临床药师在ICU感染性休克患者抗感染治疗中的作用

Role of Clinical Pharmacists in Anti-infective Therapy for Patients with Septic Shock in ICU

目的:探讨临床药师在重症加强护理病房(ICU)抗感染性休克治疗中的作用。方法:回顾性收集2018年1-12月重庆市黔江中心医院ICU收治的感染性休克患者180例,按照临床药师是否全程参与抗感染治疗分为干预组(92例)和对照组(88例)。两组患者均根据临床诊断给予常规治疗,在此基础上,临床药师全程参与干预组的抗感染治疗,包括参与药学查房、制订抗感染方案、指导护士落实抗感染方案、为患者提供药学监护等。评价两组患者有效性、安全性和抗菌药物临床应用指标(如重点监控药品使用比例、疗程、费用等)。结果:干预组患者治愈率(98.91%)显著高于对照组(93.18%),不良反应发生率(8.70%)显著低于对照组(23.86%);抗菌药物使用种类更加合理(如干预组和对照组患者碳青霉烯类使用比例分别为20.65%、36.36%,喹诺酮类使用比例分别为15.22%、28.41%);干预组患者抗菌药物使用时间[(15.18±2.25)d]显著短于对照组[(19.84±3.81)d],人均抗菌药物费用[(2846.99±712.48)元]显著低于对照组[(3991.26±577.82)元],以上差异均有统计学意义(P<0.05或P<0.01)。结论:临床药师全程参与ICU感染性休克患者的抗感染治疗,为患者提供药学服务,可提高抗感染疗效,减少药品不良反应及药源性疾病的发生,优化抗菌药物的应用指标及降低医疗费用。

OBJECTIVE:To explore the role of clinical pharmacists in anti-infective therapy in patients with septic shock in the ICU.METHODS:A total of 180 patients with septic shock were retrospectively collected from ICU of Chongqing Qianjiang Central Hospital during Jan.-Dec.2018.According to whether clinical pharmacists participated in anti-infective therapy in the whole process,the patients were divided into intervention group(92 cases)and control group(88 cases).Both groups were given routine treatment according to clinical diagnosis;on this basis,clinical pharmacists participated in the whole anti-infective therapy of the intervention group,including participating in pharmaceutical rounds,formulating anti-infective programs,guiding nurses to implement anti-infective plan,and providing pharmaceutical care for patients.The effectiveness,safety and antibiotics clinical use indexes(such as proportion,treatment course and cost of key monitored drugs)were evaluated in 2 groups.RESULTS:The cure rate of intervention group(98.91%)was significantly higher than that of control group(93.18%),while the incidence of ADR in the intervention group(8.70%)was significantly lower than control group(23.86%).The use of antibiotics types was more rational(the proportion of carbapenems used in intervention group and control group were 20.65%,36.36%;those of quinolones were 15.22%,28.41%,respectively);the duration of antibiotics use in the intervention group[(15.18±2.25)d]was significantly shorter than control group[(19.84±3.81)d].The cost of antibiotics per capita[(2846.99±712.48)yuan]was significantly lower than control group[(3991.26±577.82)yuan],with statistical significance of all above(P<0.05 or P<0.01).CONCLUSIONS:Clinical pharmacists participating in the anti-infective treatment of ICU patients with septic shock and providing pharmaceutical care,can improve the anti-infective effect,reduce adverse drug reactions and drug-induced diseases,optimize the use of antibiotics and reduce medical cost.