100例肝移植患者用藥分析及術(shù)后應(yīng)用抗感染藥物的調(diào)查與分析
發(fā)布時(shí)間：2018-09-04 13:06
【摘要】：肝移植術(shù)已成為目前公認(rèn)的治療終末期肝病的唯一有效手段,我國(guó)自上世紀(jì)70年代引進(jìn)肝移植技術(shù)以來,取得了重大發(fā)展,挽救了成千上萬肝病患者的生命,目前肝移植手術(shù)本身不再是制約肝移植發(fā)展的主要因素,而其術(shù)后相關(guān)并發(fā)癥的高發(fā)生率卻仍危及患者生命,其中免疫排斥反應(yīng)和感染一直是影響肝移植術(shù)后患者生存率的關(guān)鍵。隨著他克莫司(FK506)、嗎替麥考酚酯等新型強(qiáng)效免疫抑制劑的應(yīng)用,使機(jī)體的排斥反應(yīng)對(duì)受體生存的威脅日益減少;而由于抗菌藥物的不合理應(yīng)用及細(xì)菌耐藥性日益增加,感染卻成為威脅患者生命及術(shù)后生存質(zhì)量的一個(gè)主要因素。肝移植屬于高風(fēng)險(xiǎn),高耗費(fèi)手術(shù),患者需要承受沉重的經(jīng)濟(jì)負(fù)擔(dān)。多年臨床資料顯示,肝移植患者術(shù)后常存在急、慢性排斥反應(yīng),術(shù)后感染,電解質(zhì)紊亂,繼發(fā)性糖尿病等并發(fā)癥,使得術(shù)后需應(yīng)用大量的治療藥物,對(duì)于一些藥物,患者個(gè)體之間的藥代動(dòng)力學(xué)差異大,給臨床用藥的選擇及科學(xué)合理的配伍帶來一定的困難,另外,術(shù)后應(yīng)用免疫抑制劑和急性排斥反應(yīng)的沖擊治療,使肝移植患者在圍手術(shù)期發(fā)生感染的概率遠(yuǎn)遠(yuǎn)高于其他外科手術(shù)的患者,因此肝移植患者臨床用藥多而復(fù)雜,用藥的選擇性、科學(xué)正確的合理性以及聯(lián)合應(yīng)用效果、藥物之間的相互作用都是較為復(fù)雜的問題。本研究通過對(duì)我院肝移植患者住院期間醫(yī)囑用藥統(tǒng)計(jì)分析,系統(tǒng)的了解肝移植患者藥物利用和費(fèi)用支出狀況,以期進(jìn)一步為肝移植患者在用藥選擇、給藥途徑、用藥劑量等臨床應(yīng)用中提供依據(jù)。第一部分100例肝移植患者用藥分析目的:分析統(tǒng)計(jì)我院100例肝移植患者藥物利用以及費(fèi)用支出情況,為肝移植患者在藥物選擇、給藥途徑、用藥劑量等臨床應(yīng)用中提供依據(jù)。方法:通過調(diào)查2005年至2014年間我院肝移植患者的病例100份,對(duì)患者年齡、性別、住院天數(shù)、病因等基本信息進(jìn)行記錄;并對(duì)其用藥種類、用藥劑量、用藥頻率以及2005年至2014年患者住院費(fèi)用進(jìn)行匯總,用Excel做統(tǒng)計(jì)處理。結(jié)果:執(zhí)行醫(yī)囑用藥,涉及藥物470種。其中,電解質(zhì)平衡調(diào)節(jié)藥,維生素與營(yíng)養(yǎng)支持用藥,免疫系統(tǒng)用藥,循環(huán)系統(tǒng)用藥,血液系統(tǒng)用藥以及抗感染用藥在醫(yī)囑中出現(xiàn)頻率較高,占所用藥物的80%以上;人血白蛋白,免疫球蛋白,他克莫司,嗎替麥考酚酯,奧美拉唑,甲潑尼龍等單品中出現(xiàn)的頻率以及用藥人數(shù)均居于前列,顯示該類患者的用藥與其特殊人群的定位有密切關(guān)系。藥物費(fèi)用、住院總費(fèi)用及兩者之比的均值分別為:(11.94±5.49)萬元、(24.51±11.05)萬元、(48.68±9.12)%。影響住院費(fèi)用的原因,主要與術(shù)前機(jī)體狀況、術(shù)后重癥監(jiān)護(hù)依賴、感染等因素有關(guān)。結(jié)論:肝移植術(shù)后患者總住院費(fèi)用無明顯增長(zhǎng)趨勢(shì),但藥品費(fèi)用占總費(fèi)用比例較高。醫(yī)院用藥符合這一特殊人群的定位。第二部分肝移植患者應(yīng)用抗感染藥物的調(diào)查與分析目的:分析肝移植患者抗感染藥物的應(yīng)用情況,為肝移植患者圍手術(shù)期合理使用抗感染藥物提供依據(jù)。方法:回顧性調(diào)查2005年1月-2014年12月肝移植術(shù)后出院的100份病歷,采用世界衛(wèi)生組織(WHO)藥物利用研究小組推薦的限定日劑量(DDD)、藥物利用頻度(DDDs)和藥物利用指數(shù)(DUI)為指標(biāo),對(duì)所調(diào)查的患者用藥情況用Excel進(jìn)行統(tǒng)計(jì)分析。結(jié)果:100例肝移植患者抗感染藥物使用率為100.0%,抗感染藥物連續(xù)用藥時(shí)間最長(zhǎng)46 d、最短8 d、平均(18.2±1.8)d;其中2種以上抗感染藥物聯(lián)合連續(xù)用藥時(shí)間最長(zhǎng)38d、最短3d。單品種應(yīng)用時(shí)間最長(zhǎng)為34d、最短1 d。有61例患者采用過聯(lián)合用藥,應(yīng)用頻率為61.00%;其中二聯(lián)43例,占43.00%,三聯(lián)18例,占18.00%;統(tǒng)計(jì)應(yīng)用例/次前10位的抗感染藥物除頭孢吡肟DUI=1.03外,其他藥物DUI均1。結(jié)論:肝移植受者抗感染藥物的使用頻率、用藥時(shí)間和聯(lián)合用藥例次均大于其他外科手術(shù)患者,這與其術(shù)后易感染的特殊性有關(guān)。本組61例聯(lián)合應(yīng)用抗感染藥物的患者中,其聯(lián)用品種均顯示協(xié)同或相加的抗感染作用,屬于合理配伍。
[Abstract]:Liver transplantation has been recognized as the only effective method to treat end-stage liver disease. Since the introduction of liver transplantation technology in China in the 1970s, great progress has been made, saving the lives of thousands of patients with liver diseases. At present, liver transplantation itself is no longer the main factor restricting the development of liver transplantation, and its postoperative complications. Immune rejection and infection are the key factors affecting the survival rate of patients after liver transplantation. With the application of new powerful immunosuppressive agents such as tacrolimus (FK506), mycophenolate mofetil and so on, the threat of rejection to the survival of recipients is decreasing day by day. Liver transplantation is a high-risk, high-cost operation, and patients need to bear a heavy economic burden. Many years of clinical data show that patients with liver transplantation often have acute, chronic rejection, postoperative infection, and electricity. Complications such as derangement, secondary diabetes mellitus and so on make it necessary to apply a large number of therapeutic drugs after operation. For some drugs, the pharmacokinetic differences between individual patients are great, which brings some difficulties to the choice of clinical