基于证据质量评价泌尿结石科围术期抗菌药物用药路径的制定及效果

Establishiment and effect of clinical medication route of antibiotics for Urolithiasis Department based on evidence quality evaluation

目的 为抗菌药物在泌尿结石科围术期的合理使用提供参考依据。方法 以循证医学为基础,检索国内外临床研究、相关临床指南,根据现有证据采用GRADE系统对适应证进行评分量化其质量,并结合怀化市第一人民医院近2年泌尿外科细菌检出结果以及实际用药情况制定围术期用药路径;并将用药路径实施前后感染性休克发生率、抗菌药物使用强度、平均住院日、平均治疗费用进行对比。结果 共评价4条证据,其中B级强推荐1条,C级强推荐1条,C级弱推荐1条,D级反对该意见的弱推荐1条。制定具体的抗菌药物使用路径后,该院2020年感染性休克发生率为0.73%,低于2019年的1.79%(P<0.05),且无死亡病例。抗菌药物使用强度从2019年的82.60降至2020年的63.36,平均住院日从2019年的12.44 d降至2020年的11.83 d,术后未发生感染性休克患者平均直接治疗费用从2019年的12 798.65元下降至2020年的10 935.84元(P<0.05)。同时自主开发了泌尿结石科围术期抗菌药物临床应用决策系统,已嵌入医院管理信息系统(HIS)被临床医师使用。结论 临床药师通过循证药学结论结合临床科室自身特点制定用药路径,规范临床药物治疗,并将其实现信息化,可在临床合理用药中发挥重要作用。

Objective This study was designed to provide reference for strengthening the rational pre-operative use of antibacterial drugs in the treatment of Urolithiasis Department. Methods Clinical pharmacists searched for clinical evidence,using GRADE system to quantify the quality of existing evidence,combined with the results of urological bacteria detection and the actual drug use situation in the hospital in the past 2 years and the Actual drug use situation,the clinical drug route was formulated. The incidence of septic shock,the intensity of antibiotic use,the average hospital stay,and the average treatment cost were compared before and after the implementation of the medication route. Results A total of 4 pieces of evidence were evaluated,including 1 strong recommendation at grade B,1 strong recommendation at grade C,1 weak recommendation at grade C,and 1 weak recommendation at grade D against this opinion. And finally the researchers formulated a specific path for the use of antibacterial drugs. The specific clinical route of medication for fever and non-fever conditions were established.The chi-square analysis showed that the incidence of septic shock in 2020 was 0. 73%,which was lower than 1. 79% in 2019(P<0. 05),and there were no deaths. The value of antimicrobial use intensity was 63. 36 in 2020 lower than 82. 60 in 2019.The average length of stay was 11. 83 days in 2020 lower than 12. 44 in 2019. The average hospital cost of patients without postoperative septic shock decreased from 12 798. 65 yuan in 2019 to 10 935. 84 yuan in 2020(P<0. 05). Conclusion Clinical pharmacists apply the latest evidence-based drug therapeutics results to evidence-based clinical pharmacy practice,and play the important role in clinical rational drug use.