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基于临床治疗指南及共识的住院患者多黏菌素B应用分析与评价
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| 篇名： | 基于临床治疗指南及共识的住院患者多黏菌素B应用分析与评价 |
| TITLE： | Analysis and evaluation of the application of polymyxin B in inpatients based on clinical guidelines and consensuses |
| 摘要： | 目的 评价某三级甲等医院住院患者临床应用多黏菌素B的合理性，为该药的临床方案优化提供依据。方法运用回顾性研究方法，查阅2020年1月－2022年3月该院接受注射用硫酸多黏菌素B治疗的住院患者的电子病历，收集患者的基本信息、住院科室及时间、感染诊断及病原菌检查结果、实验室检查指标、用法用量及联合用药等情况。在参考药品说明书的基础上，根据相关指南和共识，对患者多黏菌素B的使用情况进行合理性评价，并评估其疗效和安全性。结果与结论共纳入住院患者101例，以呼吸系统感染为主（62.4%）；所有患者均接受了病原学检查，检出率最高的病原菌为碳青霉烯类耐药鲍曼不动杆菌（40.6%）；100例患者采用静脉滴注的方式给药，其中4例患者联合了雾化吸入、鞘内注射等给药途径；99例患者持续静脉注射的剂量为50万单位，q12h；51.5%的患者用药疗程为7～14d；77例患者联用了其他抗革兰氏阴性菌药物；临床存在用药时间过短（29.7%）、未联合用药（23.8%）、用药无指征（17.8%）等不合理情况。101例患者使用多黏菌素B治疗的临床有效率为49.5%，16例患者（15.8%）在用药期间出现了急性肾损伤。临床药师应积极参与到多黏菌素B的临床治疗过程中，依据指南/共识并结合患者的病情及感染情况制定个体化的治疗方案，以提高临床用药的合理性。 |
| ABSTRACT： | OBJECTIVE To evaluate the rationality of clinical application of polymyxin B in the inpatients of a third grade class A hospital，so as to provide evidence for the optimization of clinical scheme of the drug. METHODS A retrospective method was conducted on the electronic medical records of inpatients treated with Polymyxin B sulfate for injection from January 2020 to March 2022 to collect the basic information of patients， inpatient departments and time， infection diagnosis， results of pathogenic bacteria test， laboratory test indicators， usage and dosage， and combined medication，etc. Based on the drug instructions， according to relevant guidelines and consensus， the rationality， efficacy and safety of polymyxin B in inpatient were evaluated. RESULTS & CONCLUSIONS A total of 101 inpatients were included， respiratory system infection was the main cause （62.4%）. All patients had received the etiological examination， and the pathogen with the highest detection rate was carbapenem‑resistant Acinetobacter baumannii （40.6%）. One hundred patients were treated by intravenous drip， and 4 patients were treated by combination of aerosol inhalation or intrathecal injection； 99 patients were given the dose of 500 thousand units by continuous intravenous infusion， q12 h. Totally 51.5% of patients were treated for 7-14 days； and 77 patients were treated with other anti-Gram-negative drugs. There were unreasonable phenomena including too short time of medication （29.7%）， no combination of medication （23.8%）， and no indication of medication （17.8%）. The clinical effective rate of 101 patients treated with polymyxin B was 49.5%， and 16 patients （15.8%） had acute kidney injury during the treatment. Clinical pharmacists should actively participate in the clinical treatment of polymyxin B， formulate individualized treatment plans according to the guidelines/consensus and in combination with the patient’s condition and infection status to improve the rationality of clinical medication. |
| 期刊： | 2023年第34卷第06期 |
| 作者： | 李蒙；彭龙希；蓝高爽；禹洁；李正翔；袁恒杰 |
| AUTHORS： | LI Meng，PENG Longxi，LAN Gaoshuang，YU Jie，LI Zhengxiang，YUAN Hengjie |
| 关键字： | 多黏菌素B；合理性；安全性；有效性；指南；共识 |
| KEYWORDS： | polymyxin B； rationality； safety； efficacy； guideline； consensus |
| 阅读数： | 174 次 |
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