medication and scientific and reasonable compatibility. In addition, the application of immunosuppressive agents and acute rejection shock therapy after operation makes the liver difficult. The probability of infection in the perioperative period of liver transplantation patients is much higher than that in other surgical patients. Therefore, the clinical use of drugs in liver transplantation patients is more and more complex, the choice of drugs, scientific and correct rationality, combined application effect and the interaction between drugs are more complex problems. Statistical analysis of prescribed drug use during the hospital period to systematically understand the utilization and expenditure of drugs in liver transplantation patients, with a view to providing further evidence for the clinical application of drug selection, route of administration and dosage of drugs in liver transplantation patients. Methods: 100 cases of liver transplantation patients in our hospital from 2005 to 2014 were investigated, and the basic information such as age, sex, hospitalization days, etiology and so on were recorded. Results: 470 kinds of drugs were involved in the execution of medical orders. Among them, electrolyte balance regulators, vitamin and nutritional support drugs, immune system drugs, circulatory system drugs, blood system drugs and anti-infective drugs were prescribed. The frequency and the number of drug users were in the front rank, indicating that the drug use of these patients was closely related to the location of the special population. The mean of the ratio was (1194 549) 000 yuan, (2451 1105) 000 yuan, (48.68 9.12)%. The main factors influencing the hospitalization expenses were preoperative body condition, postoperative intensive care dependence, infection and other factors. Objective: To analyze the application of anti-infective drugs in liver transplantation patients, and to provide evidence for rational use of anti-infective drugs during the perioperative period of liver transplantation. Methods: Retrospective investigation was carried out after liver transplantation from January 2005 to December 2014. 100 medical records of the hospital were analyzed by Excel with DDD recommended by the World Health Organization (WHO) Drug Utilization Research Group, DDDs and DUI as indicators. Results: 100 liver transplant patients were treated with anti-infective drugs and 100.0% with anti-infective drugs. The longest and shortest duration of continuous administration was 46 days and 8 days, with an average of (18.2 1.8) days, of which the longest and shortest duration of continuous administration of two or more anti-infective drugs was 38 days and the shortest was 3 days. CONCLUSION: The frequency, duration and frequency of antibiotics used in liver transplant recipients are longer than those in other surgical patients, which is related to the particularity of postoperative infection. All varieties showed synergistic or synergistic anti infective effects, which belonged to reasonable compatibility.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3
本文編號(hào)：2222190
[Abstract]:Liver transplantation has been recognized as the only effective method to treat end-stage liver disease. Since the introduction of liver transplantation technology in China in the 1970s, great progress has been made, saving the lives of thousands of patients with liver diseases. At present, liver transplantation itself is no longer the main factor restricting the development of liver transplantation, and its postoperative complications. Immune rejection and infection are the key factors affecting the survival rate of patients after liver transplantation. With the application of new powerful immunosuppressive agents such as tacrolimus (FK506), mycophenolate mofetil and so on, the threat of rejection to the survival of