药学干预对肾内科患者腹膜透析管植入术预防性用药合理性的影响

Influence of Pharmaceutical Intervention on Rationality of Prophylactic Medication in Patients with PDCI in Nephrology Department

目的:比较药学干预前后腹膜透析管植入术(peritoneal dialysis catheter insertion,PDCI)患者围术期抗菌药物预防性使用的合理性,为侵入性诊疗操作患者合理使用抗菌药物提供参考。方法:抽取2016年1月—12月(干预前组,n=29例)和2018年1月—12月间(干预后组,n=30例)肾内科行PDCI的终末期肾功能不全患者59例病历资料,根据《抗菌药物临床应用指导原则(2015年版)》原则,统计和比较其两组患者的基本信息、医疗情况、医疗费用等指标的差异,评价药学干预对围术期预防用药及相关感染指标的影响。结果:干预后组患者抗菌药物预防使用率明显低于干预前组(63.33%vs 93.10%,P<0.05),术后导管相关并发症及炎症指标异常等发生率也显著低于干预前组(16.67%vs 48.26%,P<0.05);日均住院费(936.70 vs 964.20元/d)、日均药品费(466.20 vs 503.00元/d)、日均抗菌药物费用(21.40 vs 43.80元/d)略低于干预前组,但无统计学意义(P>0.05);两组患者在预防用药时机、疗程及所选药物品种的合理性也无明显差异(P>0.05)。结论:药学干预后PDCI患者围手术期预防性使用抗菌药物明显减少,但术后感染发生风险并未增加。

Objective:To compare the rationality of perioperative prophylactic medication of antibiotics in patients undergoing the peritoneal dialysis catheter insertion(PDCI)before and after pharmaceutical intervention,and to provide reference for the rational medication of antibiotics in patients undergoing invasive diagnosis and treatment.Methods:The clinical data of 59 patients with end-stage renal insufficiency who underwent peritoneal dialysis implantation from January to December 2016(pro intervention group,n=29 cases)and from January to December 2018(post intervention group,n=30 cases)were selected.According to the guiding principles for clinical application of antibiotics(2015 edition),the differences of basic information and medical situations as well as expenses between the two groups were analyzed and compared.To evaluate the effect of intervention on the prophylaxis medication in perioperative period and related infections.Results:The prophylactic use rate of antibiotics in post intervention group was significantly lower than that in the pre intervention group(63.33%vs 93.10%,P<0.05).The incidence of catheter-related complications and abnormal inflammatory indexes were also significantly lower than those before intervention(16.67%vs 48.26%,P<0.05).The average daily hospitalization expenses of patients(936.7 vs 964.2 RMB yuan/d),average daily drug cost(466.2 vs503.0 RMB yuan/d)and average daily cost of antibiotics(21.4 vs 43.8 RMB yuan/d)was slightly lower than that of the pre intervention group,but there was no statistical significance(P>0.05).Conclusion:After pharmaceutical intervention,the prophylactic medication of antimicrobial drugs in patients undergoing the PDCI was significantly reduced.However,the risk of postoperative infection has no increase.