫(yī)療機(jī)構(gòu)的處方進(jìn)行回顧性分析,進(jìn)而了解嶺南地區(qū)呼吸道感染的用藥情況,為合理用藥提供依據(jù),規(guī)范醫(yī)務(wù)人員的處方行為,提高合理用藥水平,為嶺南地區(qū)大綜合醫(yī)院合理用藥現(xiàn)狀提供了可靠、有代表性的參考數(shù)據(jù)。目的:本研究擬采用對醫(yī)療機(jī)構(gòu)的處方進(jìn)行回顧性分析,進(jìn)而了解嶺南地區(qū)呼吸道感染的用藥情況,為合理用藥提供依據(jù),規(guī)范醫(yī)務(wù)人員的處方行為,提高合理用藥水平,為嶺南地區(qū)大綜合醫(yī)院合理用藥現(xiàn)狀提供了可靠、有代表性的參考數(shù)據(jù)。方法:通過收集對嶺南地區(qū)三甲醫(yī)院2015年1月至2015年12月門診呼吸道感染患者的電子處方信息,對嶺南地區(qū)醫(yī)院呼吸道感染處方用藥情況進(jìn)行分析。進(jìn)入醫(yī)院信息管理系統(tǒng)提取2015年1月至2015年12月所有呼吸道感染的門診患者處方信息,主要內(nèi)容包括患者年齡、性別、治療時間、治療部門,醫(yī)院醫(yī)生的工作,醫(yī)生、疾病診斷、藥物、藥品編碼通用名稱、規(guī)格、數(shù)量及包裝的包裝單元、藥物劑型、給藥、劑量、用法及藥物藥品成本,數(shù)量,藥品金額及付款方式。比較2項檢驗與t檢驗的差異,比較不同人口學(xué)特征、不同就診方式、單次就診次數(shù)、用藥次數(shù)、抗菌藥物使用情況、抗病毒藥物的發(fā)放方式及單次費用等。結(jié)果:1門診上呼吸感染用藥分析1..1例上呼吸道感染門診患者接受單藥治療2.27例,標(biāo)準(zhǔn)差為0.998。不同性別就診的患者數(shù)為4以上者對比差距具有統(tǒng)計學(xué)意義(P0.05),單次訪視男性患者高于4例或以上患者。不同年齡組患者數(shù)為4以上者對比差距具有統(tǒng)計學(xué)意義(P0.05),18歲以下、單次隨訪超過65歲的患者數(shù)均在4以上。不同職稱的醫(yī)生次就診用藥個數(shù)在4種及以上者對比空白有統(tǒng)計學(xué)意義(P0.05),當(dāng)副主任醫(yī)師處方時,患者的單次訪訪次數(shù)在4以上的比例較高。1.29786名上呼吸道感染患者處方中,含注射劑型處方數(shù)4034份,占比為41.22%。不同性別患者使用注射類給藥方式差別具有統(tǒng)計學(xué)意義(P0.05),其中男性患者使用注射類給藥方式的比例小于女性。不同年齡段患者使用注射類給藥方式差別具有統(tǒng)計學(xué)意(P0.05)隨著年齡的增加,注射藥物的使用量增加。注射給藥的使用是有統(tǒng)計學(xué)意義的差異不同職稱醫(yī)師開具處方時(P0.05),/副教授的處方使用比例較高的醫(yī)師處方使用注射藥物投遞率低的可注射的藥物傳遞副主任。1.3門診上呼吸道感染患者單次就診平均費用為271.68± 127.95元,不同性別患者單次就診平均費用對比,差異有統(tǒng)計學(xué)意義(P0.05),單次訪男性的平均費用高于女性。不同年齡段患者單次就診平均費用對比,差異具有統(tǒng)計學(xué)意義(P0.05),門診患者單次就診費用有隨年齡增大而增大的趨勢。1.4對門診上呼吸道感染患者抗菌藥物使用情況進(jìn)行分組分析,結(jié)果顯示男性和女性患者抗菌藥物使用率沒有明顯差別,P=0.833。不同年齡組患者抗菌藥物使用率比較,差異具有統(tǒng)計學(xué)意義(P0.05),其中大于65歲上呼吸道感染患者抗菌藥物使用率最高。1.59786名門診上呼吸道感染患者中,1022例患者用抗病毒藥物治療,比例為10.45%。男性患者使用抗病毒藥物的與女性相當(dāng),兩者對比沒有統(tǒng)計學(xué)意義(P0.05)。不同年齡組上呼吸道感染患者使用抗病毒藥物使用情況對比,差異具有統(tǒng)計學(xué)意義(P0.05);18歲至65歲之間人群使用抗病毒藥物的比例較高。1.6門診上呼吸道感染患者中使用中成藥者有9324人,中成藥使用率為95.28%。不同性別的中成藥使用率差異無顯著性(P0.05)。男性患者中成藥使用率與女性患者相似。不同年齡組中成藥使用情況差異有統(tǒng)計學(xué)意義(P0.05),中成藥使用率隨年齡增長而降低。對門診上呼吸道感染患者中成藥使用個數(shù)情況進(jìn)行分組分析,結(jié)果顯示不同性別患者中成藥使用個數(shù)情況對比,差異有統(tǒng)計學(xué)意義(P0.05),中成藥在男性患者中的使用量大于女性患者2。不同年齡組患者中成藥使用個數(shù)情況對比,差異具有統(tǒng)計學(xué)意義(P0.05),18～65歲患者中成藥使用個數(shù)1個者最多,其中大于65歲人群使用2個中成藥者有1338人,占40.10%。2門診下呼吸感染用藥分析2.1例門診下呼吸道感染患者接受單藥治療2.18例,標(biāo)準(zhǔn)差為0.928。男性患者和女性在單次訪問中差異無統(tǒng)計學(xué)意義(P0.05)。不同年齡組患者均為單就診用藥個數(shù)在4種及以上者對比差距具有統(tǒng)計學(xué)意義(P0.05)18歲以下的兒童,單次訪問的年齡在65歲以下的兒童數(shù)低于。2.22568名下呼吸道感染患者處方中,含注射劑型處方數(shù)1513份,占比為58.92%。不同性別患者使用注射類給藥方式差別具有統(tǒng)計學(xué)意義(P0.05),其中男性患者使用注射類給藥方式的比例小于女性。不同年齡段患者使用注射類給藥方式差別具有統(tǒng)計學(xué)意(P0.05)隨著年齡的增加,注射藥物的使用量增加。2.3門診下呼吸道感染患者單次就診平均費用為213.88±77.42元,不同性別患者單次就診平均費用對比,差異無統(tǒng)計學(xué)意義(P0.05)。不同年齡段患者單次就診平均費用對比,差異無統(tǒng)計學(xué)意義(P0.05)。2.42568名下呼吸道感染患者中,使用抗菌藥物的有2130人,抗菌藥物使用率為82.94%,男性和女性患者抗菌藥物使用率沒有明顯差別,P=0.22。不同年齡組患者抗菌藥物使用率比較,差異具有統(tǒng)計學(xué)意義(P0.05),其中18歲以下人群抗菌藥物使用率最高。2.5門診下呼吸道感染患者中使用中成藥者有2042人,中成藥使用率為79.52%,不同性別中成藥使用率差異無顯著性(P0.05)。男性患者中成藥使用率與女性患者相似。不同年齡段中成藥使用情況差異有統(tǒng)計學(xué)意義(P0.05),其中以18歲和65歲組中成藥比例最高。對門診下呼吸道感染患者中成藥使用個數(shù)情況進(jìn)行分組分析,結(jié)果顯示不同性別患者中成藥使用個數(shù)情況對比,差異有統(tǒng)計學(xué)意義(P0.05),女性更傾向于使用2種中成藥比男性。不同年齡組患者中成藥使用個數(shù)情況對比,差異具有統(tǒng)計學(xué)意義(P0.05),18～65歲患者中成藥使用個數(shù)1個者最多,其中大于65歲人群使用2個中成藥者有653人,占69.17%。結(jié)論:嶺南地區(qū)呼吸道感染用藥有其自身的特點,我院呼吸道感染用藥具有普遍合理性,但門診處方用藥指標(biāo)和合理的水平,推薦范圍是有差距的一些方面,主要表現(xiàn)為平均處方數(shù)大于1.6-1.8,抗菌藥物使用率高于國家衛(wèi)生部的要求,噴射比例也略高。在上呼吸道感染患者的治療中,抗生素的過度使用是上呼吸道感染的主要原因菌藥物使用率遠(yuǎn)高于理論上上抗菌藥物在呼吸道感染患者中的應(yīng)用。本研究對三家三甲醫(yī)院門診處方信息進(jìn)行全面抽樣調(diào)查和綜合分析,找出處方藥的關(guān)鍵問題。為進(jìn)一步了解醫(yī)生的處方行為提供了新的思路和依據(jù)。
