本文關(guān)鍵詞： 碳青霉烯類抗菌藥物 臨床應(yīng)用評(píng)價(jià)體系 評(píng)價(jià)指標(biāo) 藥物利用評(píng)價(jià)　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的 碳青霉烯類抗菌藥物被譽(yù)為治療革蘭陰性菌感染的最后一道防線,為使碳青霉烯類抗菌藥物能夠更加持久地在治療革蘭陰性菌感染中發(fā)揮作用,延緩革蘭陰性菌對(duì)碳青霉烯類抗菌藥物耐藥性的增長(zhǎng),需要嚴(yán)格管理、合理應(yīng)用碳青霉烯類抗菌藥物。本文建立碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系并應(yīng)用于臨床,旨在加強(qiáng)碳青霉烯類抗菌藥物的臨床應(yīng)用管理,促進(jìn)碳青霉烯類抗菌藥物的合理應(yīng)用。 研究方法 應(yīng)用藥物利用評(píng)價(jià)(Drug use evaluation, DUE)方法,建立碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系。依據(jù)碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系,自行設(shè)計(jì)碳青霉烯類抗菌藥物評(píng)價(jià)工作表,主要內(nèi)容包括患者信息、診斷、用藥信息、實(shí)驗(yàn)室檢查、用藥指征評(píng)價(jià)、用藥過(guò)程評(píng)價(jià)、用藥結(jié)果評(píng)價(jià)和管理指標(biāo)評(píng)價(jià)八項(xiàng)。對(duì)2013年9月27日一2013年12月31日應(yīng)用碳青霉烯類抗菌藥物的全部病例52例進(jìn)行橫斷面調(diào)查。應(yīng)用SPSS17.0軟件建立數(shù)據(jù)庫(kù),對(duì)評(píng)價(jià)結(jié)果進(jìn)行數(shù)據(jù)統(tǒng)計(jì)、分析。 研究結(jié)果 碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系包括評(píng)價(jià)指標(biāo)、評(píng)價(jià)標(biāo)準(zhǔn)、評(píng)價(jià)依據(jù)和預(yù)期目標(biāo)。評(píng)價(jià)指標(biāo)分為四個(gè)一級(jí)指標(biāo)和十七個(gè)二級(jí)指標(biāo),四個(gè)一級(jí)指標(biāo)依次為用藥指征、用藥過(guò)程、用藥結(jié)果和管理指標(biāo)；十七個(gè)二級(jí)指標(biāo)依次為適應(yīng)癥、禁忌癥、實(shí)驗(yàn)室指標(biāo)、藥物選擇、給藥途徑、給藥劑量及間隔時(shí)間、特殊人群、溶媒劑量及選擇、靜脈滴注時(shí)間、療程、聯(lián)合用藥、相互作用、藥品不良反應(yīng)、癥狀好轉(zhuǎn)或治愈、特殊使用類抗菌藥物申請(qǐng)單、病程記錄、處方 52例病例中,8例完全符合評(píng)價(jià)標(biāo)準(zhǔn),符合率為15.4%。其中適應(yīng)癥(符合率96.2%)、禁忌癥(符合率1.9%)、生命體征監(jiān)測(cè)(符合率100.0%)、藥物選擇(符合率100.0%)、給藥途徑(符合率100.0%)、滴注時(shí)間(符合率100.0%)、相互作用(符合率98.1%)、ADR(符合率100.0%)、填寫(xiě)“特殊使用類抗菌藥物申請(qǐng)單”(符合率100.0%)達(dá)到預(yù)期目標(biāo)；用藥前進(jìn)行病原學(xué)檢查(符合率80.8%)、血象監(jiān)測(cè)(符合率53.9%)、肝腎功能監(jiān)測(cè)(符合率94.2%)、給藥劑量及間隔時(shí)間(符合率84.6%)、特殊人群(符合率88.9%)、溶媒用量及選擇(符合率17.3%)、療程(符合率73.1%)、聯(lián)合用藥(符合率86.4%)、癥狀好轉(zhuǎn)或治愈(符合率65.4%)、特殊情況下越級(jí)用藥小于等于24h并于24h內(nèi)補(bǔ)充“特殊使用類抗菌藥物申請(qǐng)單”(符合率46.2%)、病歷記錄用藥指征(符合率84.6%)及聯(lián)合用藥指征(符合率63.6%)、處方權(quán)(符合率69.2%)未達(dá)到預(yù)期目標(biāo)。 52例病例共送檢病原學(xué)標(biāo)本189份,其中痰標(biāo)本61份,占32.3%；血液標(biāo)本118份(包括PCT標(biāo)本和血培養(yǎng)標(biāo)本),占62.4%。分離出革蘭陰性菌8株,占72.7%；革蘭陽(yáng)性菌1株,占9.1%；真菌2株,占18.2%。52例病例全部進(jìn)行病原學(xué)監(jiān)測(cè),占100.0%。52例病例全部進(jìn)行PCT試驗(yàn),占100.0%；7例病例進(jìn)行痰涂片(檢測(cè)細(xì)菌),占13.5%；23例病例進(jìn)行痰涂片(檢測(cè)真菌),占44.2%；29例病例進(jìn)行痰培養(yǎng),占55.8%；18例病例進(jìn)行血培養(yǎng),占34.6%。 結(jié)論 1.本文制訂的碳青霉烯類抗菌藥物評(píng)價(jià)指標(biāo)包括四個(gè)一級(jí)指標(biāo),十七個(gè)二級(jí)指標(biāo),具有科學(xué)性、代表性、實(shí)用性。 2.本文建立的碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系具有可行性。應(yīng)用碳青霉烯類抗菌藥物臨床應(yīng)用評(píng)價(jià)體系對(duì)某醫(yī)院碳青霉烯類抗菌藥物進(jìn)行評(píng)價(jià),有利于發(fā)現(xiàn)該醫(yī)院碳青霉烯類抗菌藥物臨床應(yīng)用過(guò)程中的問(wèn)題與不足。 3.某醫(yī)院碳青霉烯類抗菌藥物臨床應(yīng)用過(guò)程中,尚存在一些問(wèn)題亟待解決。如：溶媒用量及選擇、給藥劑量及間隔時(shí)間、管理指標(biāo)、實(shí)驗(yàn)室指標(biāo)、特殊人群、療程、聯(lián)合用藥未達(dá)到預(yù)期目標(biāo)。
[Abstract]:research objective
Carbopenems leather treatment known as the last line of defense of Gram-negative bacteria infection, the carbapenem antibiotics can be more persistent in the treatment of leather to play the role of Gram-negative bacteria infection, delaying the gram negative bacteria antibiotic resistance to carbapenems growth, the need for strict management and the rational use of carbapenem antibiotics. The establishment of carbapenem antibiotics clinical application evaluation and clinical application, to strengthen the management of clinical application of carbapenem antibiotics, promote the reasonable application of carbapenem antibiotics.
research method
The application of drug utilization evaluation (Drug use evaluation, DUE) method, the establishment of carbopenems system evaluation of clinical application of antibacterial drugs. On the basis of carbapenem antibiotics clinical application evaluation system, designed to carbopenems evaluation table, including main contents of patient information, diagnosis, drug information, laboratory examination. The indications of drug use medication evaluation, process evaluation, outcome evaluation and medication management index evaluation of eight. On September 27, 2013 December 31, 2013, the use of carbapenem antibacterial drugs in all cases in 52 cases. A cross-sectional survey was conducted using SPSS17.0 software to establish database, analysis of the results of the evaluation of statistical data.
