临床药师干预下万古霉素用药行为分析

Analysis of clinical administration behavior of vancomycin under clinical pharmacy intervention

目的:探讨临床药师进行干预是否能影响临床对于万古霉素的用药行为。方法:以2016年9月–2017年8月期间我院神经外科使用万古霉素治疗药物监测(TDM)为例,研究临床药师干预前后TDM的达标率、及时性、用药合理性和治疗效果等情况,并探讨影响血药浓度结果的因素。结果:临床药师的干预提高了万古霉素TDM的数量(干预前43例,干预后92例)和及时性(首次测定为用药后第几日,干预前4.87±3.78 d,干预后3.23±2.51 d),缩短了治疗时间(干预前10.98±10.18 d,干预后10.92±7.15 d),但未能提高血药浓度达标率,血药浓度达标率与给药方案有更强的关联性。结论:临床药师干预能够促进临床合理用药,提高患者的治疗效果。

Objective： To investigate the effect of intervention by clinical pharmacists in vancomycin application. Methods： Data of vancomycin therapeutic drug monitoring （TDM） was collected from September 2016 to August 2017 in our neurosurgery department. Compliance rate, timeliness, medication rationality, treatment effect, and result of vancomycin TDM before and after clinical pharmacist＇s intervention were analyzed. Results： The quantity （before intervention 43 cases, after intervention 92 cases） and timeliness （before intervention 4.87 ± 3.78 d, after intervention 3.23 ± 2.51 d） of vancomycin TDM were improved after the intervention of clinical pharmacists. The course of therapy was shortened by pharmaceutical intervention （before intervention 10.98 ± 10.18 d, after intervention 10.92 ± 7.15 d） while the compliance rate of vancomycin concentration was not risen after intervention. The compliance rate of vancomycin concentration was more correlated with the regimen. Conclusion： The intervention of clinical pharmacists could promote the rational use of medication and improve the treatment effcacy.