[Abstract]:Respiratory tract infection is a common and frequently occurring disease in clinical and daily life. It has the characteristics of multiple incidence and susceptibility. Respiratory tract infection not only directly affects people's daily work and learning, but also has serious complications. The serious people can appear multiple organ failure and threaten human life. Respiratory infection seriously endangers human health. The respiratory infection is serious harm to human health. South of the Five Ridges The region is located in the subtropics, on the brink of the South China Sea, the dense river network, the tropical and subtropical climate, warm humid, rainfall; south of the Five Ridges people are fat, sweet and greasy Tan Liang, cold drink, easy to appear in the heat and humid climate of each year in the spleen and stomach dysfunction, resulting in the weakness of the spleen and stomach, and the moisture of the phlegm. The respiratory infection in south of the Five Ridges area is often easy to "Conghua", from traditional Chinese medicine, from traditional Chinese Medicine Syndrome differentiation often has the characteristics of damp and hot. In recent years, antibiotics are abused in the treatment of respiratory tract infection, and a large number of drug-resistant strains are produced, which brings great difficulties to clinical treatment, especially for the treatment of severe infection. It is obvious that irrational use of antibiotics often exists in the treatment of respiratory tract infection. The irrational use of antibiotics has become the world. The problem of public health is the focus of public health. The irrational use of antibiotics includes the abuse of antibiotics, overdose of the prescription, non compliance with the clinical treatment guidelines and the irrational self purchase of the patients. This study intends to use a retrospective analysis of the prescriptions of medical institutions to understand the south of the Five Ridges area. The use of drug use in the area of respiratory tract infection provides a basis for rational use of drugs, standardizing prescription behavior of medical personnel, improving the level of rational use of drugs, providing reliable and representative reference data for the rational use of drugs in south of the Five Ridges general hospital. Objective: This study intends to adopt a retrospective analysis of the prescription of medical institutions and then to solve the mountain range. The drug use of respiratory tract infection in southern China provides a basis for rational use of drugs, standardizing prescription behavior of medical personnel, raising the level of rational use of drugs, providing reliable and representative reference data for the rational use of drugs in south of the Five Ridges general hospital. Method: through collecting the outpatient clinic from January 2015 to December 2015 in the third one hospital in south of the Five Ridges The electronic prescription information of the patients with respiratory tract infection was analyzed in the prescription drug use of respiratory tract infection in south of the Five Ridges hospital. The hospital information management system was entered to extract all the outpatient patients' prescription information from January 2015 to December 2015. The main contents included patient's age, sex, treatment time, treatment department, hospital doctor. Work, doctor, disease diagnosis, medicine, drug code general name, specification, quantity and packing unit, drug dosage form, dosage, dosage, usage and drug and drug cost, quantity, drug amount and t test. Compare the difference of the 2 test and the difference of the demography, the different methods of medical treatment, the number of medical treatment, the use of Medicine The number of times, the use of antibacterials, the distribution of antiviral drugs and the single cost and so on. Results: 1 1..1 cases of outpatient respiratory infection were analyzed by single