智能化抗菌药物监测系统在老老年人群中的应用效果

Appling effect of intelligent antibiotic prescription automatic screeing system in very-elderly patients

目的探讨智能化抗菌药物监测系统对于减少老老年患者抗菌药物不良事件(ADEs),提高临床医疗安全的影响。方法选取2007年7月—2009年6月收治>80岁、发生感染性疾病并使用抗菌药物的患者为研究对象。2007年7月—2008年6月的患者为非干预组,2008年7月—2009年6月的患者经智能化系统进行干预为干预组。根据Naranjo评分表,判定药物不良事件(ADEs)。比较2组患者抗菌药物相关的ADEs发生率及其严重程度和分布,可预防ADEs对住院时间、住院费用的影响。结果 (1)肾功能正常的患者,警示主要以使用时间依赖性抗菌药时每日使用频次不足居多;肾功能不全的患者,警示均为每日使用剂量或频次过多;(2)研究期间,鉴定抗菌药物相关ADEs 124例,非干预组可预防ADEs发生率为47.3%,干预组为24.7%,差异有统计学意义(P<0.01)。重度药物不良事件发生率2组分别为8.48%和3.23%;(3)在干预介入后,可预防ADEs的住院时间、住院费用都有所下降(均P<0.01)。结论抗菌药物相关的ADEs在住院高龄患者中是普遍存在的,发生率高于普通人群ADEs发生率的平均水平。使用智能化抗菌药物监测系统,能减少ADEs发生率,显著降低临床住院时间、住院费用。

Objective To evaluate the effects of intelligent antibiotic prescription automatic screening system on adverse drug events（ADEs） and improvement of clinical safety in very-elderly patients.Methods Elderly in-patients （80 years old） from Gerontology Departments,July,2007 to June,2009） were selected randomly.At phaseⅠ,intelligent antibiotic prescription automatic screening system was not used.At phaseⅡ,the screening system was used.According to Naranjo score sheet,ADEs would be determined.Efficiency of antibiotics;incidence,distribution, and severity of antibiotic-related ADEs;hospitalization duration,cost of preventable ADEs were compared between phaseⅠand phaseⅡ.Results（1） In very-elderly patients with normal renal function,alarm system warning was mainly because of inadequate daily frequency when using time-dependent antibiotics.However,in patients with renal insufficiency,the warning was mainly due to the usage of antibiotics over the dose or frequency.（2）The incidence of total ADEs and preventable ADEs had decreased after intervention（P0.01）.The severe events accounted for a maximum of ADEs,which decreased most significantly after intervention.（3） Hospitalization duration and hospitalization costs for preventable ADEs decreased significantly（P0.01） in interventional group.Conclusion The incidence of antibiotics-related ADEs was higher in very-elderly inpatient than that in young.The use of intelligent antibiotic prescription automatic screening system would achieve more clinical benefit,including significantly shortening the hospitalization duration,lowering hospital costs,reducing medical risks.