临床药师干预对提高儿童急性阑尾炎抗感染方案合理性的意义

Significance of Clinical Pharmacists’ Intervention in Improving the Rationality of Anti-Infection Regimens for Children with Acute Appendicitis

目的:比较临床药师干预前后临床抗菌药物使用的合理性,为急性阑尾炎患儿抗菌药物的使用提出临床指导意见。方法:制定急性阑尾炎抗菌药物合理应用的评价指标及评价标准,采取相应的干预措施对阑尾炎患儿抗菌药物使用进行宣教和管控,对干预前(2014年)和干预后(2016年)阑尾炎患儿的抗感染方案进行回顾性分析。结果:干预后,急性阑尾炎患儿围手术期首选抗菌药物更为合理;规范了抗菌药物的用法用量,给药剂量的合理率由干预前的76. 62%提高到干预后的92. 16%,给药频次的合理率由80. 09%提高到98. 53%,用药疗程合理率由81. 39%提高到88. 73%;降低了抗菌药物联合使用率,二联用药率由94. 81%降至66. 67%,单用药品率由0. 79%提高到33. 33%;病原学送检率由80. 52%提高到95. 10%,临床应用抗菌药物更加有针对性,抗菌药物的使用合理性显著提高。结论:临床药师采取切实可行的综合干预措施,有效地提高了儿童急性阑尾炎抗菌药物应用的合理性,但仍存在不合理使用抗菌药物的现象,有待进一步规范。

Objective: To compare the application rationality of antibiotics before and after the intervention by clinical pharmacists,and to provide clinical guidance for the application of antibiotics in children with acute appendicitis. Methods: The evaluation indicators and criteria for rational application of antibiotics in acute appendicitis were formulated,and corresponding intervention measures were taken to publicize and control the application of antibiotics in children with appendicitis. The anti-infection regimens for children with appendicitis were retrospectively analyzed before intervention( 2014) and after intervention( 2016). Results: After intervention,the preferred selection of antibiotics was more rational in children with acute appendicitis during perioperative period. The usage and dosage of antibiotics were regulated. The rational rate of dosage increased from 76. 62% before intervention to 92. 16% after intervention,the rational rate of administration frequency increased from 80. 09% to 98. 53%,and the rational rate of treatment course increased from81. 39% to 88. 73%. The application rate of drug combination in antibiotics decreased significantly. The application rate of two-drug combination decreased from 94. 81% to 66. 67%,and the application rate of single medication increased from 0. 79% to 33. 33%. The detection rate of pathogens increased from 80. 52% to 95. 10%,the clinical application of antibiotics became more targeted,and the application rationality of antibiotics had been significantly improved. Conclusion: Our hospital has adopted practical and comprehensive intervention measures to effectively improve the rationality of antibiotics for acute appendicitis in children,yet there are still irrational application of antibiotics,which needs further regulation.