某二级医院慢性阻塞性肺疾病急性加重期抗菌药物利用及其合理性评价研究-现代医学

某二级医院慢性阻塞性肺疾病急性加重期抗菌药物利用及其合理性评价研究

单位：1. 南京医科大学第四附属医院/南京市浦口医院, 江苏南京 210031;
2. 南京医科大学药学院临床药学系, 江苏南京 210029

分类号：R563

出版年·卷·期（页码）：2019·38·第九期（1063-1069）

摘要：

目的：探讨慢性阻塞性肺疾病急性加重期（AECOPD）住院患者使用抗菌药物的有效性、安全性和经济性，以促进抗菌药物的合理使用。方法：选取某市二级医院2017年7月至2018年12月AECOPD住院患者的临床资料进行回顾性分析，统计分析抗菌药物使用的种类、金额和用药时间等，并结合病例资料判断抗菌药物使用的合理性。结果：纳入本研究的AECOPD患者共662例次，用药正确合格率平均达94.4%；用药准确+剂量正确方面合格率平均达82.1%；用药准确+剂量正确+给药定时合格率平均达66.9%；用药准确+剂量正确+给药定时+用药时长合格率达54.8%。药物使用频度（DDDs）占比前3的是头孢类、B-内酰胺酶类抑制剂类及喹诺酮类，其中DDDs一直较高的注射头孢曲松钠他唑巴坦钠平均治疗时长（ATD）都大于10 d，且药物利用指数（DUI）也远大于1.0，而哌拉西林舒巴坦钠DUI远小于1.0。注射用头孢他啶B/A在3个半年度中都在1~2之间。结论：该院AECOPD抗菌药物利用基本合理，抗菌药物数量在逐年增加，抗菌药物使用率在逐年下降。其销售金额与DDDs的同步性较好且稳定，符合经济实用型药物的特点；在抗生素药物合理性使用以及剂量和给药时长方面还需进一步加强管理。

Objective:To assess the efficacy, safety and economy of antimicrobial agents in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), and to rationalize use of antimicrobial agents. Methods:Clinical data of hospitalized patients with AECOPD from July 2017 to December 2018 in a municipal secondary hospital were retrospectively investigated, the category, cost and use length of antimicrobial drugs were statistically analyzed, and the rationality of antimicrobial drug use was determined by combining case data. Results:A total of 662 patients with AECOPD were included in this study, with a general accuracy rate of 94.4%. On average, the rates were 82.1% in accuracy+correct dosage, 66.9% in accuracy+correct dosage+timing of administration, and 54.8% in accuracy+correct dosage+timing of administration+duration of administration, respectively. The top 3 drugs ranked by defined daily doses(DDDs) were B-lactam enzyme inhibitors, cephalosporins, and quinolones, of which ceftriaxone sodium and tazobactam sodium for injection showed an average treatment duration(ATD) of>10 d, and drug utilization index(DUI) of>1.0, while piperacillin sodium and sulbactam for injection had a DUI far less than 1.0, and ceftazidime B/A for injection ranged from 1 to 2 in all three semi-annual periods. Conclusion:The use of antibacterial drugs for AECOPD in this hospital is basically reasonable, and the number of antibacterial drugs is increasing but the utilization rate of antibacterial drugs is decreasing on the yearly basis. There is a steadily good synchronization of sales amount with DDDs, in line with the characteristics of economic and practical drugs. Admittedly, more works are needed to rationally use antibiotic drugs, especially in dosage and length of administration.

参考文献：

[1] URA M,TANAKA H,TAKAHASHI K,et al.Value of fractional exhaled nitric oxide after using a beta2 bronchodilator in the differential diagnosis of bronchial asthma and chronic obstructive pulmonary disease[J].Rinsho Byori,2016,64(2):127-132.
[2] BLASI F,CESANA G,CONTI S,et al.The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease:a cohort of hospitalized patients[J].PLoS One,2014,9(6):1-8.
[3] 慢性阻塞性肺疾病急性加重诊治专家组.慢性阻塞性肺疾病急性加重(AEAECOPD)诊治中国专家共识(2014年修订版)[J].国际呼吸杂志,2014,34(1):1-11.
[4] 中华医学会呼吸病学分会慢性阻塞性肺疾病分组.慢性阻塞性肺疾病诊疗指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[5] 宫建,杨传家,陈德才,等.沈阳地区慢性阻塞性肺疾病住院患者的初步分析[J].东南大学学报(医学版),2017,36(3):365-368.
[6] DIMOPOULOS G,TSIODRAS S,LERIKOU M,et al.Viral profile of COPD exacerbations according to patients[J].Open Respiratory Medicine Journal,2015,9(1):1-8.
[7] 刘尧,邹剑,周后凤,等.呼吸内科老年AECOPD住院患者抗菌药物应用分析[J].世界最新医学信息文摘,2015,15(28):103-105.
[8] 陈泉.克拉霉素联合头孢哌酮/舒巴坦治疗COPD合并下呼吸道感染的疗效观察[J].中华医院感染学杂志,2013,10(8):2451-2453.
[9] 许进福,熊世娟,黄成.慢性阻塞性肺病"医保"与非"医保"患者抗菌药物利用分析[J].中国药房,2007,18(17):1286-1287.
[10] 国家药典委员会.临床用药须知[M].北京:化学工业出版社,2001:603-689.
[11] HAUG J B,REIKVAM A.WHO defined daily doses versus hospital-adjusted defined daily doses:impact on results of antibiotic use surveillance[J].J Antimicrob Chemother,2013,68(12):2940-2947.
[12] 高兰,田刚,李昊,等.慢性阻塞性肺疾病急性加重患者抗菌药物的应用情况分析[J].西安交通大学学报(医学版),2018,39(3):447-450.
[13] 赵留明,刘志鑫,赵国江.B-内酰胺类抗菌药物的研究进展[J].国外医药抗菌药物分册,2018,39(5):450-455.
[14] 杨生岳,贺巍,冯恩志,等.高原地区慢性阻塞性肺疾病合并肺心病急性加重期患者下呼吸道感染的病原菌分布特点及耐药性分析[J].中华临床医师杂志,2011,14(1):209-211.
[15] 旷琛,吴逢波,蒋学华.国家基本药物制度和抗菌药物专项整治活动对我院抗菌药物利用情况的影响[J].中国药房,2014,25(14):1267-1270.
[16] 董凤勇.时间依赖性与浓度依赖性抗菌药物的比较[J].医学信息,2016,29(4):380-381.
[17] 临床药物观察协作组,刘又宁,赵会泽,等.头孢曲松每日一克单次给药治疗下呼吸道感染的研究[J].中华结核和呼吸杂志,2001,24(3):189-190.

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