某基层中医院骨伤科患者万古霉素的临床使用情况分析

Analysis of Clinical Use of Vancomycin in Patients of Orthopedics Department in a Primary Traditional Chinese Medicine Hospital

目的:分析医院骨伤科患者万古霉素的临床使用情况,为该科万古霉素的临床合理使用提供参考。方法:选取2018年11月—2020年11月泗洪县中医院骨伤科收治的使用了万古霉素治疗的41例患者作为研究对象,分析患者的性别和年龄分布、病原菌检出情况、万古霉素使用和监测情况,以及不合理用药原因类型。结果:41例使用万古霉素治疗的患者中男性多于女性(56.10%vs 43.90%),年龄上>60~80岁患者较多(占21.95%),而>10~20患者相对较少(占12.20%),但整体上性别和年龄的分布较为均衡;41例患者中有35例进行了病原菌培养,共检出病原菌35株,其中主要为金黄色葡萄球菌(10株,占28.57%)、溶血葡萄球菌(7株,占20.00%)和表皮葡萄球菌(5株,占14.29%);在万古霉素的使用和监测方面,用药目的以治疗为主(36例,占87.80%),日剂量以<2 g为主(24例,占58.54%),用药疗程以<1周为主(24例,占58.54%),给药方式主要为静脉滴注(38例,占92.68%),多数患者存在与其他抗菌药物联用的情况(31例,占75.61%),绝大多数患者治疗后痊愈或好转且无药物不良反应发生(均为36例,占87.80%),多数患者开展了血药浓度监测(33例,占80.49%)和肾功能监测(29例,占70.73%);41例患者中有24例存在万古霉素不合理使用的情况,其中以配液浓度过高(10例,占41.67%)和用药时间短(5例,占20.83%)为主。结论:医院使用万古霉素治疗的患者的病原学送检率较高,血药浓度监测和肾功能监测开展较为普遍,且治疗后预后较好、不良反应发生较少,但不合理用药情况较为严重,医院应当加强万古霉素的规范管理,提高临床万古霉素的合理用药水平。

Objective:To analyze clinical use of vancomycin in patients of orthopedics department in a hospital,and to provide reference for the rational clinical use of vancomycin in the department.Methods:41 patients who were admitted to the orthopedics department of Sihong Hospital of Traditional Chinese Medicine and treated with vancomycin from November 2018 to November 2020 were sellected as study subjects,and the gender and age distribution,pathogenic bacteria detection,vancomycin use and monitoring,and types of reasons for irrational drug use of the patients were analyzed.Results:Among 41 patients treated with vancomycin,there were more males than females(56.10%vs.43.90%),more patients greater than 60-80 years old(21.95%)and fewer patients greater than 10-20 years old(12.20%),but the gender and age were generally distributed in balance.35 of 41 patients had pathogenic bacteria culture,and 35strains of pathogenic bacteria were detected in total.Among them,the main strains were Staphylococcus aureus(10strains,accounting for 28.57%),Staphylococcus haemolyticus(7 strains,accounting for 20.00%)and Staphylococcus epidermidis(5 strains,accounting for 14.29%).Regarding the use and monitoring of vancomycin,the drug was mainly for treatment(36 cases,accounting for 87.80%),the daily dose was mainly less than 2 g(24 cases,accounting for58.54%),and the duration of the drug mainly was shorter than 1 week(24 cases,accounting for 58.54%).The drug was mainly administrated in mode of intravenous drip(38 cases,accounting for 92.68%),most of the patients were combined with other antibacterial drugs(31 cases,accounting for 75.61%),most of them were cured or improved after treatment with adverse drug reactions(all 36 cases,accounting for 87.80%),and most had blood concentration monitored(33 cases,accounting for 80.49%)and renal function monitored(29 cases,accounting for 70.73%).24 of 41 patients had unreasonable use of vancomycin,as predominant cases of excessive liquid concentration(10 cases,accounting for41.67%)and short drug administration(5 cases,accounting for 20.83%).Conclusion:Patients treated with vancomycin in the hospital have a high pathogenic detection rate,and blood concentration monitoring and renal function monitoring are commonly carried out,with good prognosis after treatment and fewer adverse reactions.However,irrational drug use is more serious,and hospitals should strengthen the standardized management of vancomycin to improve the rational clinical use level of vancomycin.