药学干预对ICU感染患者药费及临床转归的影响

Influence of pharmaceutical intervention on drug cost and clinical prognosis of infected patients in intensive care unit

目的:分析临床药师对西安交通大学第二附属医院ICU感染患者的药学干预,评价药学干预对患者药费和临床转归的影响。方法:临床药师对ICU感染患者的药学干预主要包括3部分,基于临床疗效和肾毒性的药学干预、基于医疗费的药学干预及其他药学干预。具体的药学干预措施包括更换合适的抗菌药物,停用不必要的抗菌药物,停用2种及以上有肾毒性的药物,调整用药频次或用药剂量,联合使用抗菌药物,改变给药途径等。将402例本院ICU感染患者分为药学干预组(n=190)和无药学干预组(n=212),比较两组患者的药费和转归情况。结果:药学干预组患者的日均药费明显低于无药学干预组[(2220.99±734.45)元/dvs(2455.27±811.24)元/d,P=0.003],平均住院时间更短[(7.81±4.00)dvs(8.73±4.08)d,P=0.022],肾毒性药品不良反应(ADRs)发生率明显更低[5.79%(11/190)vs12.73%(27/212),P=0.019]。结论:临床药师对ICU感染患者的药学干预可以降低药费,缩短住院时间,降低肾毒性ADRs发生率,有重要临床价值。

Objective: To analyze pharmaceutical intervention by clinical pharmacists on patients in the intensive care unit(ICU) of the Second Hospital Affiliated to Xi’an Jiaotong University,and evaluate the influence of pharmaceutical intervention on drug cost and clinical prognosis.Methods:Pharmaceutical intervention by clinical pharmacists on infected patients in ICU mainly includes three types,the intervention based on clinical efficacy and nephrotoxicity,the intervention based on medical cost and other interventions.Specific interventions include replacement with appropriate antibacterials,abandoning of unnecessary antibacterials,abandoning of two or more drugs with nephrotoxicity,adjustment of medication frequency or dosages of the drugs,combined use of antibiotics,changes of administration routes,etc.402 infected patients in the ICU of the hospital were divided into the pharmaceutical intervention group( n =190) and the non-pharmaceutical intervention group( n =212).The drug cost and prognosis of infected patients were compared between the two groups. Results:The daily average drug cost of the patients in the pharmaceutical intervention group was significantly lower than that of the patients in the non-pharmaceutical intervention group [(2 220.99± 734.45) RMB/d vs (2 455.27±811.24) RMB/d,P =0.003],the average hospitalization duration was even shorter [(7.81± 4.00) d vs (8.73±4.08) d,P =0.022],and the rate of nephrotoxic adverse drug reactions(ADRs) was significantly lower [5.79%(11/190) vs 12.73%(27/212),P =0.019].Conclusion:Pharmaceutical intervention by clinical pharmacists on the infected patients in ICU could reduce drug cost,shorten hospitalization duration,lower the rate of nephrotoxic ADRs,and is of important clinical significance.