临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用的效果评价

Effect of perioperative use of antibacterials interfered by clinical pharmacist on permanent heart pacemaker implantation

目的 评价临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用的效果。方法 选择2015年6月至2016年5月于首都医科大学附属北京同仁医院接受永久性心脏起搏器植入术的患者110例。根据临床药师是否干预患者围术期抗菌药物使用，将所有患者分为未干预组（57例）和干预组（53例）。比较2组患者围术期抗菌药物使用的效果。 结果 干预组头孢呋辛和克林霉素（头孢过敏）使用比例明显高于未干预组［88.7%（47/53）比70.2%（40/57）、9.4%（5/53）比0.0%（0/57）］，头孢西丁使用比例明显低于未干预组［0.0%（0/53）比17.5%（10/57）］，差异均有统计学意义（均P＜0.05）。干预组药物选择、给药时机、预防用药疗程和预防用药合理率明显高于未干预组［98.1%（52/53）比70.2%（40/57）、100.0%（53/53）比87.7%（50/57）、56.6%（30/53）比22.8%（13/57）、52.8%（28/53）比14.0%（8/57）］，差异均有统计学意义（均P＜0.05）。干预组抗菌药物预防用药疗程短于未干预组［（2.3±0.8）d比（3.0±0.6）d］，差异有统计学意义（P＜0.001）。结论 临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用，可以提高药物选择、用药时机、预防用药疗程和预防用药的合理率，缩短用药疗程，在一定程度上提高了医院合理用药水平。

Objective To evaluate the effect of perioperative use of antibacterials intervented by clinical pharmacist on permanent heart pacemaker implantation. Methods Totally 110 patients who had permanent heart pacemaker implantation from June 2015 to May 2016 in Beijing Tongren Hospital, Capital Medical University were enrolled; 53 patients had perioperative use of antibacterials intervented by clinical pharmacist（observation group）; 57 patients were grouped as control group. Clinical effects of perioperative use of antibacterials were analyzed. Results Use rates of cefuroxime and clindamycin in observation group were significantly higher than those in control group［88.7%（47/53） vs 70.2%（40/57）, 9.4%（5/53） vs 0.0%（0/57）］; cefoxitin use rate in observation group was significantly lower than that in control group［0.0%（0/53） vs 17.5%（10/57）］（P＜0.05）. Rational rates of drug choice, administration time, medication course and preventive medication in observation group were significantly higher than those in control group［98.1%（52/53） vs 70.2%（40/57）, 100.0%（53/53） vs 87.7%（50/57）, 56.6%（30/53） vs 22.8%（13/57）, 52.8%（28/53） vs 14.0%（8/57）］（P＜0.05）. The medication course in observation group was significantly shorter than that in control group［（2.3±0.8）d vs （3.0±0.6）d］（P＜0.001）. Conclusion Clinical pharmacist intervention helps improve rational use of antibacterials in patients with permanent heart pacemaker implantation.