我院万古霉素使用的合理性评价及分析

Evaluation and Analysis on Rationality of Vancomycin Use in Our Hospital

目的：分析医院万古霉素临床用药的合理性。方法：参照《抗菌药物临床应用指导原则》（卫生医发[2004]285号），随机抽取我院2012年～2013年住院患者使用万古霉素的160份病历对其进行回顾性调查分析。结果：万古霉素药物利用指数（Drug Utilization Index，DUI）为0.77；140例治疗性应用万古霉素的患者中132例进行了病原学检查，送检率为94.3％，联合使用了抗菌药物的有138例（86.3%），临床治疗有效率为80.0%，不合理用药36例（22.5%），进行肾功能监测106例（75.7%），有血药浓度监测（TDM）指征的90例（56.3%），其中9例（10.0%）进行了血药浓度检测。结论：我院万古霉素的使用基本合理，存在的问题主要有适应证、给药浓度、用药剂量及疗程等不合理，应进行血药浓度和肾功能监测，实行个体化给药方案，严格控制联合用药，确保万古霉素使用的合理性。

Objective：To study the correlation of the serum high sensitivity C-reactive protein content and the coronary artery stenosis degree and stent restenosis in patients before and after stenting. Methods：In this study, we choose 105 patients affected with coronary heart disease or acute myocardial infarction from the First People＇s Hospital of Jingzhou in 2010～2013, all of which are accepted radial artery or femoral artery coronary stenting including single and multiple lesions. Contrast test data and patients angiograms of the serum high sensitivity C-reactive protein content before and 48 hours after stenting, observe the correlation of the serum high sensitivity C-reactive protein content and the lesion severity before stenting, and discuss the the correlation of the serum high sensitivity C-reactive protein content 48 hours after stenting and restenosis and emerging pathological changes one year after stenting. Results： Single-vessel disease,Preoperative serum hs-CRP levels in 3～5mg/L.Three lesions,hs-CRP levels≥10mg/L.Two and two multiple lesions conifned hs-CRP levels in 5～9mg/L.There are signiifcant differences between the two groups（P〈0.01）. Check blood serum hs-CRP levels again after 48 hours, patients with single-vessel disease did not change signiifcantly, three lesions did not change signiifcantly ,hs-CRP levels remained above the level of 10mg/L;Two more and two local lesions have larger changes in hs-CRP levels, Two multiple lesions, hs-CRP levels≥10mg/L.Two limitations lesions decreased to about 5mg/L, One year after the review coronary angiography showed that hs-CRP levels〈5mg/L, two cases of restenosis, Restenosis within the stent was 3.2%,six cases of restenosis was about 12.2%, there was signiifcant difference. Conclusion： Hs-CRP was positively correlated with the severity of coronary lesions and the stent restenosis, can become a monitoring indicators of stent restenosis.