三甲综合医院破伤风被动免疫制剂误用调查

Investigation and analysis of misuse of tetanus passive immunologic preparation in a tertiary class-one hospital

目的通过对某三甲综合医院误用破伤风被动免疫制剂现况调查分析,为加强临床破伤风规范防治提供依据。方法调取2017年1月1日-2018年6月30日三甲医院HIS系统中所有门诊就诊使用破伤风被动免疫制剂患者信息,统计患者三间分布及费用,利用该地区儿童免疫规划信息系统,统计1~16岁儿童含破伤风类毒素成分疫苗接种率,以此分析临床误用破伤风被动免疫制剂现况。结果在最近1年半期间内,该院共有18726例门诊患者使用破伤风被动免疫制剂,其中破伤风抗毒素和破伤风免疫球蛋白分别使用13261剂次、5531剂次,费用分别为47739.66元、1894514元。患者中0~16岁儿童占20.66%,17~30岁年龄组人群占23.94%。该地区1~16岁儿童含破伤风类毒素成分疫苗全程接种率达99%以上,17~30岁年龄组人群全程接种率在85%以上。结论该院有20.66%患者不需要进行破伤风主动及被动免疫,23.94%患者不应使用破伤风被动免疫制剂,而应该进行主动免疫,即破伤风类毒素疫苗接种。

Objective Through the investigation and analysis of the misuse of tetanus passive immune preparations in a tertiary class-one hospital to provide the standardized data for prevention and treatment of tetanus.Methods The information of all outpatients using tetanus passive immune preparations were collected from January 1,2017to June 30,2018 in the HIS system of the tertiary class-one hospital,the three-dimensional distribution and cost of outpatients were analysed,tetanus toxoid vaccine immunization rate was counted on children aged 1to 16 by using the regional child immunization program information system,so as to analyze the current situation of clinical misuse of tetanus passive immune preparations.Results During the last one and a half years,18726 outpatients used tetanus passive immune preparations in the hospital.13261 doses of tetanus antitoxin and 5531doses of tetanus tetanus immune globulin were used,and the cost were 47739.66 yuan and 1894514 yuan respectively.Among the outpatients,under 16years old accounted for 20.66%,and 17 to 30 years old accounted for 23.94%.Children aged 1 to 16and people aged 17 to 30 vaccinated with tetanus toxoid-containing vaccines accounted for above 99%and 85% respectively.Conclusions 20.66%of the outpatients in the hospital no longer need active and passive immunization against tetanus.23.94% of the outpatients should not use tetanus passive immunologic preparation,but should receive active immunization,namely tetanus toxoid vaccine.