recipients is decreasing day by day. Liver transplantation is a high-risk, high-cost operation, and patients need to bear a heavy economic burden. Many years of clinical data show that patients with liver transplantation often have acute, chronic rejection, postoperative infection, and electricity. Complications such as derangement, secondary diabetes mellitus and so on make it necessary to apply a large number of therapeutic drugs after operation. For some drugs, the pharmacokinetic differences between individual patients are great, which brings some difficulties to the choice of clinical medication and scientific and reasonable compatibility. In addition, the application of immunosuppressive agents and acute rejection shock therapy after operation makes the liver difficult. The probability of infection in the perioperative period of liver transplantation patients is much higher than that in other surgical patients. Therefore, the clinical use of drugs in liver transplantation patients is more and more complex, the choice of drugs, scientific and correct rationality, combined application effect and the interaction between drugs are more complex problems. Statistical analysis of prescribed drug use during the hospital period to systematically understand the utilization and expenditure of drugs in liver transplantation patients, with a view to providing further evidence for the clinical application of drug selection, route of administration and dosage of drugs in liver transplantation patients. Methods: 100 cases of liver transplantation patients in our hospital from 2005 to 2014 were investigated, and the basic information such as age, sex, hospitalization days, etiology and so on were recorded. Results: 470 kinds of drugs were involved in the execution of medical orders. Among them, electrolyte balance regulators, vitamin and nutritional support drugs, immune system drugs, circulatory system drugs, blood system drugs and anti-infective drugs were prescribed. The frequency and the number of drug users were in the front rank, indicating that the drug use of these patients was closely related to the location of the special population. The mean of the ratio was (1194 549) 000 yuan, (2451 1105) 000 yuan, (48.68 9.12)%. The main factors influencing the hospitalization expenses were preoperative body condition, postoperative intensive care dependence, infection and other factors. Objective: To analyze the application of anti-infective drugs in liver transplantation patients, and to provide evidence for rational use of anti-infective drugs during the perioperative period of liver transplantation. Methods: Retrospective investigation was carried out after liver transplantation from January 2005 to December 2014. 100 medical records of the hospital were analyzed by Excel with DDD recommended by the World Health Organization (WHO) Drug Utilization Research Group, DDDs and DUI as indicators. Results: 100 liver transplant patients were treated with anti-infective drugs and 100.0% with anti-infective drugs. The longest and shortest duration of continuous administration was 46 days and 8 days, with an average of (18.2 1.8) days, of which the longest and shortest duration of continuous administration of two or more anti-infective drugs was 38 days and the shortest was 3 days. CONCLUSION: The frequency, duration and frequency of antibiotics used in liver transplant recipients are longer than those in other surgical patients, which is related to the particularity of postoperative infection. All varieties showed synergistic or synergistic anti infective effects, which belonged to reasonable compatibility.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3
【共引文獻(xiàn)】
相關(guān)博士學(xué)位論文 前1條
1 邰沁文;自體肝移植的臨床和相關(guān)實(shí)驗(yàn)研究[D];新疆醫(yī)科大學(xué);2013年
，本文編號(hào)：2222190
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