某院神经外科患者特殊使用级抗菌药物临床使用的相关因素分析与点评

Analysis and Comment on Factors Related to Clinical Medication of Special Grade Antibacterial Drugs in Neurosurgery Patients in a Hospital

目的:分析医院神经外科患者特殊使用级抗菌药物的使用情况,为规范抗菌药物的合理使用提供参考。方法:抽取2018年1月-12月间神经外科收治的住院患者使用特殊使用级抗菌药物的品种、使用率、适应证、用法用量和标本培养的送检率等资料,分析其特殊使用级抗菌药物临床使用的合理性及不合理的原因。结果:88例患者使用特殊使用级抗菌药物中,美罗培南使用率占77.36%,其次是万古霉素占14.15%;79份病历在使用特殊使用级抗菌药物前进行病原学检查(占89.77%)(送检标本以痰液为主);不合理用药41份病历中,其中12份病历存在用法用量不规范占29.27%,15份病历无专家组成员会诊记录占36.59%,2份病历存在用药适应证不适宜占4.88%。结论:该科室特殊使用级抗菌药物在病原学送检率方面控制较好,但存在用法用量不合理、使用程序不规范及适应证不适宜等问题,提示医院应加强特殊使用级抗菌药物临床使用的管理,以确保患者用药的合理性。

Objective: To analyze the use of special grade antibiotics in neurosurgery patients, and to provide a reference for the rational use of antibacterial drugs. Methods: The data of varieties, utilization rate, indications, usage and dosage of antibiotics of special grade were collected from inpatients admitted to the department of neurosurgery from January to December 2018. The rationality and unreasonable reasons of the special grade antibacterial drugs in clinical use were analyzed. Results: 88 patients were treated with special grade antibiotics;among them,the rate of meropenem was77.36%, followed by vancomycin 14.15%.98 medical records(89.77%) were examined for etiology before the use of special grade antibiotics(sputum was the main sample). Among the 41 cases of unreasonable medication, 12 cases of irregular usage and dosage accounted for 29.27%, 15 cases of irregular usage and dosage, 15 cases of no consultation record of expert group members accounted for 36.59%, and 2 cases of improper medication and indications accounted for 4.88%.Conclusion: In this department, the application rate of special grade antibacterial drugs was well controlled in etiology,but there were some problems, such as unreasonable usage and dosage, non-standard application procedure, inappropriate indications, etc.. It is suggested that the hospital should strengthen the management of clinical use of special grade antibacterial drugs, so as to ensure the rationality of patients’ medication.