本文選題：萬古霉素　切入點(diǎn)：不良反應(yīng)　出處：《新疆醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究調(diào)查烏魯木齊市某三級甲等醫(yī)院使用萬古霉素的住院患者,了解和評價(jià)該藥的使用情況,評估其合理性,以指導(dǎo)臨床合理用藥。方法：對該院2012年1月至2013年12月期間使用萬古霉素的住院患者經(jīng)電子病歷系統(tǒng)(electronic medical record, EMR)和醫(yī)院信息系統(tǒng)(hospital information system, HIS)調(diào)取入選研究對象病歷資料,調(diào)查患者基本情況,臨床診斷,臨床治療方案,聯(lián)合用藥情況,各項(xiàng)生化檢查指標(biāo)結(jié)果,既往藥物過敏史,痰、膿液以及分泌物病原學(xué)檢查,藥敏和病原學(xué)檢查結(jié)果,血藥濃度監(jiān)測結(jié)果。綜合分析萬古霉素臨床療效及使用合理性的評價(jià)。結(jié)果：入選研究患者212例,共檢出五種細(xì)菌,包括葡萄球菌119株、大腸埃希菌28株、肺炎克雷伯菌23株、銅綠假單胞菌21株、不動桿菌21株。其中119株葡萄球菌包括金黃色葡萄球菌39株、表皮葡萄球菌33株、耐甲氧西林金黃色葡萄球菌(MRSA)25株、耐甲氧西林表皮葡萄球菌(MRSE)22株。所檢出的五種細(xì)菌對萬古霉素均未表現(xiàn)出耐藥性。212例患者中發(fā)生萬古霉素不良反應(yīng)31例,占14.62%。萬古霉素的DUI值小于1,平均用藥天數(shù)小于10天。調(diào)查期間住院患者使用萬古霉素的總費(fèi)用為667296元,人均為3147.62元,平均用藥時間為8.37天,有效率為81.40%。結(jié)論：所調(diào)查的醫(yī)院萬古霉素臨床應(yīng)用較好,不存在濫用現(xiàn)象,但患者使用萬古霉素后發(fā)生不良反應(yīng)比例仍較高,值得臨床關(guān)注。萬古霉素血藥濃度監(jiān)測,有助于制定個體化給藥方案,為臨床合理應(yīng)用提供參考。
[Abstract]:Objective: to investigate the inpatients who used vancomycin in a Grade 3A hospital in Urumqi, to understand and evaluate the use of vancomycin, and to evaluate the rationality of the use of vancomycin. Methods: from January 2012 to December 2013, the medical records of the patients who were enrolled in the study were collected by electronic medical record (EMRs) and hospital information system (HIS), which were treated with vancomycin during the period from January 2012 to December 2013. To investigate the patients' basic condition, clinical diagnosis, clinical treatment plan, combined use of drugs, the results of various biochemical indicators, the past history of drug hypersensitivity, the etiological examination of sputum, pus and secretions, the results of drug sensitivity and etiology, Results: the clinical efficacy and rationality of vancomycin were comprehensively analyzed. Results: five kinds of bacteria including 119 strains of Staphylococcus, 28 strains of Escherichia coli and 23 strains of Klebsiella pneumoniae were detected in 212 patients. Among the 21 strains of Pseudomonas aeruginosa and 21 strains of Acinetobacter, 119 strains of Staphylococcus aureus included 39 strains of Staphylococcus aureus, 33 strains of Staphylococcus epidermidis and 25 strains of methicillin-resistant Staphylococcus aureus. There were 22 strains of methicillin-resistant Staphylococcus epidermidis. None of the 5 strains detected showed resistance to vancomycin. Among 212 patients, 31 had adverse reactions to vancomycin. The DUI value of vancomycin was less than 1, the average days of using vancomycin was less than 10 days. The total cost of using vancomycin in inpatients during the investigation was 667296 yuan, the average cost of vancomycin was 3147.62 yuan, and the average time of taking vancomycin was 8.37 days. Conclusion: the clinical application of vancomycin in the investigated hospital is good and there is no abuse, but the adverse reaction rate of patients with vancomycin is still high, which is worthy of clinical attention. It is helpful to make individualized drug administration plan and provide reference for rational clinical application.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R969.3

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