Research results
Carbapenem antibacterial drug clinical application evaluation system including evaluation index, evaluation criteria, evaluation criteria and expectations. Evaluation index is divided into four indexes and seventeen level two indexes, four level indicators are the indications of drug use, drug use, drug results and management index; seventeen level two index were indications, contraindications, laboratory index, drug selection, route of administration, dosage and time interval, special populations, and selection of solvent dosage, infusion time, treatment, drug combination, interaction, adverse drug reactions, symptoms improved or cured, special use of antimicrobial drugs for single disease record, prescription
In 52 cases, 8 cases were fully consistent with the evaluation criteria, the coincidence rate is 15.4%. the indications (coincidence rate 96.2%), contraindications (coincidence rate 1.9%), monitoring of vital signs (coincidence rate 100%), drug selection (coincidence rate 100%), route of Administration (coincidence rate 100%), infusion time (coincidence rate 100%), interaction (coincidence rate 98.1%), ADR (coincidence rate 100%), fill in the "special use of antimicrobial agents application form" (in line with the rate of 100%) to achieve the desired objectives before treatment; etiology examination (coincidence rate 80.8%), blood monitoring (coincidence rate 53.9%), liver and kidney function monitoring (coincidence rate 94.2%), the dosage and time interval (coincidence rate 84.6%), special populations (coincidence rate 88.9%), and the amount of solvent selection (with the rate of 17.3%), treatment (coincidence rate 73.1%), combination (coincidence rate 86.4%), the symptoms improved or cured (coincidence rate 65.4%), the special case of leapfrog medication less than or equal to 24h and in 24h. Supplementation of the "special application antimicrobial drug application form" (coincidence rate 46.2%), medication record indications (coincidence rate 84.6%) and combined medication indications (coincidence rate 63.6%), prescription rights (coincidence rate 69.2%) failed to achieve the expected goal.
A total of 52 cases from pathogens from 189 samples including 61 sputum samples, accounting for 32.3%; 118 blood specimens (including PCT specimens and blood culture specimens), accounted for 62.4%. isolated from 8 strains of gram negative bacteria, accounting for 72.7%; 1 strains of gram positive bacteria, accounting for 9.1%; 2 strains of fungi, accounting for 18.2%.52 all cases of pathogen monitoring, accounting for 100.0%.52 cases were carried out PCT test, accounting for 100%; 7 cases of sputum smear (detection of bacteria), accounting for 13.5%; 23 cases of sputum smear (detection of fungal), accounting for 44.2%; 29 cases of sputum culture, accounting for 55.8%; 18 cases of blood culture, accounting for 34.6%.
conclusion
1. the evaluation indexes of carbapenems include four first grade indexes and seventeen two grade indexes, which are scientific, representative and practical.
The feasibility of this 2. carbapenem antibacterial drug clinical application evaluation system. The application of carbapenem antibiotics clinical application evaluation system of a hospital to carbopenems were evaluated, the hospital for the discovery of carbapenem antibiotics should be used in the process of clinical problems.
3., there are still some problems to be solved in the clinical application of carbapenem antibiotics in a hospital. For example, dosage and selection of solvents, dosage and interval time, management indicators, laboratory indicators, special populations, and course of treatment did not achieve the desired goal.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R95