drug treatment in 2.27 cases, the standard deviation of the standard deviation was more than 4 of the patients with different sex of 0.998. (P0.05), a single visit. The male patients were more than 4 or more patients. The contrast gap was statistically significant (P0.05), under 18 years old, and the number of patients over 65 years old was more than 4. The number of doctors with different titles was statistically significant (P0.05) in 4 or more cases (P0.05). When the number of patients visited more than 4, the number of patients with upper respiratory tract infection was higher than 4, including 4034 prescriptions of injection type, which accounted for the difference in the use of injection mode in patients with different sex of 41.22%. (P0.05), and the proportion of male patients using injection method was less than that of women (P0.05). The difference in the way of injection in different age groups was statistically significant (P0.05) with the increase of age, the use of injectable drugs increased. The use of the injection was statistically significant (P0.05) when different professional titles were prescribed (P0.05). The average cost of a single visit to the.1.3 outpatient was 271.68 + 127.95 yuan. The average cost of the single visit for different sex patients was statistically significant (P0.05). The average cost of the single visit to the male was higher than that of the female. The difference was statistically significant (P0.05). The single visit cost of outpatients had a trend of.1.4 increasing with age. The use of antimicrobial agents in outpatients with upper respiratory tract infection was analyzed. The results showed that there was no significant difference in the use of antibacterial drugs between male and female patients, and the antibacterials in different age groups of P=0.833. were antibacterials. The difference was statistically significant (P0.05). Among the patients older than 65 years old, the highest use rate of Antibacterials in the upper respiratory tract was.1.59786 in the patients with upper respiratory tract infection, and 1022 patients were treated with antiviral drugs, and the proportion of the male patients with 10.45%. was equivalent to that of the women, and there was no statistical difference between the two. Significance (P0.05). The use of antiviral drugs in patients with upper respiratory infection in different age groups was compared, the difference was statistically significant (P0.05); the proportion of people aged 18 to 65 years old with antiviral drugs was higher in.1.6 outpatient patients with upper respiratory tract infection by 9324 people, and the use rate of Chinese patent medicine was 95.28%. different sex. The use rate of Chinese patent medicine was not significant (P0.05). The use rate of Chinese patent medicine was similar to that of female patients. The use of Chinese patent medicine in different age groups was statistically significant (P0.05), and the use rate of Chinese patent medicine decreased with age. The difference was statistically significant (P0.05). The use of Chinese patent medicine in male patients was greater than that of female patients in 2. different age groups. The difference was statistically significant (P0.05). The number of Chinese patent medicines in 18~65 years old was the most, of which more than 65 were more than 65. 