基于PK/PD理论临床药师参与ICU抗菌药物应用监护的成效研究

Effect of Clinical Pharmacist in ICU Based on PK/PD Theory

目的研究基于PK/PD理论临床药师参与ICU抗菌药物应用监护的成效,方法随机纳入研究单位ICU收治的2020年5月-2021年5月共100例符合急性重症感染诊断标准的重症患者,运用前瞻性队列研究法根据临床药师是否加入NDT团队分为非干预组和干预组各50例。非干预组由原ICU治疗团队指导抗菌药物使用,干预组则是临床药师介入的多学科协作诊疔(MDT)团队,并根据蒙特卡洛模拟法姑合抗菌药物的PK/PD理论优化抗菌药物治疗,对比两组抗菌药物使用情况及临床疗效。结果干预组总有效率高于非干预组,差异具有统计学意义(P<0.05)。干预组抗菌药物使用种类、药物疗程、降阶梯治疗时间以及不合理用药率均低于非干预組,差异具有统计学意义(P<0.05)。干预组治疗后CRP、VBC、ESR、PCT、APACHB-Ⅱ评分以及ICU停留时间,住院成本均低于非干预组,差异具有统计学意义(P<0.05).干预组不良反应发生率低于非干预组,但差异无统计学意义(P>0.05).结论基于PK/PD理论临床药师参与ICU抗菌药物应用监护具有良好的效果,能够有效保证抗菌药物应用的合理性,提高药物临床疗效,促进PCT等相关指标的恢复,同时还能够缩短患者的住院时间,缓解悲者的经济压力,值得推广应用。

0bjective To study the fiectiveness of elinical pharmacists in ICU anibiotics.Methods 100 severe patients met the diagnosis eriteria from May 2020 to May 2021.The prospective obort study was divided into 50 non-intervention groups according to whether clinical pharmacists joined the MDT group.The non-intervention group was guided by the original ICU therapy team,while the inlervenion group was a multidisciplinary(MDT)leam of dlinical pharmacist intervention,and optimized antimicrobial therapy according to Monte Carlo simulation and PK/PD theory of anibiotics,to compare the use aund eliniad eficacy a the two groups.Results The intervention group was more fficient than non-intervention and the dfference was stitically significant(P<0.05).The types of antimicrobial use,dnug course,descending treatment time,and urreasonable rate of dnug use in the intervention group were all lower than those in the non-intervention group(P<0.05).The CRP,WBC,ESR,PCT,APACHE-Ⅱscore,ICU stay time and hospitalization costs were lower than the non inevention group and the dfference were stsnificant(P<0.05).The incidence of adverse reactions in the interention group was lower than in non-inlervention groups,but the diferences were not stitically sgnificant(P>0.05).Conclusion Based on PK/PD theory,elinical pharmacists have good efl in ICU antimicrobial application monitoring,can efctivel guarantee the rationality of antimicrobial application,improve drug elinical eficacy,promote the recovery of PCT and other related indicatons,shorten the hospiulization time,relieve the economie pressure of patients,and apply.