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 曹國(guó)穎,傅得興,孫春華;新型碳青酶烯類抗生素——艾他培南[J];中國(guó)臨床藥理學(xué)雜志;2005年01期

2 趙靜;王晶;陳海怡;趙彩蕓;;β內(nèi)酰胺類抗生素的皮膚過(guò)敏試驗(yàn)現(xiàn)狀及建議[J];中國(guó)臨床藥理學(xué)雜志;2009年02期

3 田文芳;唐喜軍;林壯;;135株銅綠假單胞菌的耐藥譜分析及感染分布[J];檢驗(yàn)醫(yī)學(xué)與臨床;2011年05期

4 習(xí)慧明;徐英春;朱德妹;汪復(fù);倪語(yǔ)星;孫景勇;孫自鏞;簡(jiǎn)翠;胡云建;艾效曼;張泓;李萬(wàn)華;賈蓓;黃文祥;王傳清;王愛(ài)敏;魏蓮花;吳玲;卓超;蘇丹虹;張朝霞;季萍;徐元宏;熊自忠;沈繼錄;單斌;杜艷;俞云松;楊青;;2010年中國(guó)CHINET鮑曼不動(dòng)桿菌耐藥性監(jiān)測(cè)[J];中國(guó)感染與化療雜志;2012年02期

5 李志業(yè);冀建偉;;DUE臨床藥學(xué)工作模式在頭孢西丁的合理應(yīng)用中的作用[J];醫(yī)藥論壇雜志;2013年10期

6 滕瑛玨;高蘊(yùn)秀;;碳青霉烯類抗生素臨床合理應(yīng)用探討[J];中華全科醫(yī)學(xué);2009年10期

7 楊華;董海燕;劉青;梁銦;;利奈唑胺的藥物利用評(píng)價(jià)[J];西北藥學(xué)雜志;2010年05期

8 石慶平;許善初;程鵬;朱錦秀;丁峰;袁浩宇;;萬(wàn)古霉素DUE標(biāo)準(zhǔn)的建立及其應(yīng)用[J];中國(guó)現(xiàn)代應(yīng)用藥學(xué);2010年05期

9 黃仲義;;美羅培南的藥理學(xué)和臨床應(yīng)用[J];中國(guó)新藥與臨床雜志;2005年12期

10 顧覺(jué)奮;王婧;;新型碳青霉烯類抗生素多尼培南的藥效分析[J];藥學(xué)與臨床研究;2008年01期

，

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