2 Chinese traditional Chinese medicines were used in 1338 people, accounting for 2.1 cases of lower respiratory tract infection in 40.10%.2 outpatient clinic, 2.1 cases of lower respiratory tract infection were treated with single drug treatment in 2.18 cases. The difference was not statistically significant (P0.05) in the single visit of 0.928. male patients and women (P0.05). The contrast gap is statistically significant (P0.05) children under 18 years of age, the number of children under the age of 65 years under the age of one visit is lower than that of the.2.22568 patients with lower respiratory tract infection, with 1513 injectable prescriptions, and the difference is statistically significant (P0.05) in the use of injections in different sexes of 58.92%.. The proportion of injecting drug delivery in male patients is less than that of women. The difference of the use of injection methods in different age groups is statistically significant (P0.05) with the increase of age and the increase in the use of injection drugs in.2.3 outpatient patients with lower respiratory tract infection, the average cost of the single visit is 213.88 + 77.42 yuan. There was no significant difference in the average cost of diagnosis (P0.05). There was no significant difference in the average cost of medical treatment in different age groups (P0.05) among the patients with.2.42568 lower respiratory tract infection, 2130 people used antibiotics, the use rate of antibiotics was 82.94%, and there was no significant difference in the use of antibiotics in men and women. The difference of the use rate of P=0.22. in different age groups was statistically significant (P0.05). Among the patients under 18 years old, 2042 of the patients with lower respiratory tract infection in.2.5 outpatients were used with Chinese patent medicine, the use rate of Chinese patent medicine was 79.52%, and there was no significant difference in the use rate of Chinese traditional Chinese medicine (P0.05). The use rate of Chinese patent medicine was similar to that of female patients. There was a significant difference in the use of Chinese patent medicine in different age groups (P0.05), among which the proportion of Chinese patent medicine was the highest in 18 and 65 years old. The number of Chinese patent medicine in the patients with lower respiratory tract infection was analyzed. The results showed the number of use of Chinese patent medicine in different sex patients. The difference was statistically significant (P0.05), and women were more inclined to use 2 kinds of Chinese patent medicine than men. The difference was statistically significant (P0.05). The number of 18~65 year old Chinese patent medicines used the largest number of 1, of which 65 years old people used 2 Chinese patent medicines in 653, accounting for 69.17%. conclusion: The drug use of respiratory tract infection in south of the Five Ridges area has its own characteristics. The drug use of respiratory tract infection in our hospital is generally reasonable, but the drug use index and reasonable level of the outpatient prescription are in some aspects, the main manifestation is that the average number of prescriptions is greater than 1.6-1.8, the use rate of antibacterials is higher than that of the national Ministry of health, and the injection ratio is higher than that of the national Department of health. In the treatment of patients with upper respiratory tract infection, the overuse of antibiotics is the main cause of upper respiratory infection and the use of antibiotics is far higher than the application of the theoretical upper antimicrobial agents in the patients with respiratory infection. This study conducted a comprehensive sampling survey and comprehensive analysis on the outpatient prescription information of three three A hospitals to find out the prescriptions. The key questions of medicine provide a new idea and basis for further understanding the prescribing behavior of doctors.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R95

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