某综合教学医院利奈唑胺的临床应用适宜性、有效性及安全性分析

Clinical evaluation of suitability,effectiveness and safety analysis of linezolid in a general teaching hospital

目的:综合评价某综合教学医院住院患者使用利奈唑胺的适宜性、有效性和安全性。方法:采用回顾性研究方法,选取广州市某三甲医院2015年1月-2015年12月使用利奈唑胺注射剂或片剂的患者病例,根据药品说明书和相关指南,分析利奈唑胺的应用情况,并统计有效率及不良反应发生率。结果:共纳入有效病例232例,评价结果合理的有186例(80.17%),不合理的有46例(19.83%);治疗结果痊愈118例(50.86%),显效48例(20.69%),进步21例(9.05%),无效45例(19.40%)。用药后出现不良反应的有69例(29.74%),其中血小板减少50例(21.55%),白细胞减少13例(5.56%),血红蛋白减少9例(3.85%),恶心、呕吐13例(5.56%),腹泻6例(2.56%),皮疹4例(1.71%),乳酸性酸中毒3例(1.28%)。ICU患者血小板减少症的发生率明显高于非ICU患者(P=0.004),但片剂与注射剂、≥65岁与<65岁患者间的发生率均无明显差异(P值分别为0.152,0.148)。结论:利奈唑胺治疗革兰阳性球菌感染的疗效较好,但临床应用存在不合理情况,发生血小板减少的比例较高,尤其是ICU患者,值得临床关注。

OBJECTIVE To evaluate the suitability,effectiveness and safety of clinical use of linezolid（LZD）in a general teaching hospital.METHODS A retrospective study was performed in patients treated with LZD injection or tablets between January 2015 and December 2015 at a tertiary hospital in Guangzhou.The application of linezolid,and the effective rate and incidence of adverse reactions（ADR）were analyzed,according to the drug instruction and relevant guidelines.RESULTS There were 232 patients enrolled inthe study,with186 cases for rational use（80.17%）,46 for unreasonable usecases（19.83%）.Among the 232 patients,118 were cured（50.86%）,48 obviously improved（20.69%）,21 improved（9.05%）,while 45 were invalid（19.40%）.ADRs induced by LZD were observed in 69 cases（29.74%）,including thrombocytopenia（n=50,21.55%）,leukopenia（n=13,5.56%）,hemogloinemia（n=9,3.85%）,nausea and vomiting（n=13,5.56%）,diarrhea（n=6,2.56%）,skin rash（n=4,1.71%）,and lactic acidosis（n=3,1.28%）.The incidence of thrombocytopenia in patients from ICU was significantly higher than those in non-ICU departments（P=0.004）,but without statistical significance between tablets and injections（P=0.152）,nor between different ages of≥65 y and〈65 y（P=0.148）.CONCLUSION Linezolid is effective against on Ggram-positive bacterial infections.However,research shows that linezolid might be used irrationally sometimes,and has high rate of thrombocytopenia,especially in ICU,to which worth more clinical attention should be paid in future practice.