医院CAP初始治疗方案的效益分析

Benefit analysis of the initial treatment regimens of CAP in hospital

目的探索本院成人社区获得性肺炎(CAP)住院患者遵循CAP指南的抗菌药物使用情况,确定本院治疗CAP的最佳临床路径。方法 125例成人CAP住院患者,对其初始治疗方案抗菌药物使用频率、治疗效果、药物成本-效果(C/E)进行分析。结果抗菌药物使用频率的前三位从高到低依次为阿奇霉素、头孢地嗪、哌拉西林舒巴坦;二联用药有效率为80.6%(79/98),明显高于单一用药的51.85%(14/27),差异具有统计学意义(χ~2=9.2,P=0.0024<0.05)。用药方案以二联用药为主,使用频率的前三位从高到低依次是头孢地嗪+阿奇霉素、哌拉西林舒巴坦+阿奇霉素、美洛西林舒巴坦+阿奇霉素,三种方案有效率两两比较差异无统计学意义(P>0.05)。美洛西林舒巴坦+阿奇霉素方案的C/E最低,△C/△E也最低,费用合理。结论本院遵循CAP指南的CAP初始治疗方案中,二联用药有效率更高,其中美洛西林舒巴坦+阿奇霉素方案的药物成本-效果最低,有效率最高,值得应用推广。

Objective To investigate the use of antibiotics in adult patients with community-acquired pneumonia（CAP） in our hospital according to the CAP guidelines, so as to determine the best clinical pathway for CAP treatment in our hospital. Methods There were 125 adult CAP inpatients, and their initial treatment regimens, frequency of antibiotic use, treatment effect and cost-effectiveness（C/E）. Results The top three frequency of antibiotics from high to low were azithromycin, cefdizine, piperacillin sulbactam, and the effective rate of double medication was 80.6%（79/98）, which was significantly higher than that of single medication（14/27）. Thedifference was statistically significant（χ^2=9.2, P=0.00240.05）. The medication regimens was based on double medication, and the top three frequencies of antibiotics from high to low were cefodizime ＋ azithromycin, piperacillin sulbactam ＋ azithromycin, mezlocillin sulbactam ＋ azithromycin. There was no significant difference in the effective rate between the three regimens（P〈0.05）. The C/E and △C/△E were the lowest in moxilin sulbactam ＋ azithromycin scheme, and the cost was reasonable. Conclusion In the CAP initial treatment regimens following the CAP guidelines, the double-medication is more efficient. The mezlocillin sulbactam ＋ azithromycin regimens has the lowest cost-effectiveness and highest efficiency, and this regimen is worthy of application and promotion.