集束化方案降低重症监护病房抗生素相关性腹泻的临床评价

Clinical evaluation of cluster scheme reducing antibiotic associated diarrhea in intensive care unit

[目的]探讨集束化方案降低重症监护病房抗生素相关性腹泻的临床价值。[方法]2014年1月~2015年12月重症监护病房患者320例患者作为观察组,2012年1月~2013年12月重症监护病房290例患者作为对照组;对照组根据病情实施对因、对症等综合治疗,必要时加用抗生素治疗,观察组在对照组基础上进行以下集束化方案:健全合理应用抗生素管理组织、制定抗生素合理应用制度、评估危险因素及观察、加强病原微生物及药敏检查、补充肠道益生菌、避免抗生素相关性腹泻危险因素。[结果]观察组应用抗生素68.75%、应用抗生素(1.79±0.40)种、抗生素使用时间(10.23±2.65)d、抗生素相关性腹泻发生率1.36%、抗生素相关性腹泻腹泻持续时间(3.22±1.78)d低于对照组80.00%、(2.08±0.45)种、(13.87±2.88)d、6.90%、(5.45±2.03)d;进行细菌培养86.36%高于对照组64.66%(P<0.05)。[结论]重症监护病房进行集束化预防方案,能够提高细菌培养率,降低抗生素应用及应用种类、缩短使用时间、降低抗生素相关性腹泻发生率,缩短抗生素相关性腹泻持续时间,值得临床应用。

[Objective]To explore the clinical value of cluster based method for reducing antibiotic associated diarrhea in intensive care unit.[Methods]320cases of ICU patients from January 2014 to December2015were collected as the observation group,and 290 cases of ICU patients from January 2012 to December2013were collected as the control group.The control group was given the comprehensive treatment for symptomatic,if necessary with antibiotic treatment.The observation group was given the following bundle programs,perfecting the management organization of using antibiotics rationally,making rational use of antibiotics,assessing of risk factors and strengthening microbial pathogens and drug sensitivity test,supplementing intestinal probiotics,avoiding the risk factors of antibiotic associated diarrhea.[Results]68.75%patients of the observation group applied antibiotics,applied antibiotics（1.79±0.40）types,the time of using antibiotics was（10.23±2.65）days,the incidence of antibiotic associated diarrhea was 1.36%,and antibiotic associated diarrhea duration（3.22±1.78）days,which was lower respectively than that in the control group 80.00%,（2.08±0.45）type,（13.87±2.88）days,6.90%,（5.45±2.03）days,in addition,bacterial culture 86.36% was higher than that of control group 64.66%（P〈0.05）.[Conclusion]ICU intensive prevention programs can improve the culture rate of bacterial,reduce the application and the type of application of antibiotics,and reduce the incidence of antibiotic associated diarrhea,shorten the duration of antibiotic associated diarrhea.It is worthy of clinical application.