临床药师对自发性脑出血的干预研究

Pharmacist intervention in spontaneous intracerebral hemorrhage

目的:评价临床药师对神经外科自发性脑出血(ICH)患者的干预效果。方法:选取神经外科ICH患者30例,A医疗组2015年7月1日至2015年10月31日,B医疗组2016年4月1日至2016年7月31日入院的为干预组进行实时药学干预,同期另一医疗组为未干预组,采用前瞻性对照研究方法,比较干预组和未干预组患者死亡率、平均重症监护室(ICU)停留时间、平均住院时间、抗菌药物使用强度(AUD)、药费/总费用、抗菌费用/药费、非感染患者抗菌药物预防使用率、院内感染发生率、多部位感染(≥2个部位)发生率、多重耐药菌(MDR)感染发生率。结果:临床药师的干预可明显减少非感染患者抗菌药物预防使用率(0%vs.33.3%),明显降低B治疗组的AUD(49.68 vs.85.40)、药费/总费用(0.483±0.093 vs.0.655±0.082)及A治疗组的多部位感染率(14.29%vs.40%)、MDR感染率(0%vs.40%),而不会增加死亡率。对ICU停留时间、平均住院时间、抗菌费用/药费等也略有降低。结论:临床药师的参与能使ICH患者从中获益。

OBJECTIVE To evaluate the effect of clinical pharmacists on patients with spontaneous intracerebral hemorrhage（ICH）from the department of neurosurgery.METHODS Thirty patients with spontaneous ICH were included.Patients were included in group A from July 1,2015 to October 31,2015,and in group B from April 1,2016 to July 31,2016.In the same period,the control groups were assigned for both groups.A prospective control study was performed to compare the difference between the intervention group and control group in terms of mortality,average stay in intensive care unit（ICU）,median hospital stay,use of antibacterial drugs（AUD）,medication cost/total cost,antibiotic associated cost/medication cost,usage of prophylactic antimicrobials in noninfected patients and rate of nosocomial infections in multiple sites（≥2 sites）and multidrug resistant bacteria（MDR）.RESULTS This study showed a significant decrease in the usage of prophylactic antimicrobials in noninfected patients（0% vs.33.3%）,AUD（49.68 vs.85.40）,medication cost/total cost（0.483±0.093 vs.0.655±0.082）in group B,the multiple site infection rates（14.29%vs.40%）and MDR infection rates（0% vs.40%）in group A.The results showed no reduction of mortality,a slight decrease in ICU stay,median hospital stay and antibiotic associated cost/medication cost.CONCLUSION Clinical pharmacists can play apositive role to benefit the ICH patients.