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我院社区获得性肺炎住院患者临床路径变异原因及用药情况分析
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| 篇名： | 我院社区获得性肺炎住院患者临床路径变异原因及用药情况分析 |
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| 摘要： | 目的：了解同济大学附属东方医院（简称“我院”）社区获得性肺炎住院患者临床路径发生变异的原因，并分析临床路径中的用药情况。方法：从医院信息系统（HIS）数据库中提取我院2015年7月－2016年6月收治的255例普通病房（非重症）社区获得性肺炎临床路径发生变异的患者（以下简称为“社区获得性肺炎变异患者”）的病历资料，采用Excel 2016软件对患者基本情况、变异因素、用药方案及用药情况进行统计和分析。结果：255例患者中，女性142例（55.69％），男性113例（44.31％）；多数患者年龄＜65岁（88.24％）；住院天数以7～14 d居多（69.02％）；＜65岁且无并发症者有96例（37.65％）。变异因素分为不可控因素（99.32％）和可控因素（0.68％），不可控因素包括疾病转归（70.75％）、患者需求（26.87％）和其他不可控因素（1.70％）几个方面，其中疾病转归以病情变化增加医嘱（37.41％）为主，患者需求以患者或其家属拒绝出院（13.95％）为主；可控因素包括医院系统（0.34％）和医护人员（0.34％）两个方面。我院社区获得性肺炎临床路径用药模板方案中包括11种药物，其中1种药物（克林霉素）在《中国成人社区获得性肺炎诊断和治疗指南（2016年版）》中被认为证据不足；2种药物（青霉素、克林霉素）在《美国感染病学会/美国胸科学会成人社区获得性肺炎诊疗指南（2009年修订版）》中未提及。＜65岁且无并发症的社区获得性肺炎变异患者中，以单用喹诺酮类、大环内酯类或β-内酰胺类/头孢菌素类药物为主，占56.25％；＜65岁且有并发症及≥65岁的社区获得性肺炎变异患者中，单用喹诺酮类或碳青霉烯类药物的占47.34％，联用喹诺酮类+β-内酰胺类/头孢菌素类药物的占41.42％。结论：我院社区获得性肺炎临床路径变异因素以疾病转归等不可控因素为主，且临床路径用药模板方案及执行均存在缺乏临床证据支持的情况。建议针对变异因素加强干预管理，及时分析、处理，同时对临床路径用药模板方案进行修改和完善，并根据患者年龄和疾病特点分别制定用药方案，并进一步规范诊疗方案，以保证临床路径的实施效果。 |
| ABSTRACT： | OBJECTIVE： To investigate the causes of the variation of clinical inpatients in inpatients with community acquired pneumonia （CAP） of Dongfang Hospital （called “our hospital” for short）， and analyze drug use of clinical pathway. METHODS： The medical records of 255 CAP variant patients in general wards （non-ICU） were collected from HIS database of our hospital during Jul. 2015-Jun. 2016. General information， variation cause， medication plan and drug use were analyzed statistically by using Excel 2016 software. RESULTS： Among 255 patients， there were 142 female cases （55.69％） and 113 male cases （44.31％）. Most of cases occurred under the age of 65 （88.24％）. Hospitalization duration mostly ranged 7-14 d （69.02％）. Totally 98 patients were less than 65 years old and had no complications （37.65％）. Variation causes were divided into uncontrollable causes （99.32％） and controllable causes （0.68％）. The uncontrollable causes included disease outcome （70.75％）， patient demand （26.87％） and other causes （1.70％）； disease outcome mainly included increasing medical order due to the change of disease condition （37.41％）； patient demand mainly included patients or their family members refused to （or required） discharge （13.95％）. The controllable causes contained hospital system （0.34％） and medical staff （0.34％）. There were 11 kinds of drugs in the clinical pathway medication plan templates of CAP in our hospital， among which one kind of anti-inflammatory drug lacked of evidence in Guidelines for Diagnosis and Treatment of Adult Community Acquired Pneumonia in China （2016 edition）； 2 kinds of drugs （penicillin， clindamycin） were not mentioned in modified edition of American Society of Infectious Diseases/American Thoracic Society Diagnosis and Treatment Guidelines for Adult Community Acquired Pneumonia （2009）. The CAP variant patients aged below 65 years old without complications were mainly given quinolones， macrolides or β-lactams alone， accounting for 56.25％. The CAP variant patients aged below 65 years old with complications and aged 65 years old or above were given quinolones or carbapenems alone， accounting for 47.34％. Quinolones+β-lactams/cephalosporins accounted for 41.42％. CONCLUSIONS： The causes for the variation of CAP clinical pathway are mainly uncontrollable causes such as disease outcome. There is a lack of clinical evidence support in clinical pathway medication plan and implementation. It is suggested to strengthen administrative management according to variation causes，analyze and deal with them in time，and modify and perfect the medication template plan of clinical pathway. It is suggested to formulate medication plan according to age and disease condition， so as to further standardize CAP medication plan and guarantee the effects of clinical pathway. |
| 期刊： | 2018年第29卷第16期 |
| 作者： | 李玉婷，金丽，何志高 |
| AUTHORS： | LI Yuting，JIN Li，HE Zhigao |
| 关键字： | 社区获得性肺炎；临床路径变异；原因；用药情况；分析 |
| KEYWORDS： | Community acquired pneumonia； Clinical pathway variation； Causes； Drug use； Analysis |
| 阅读数： | 547 次 |
| 本月下载数： | 5 次 |
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