重症医学科碳青霉烯类药物管理模式探讨

Discussion on the management model of carbapenems in the intensive care unit

目的:研究多学科综合管理碳青霉烯类药物的模式在重症医学科(ICU)中的应用,构建一种评价该类药物合理性的评价体系,为临床中该类药物的合理使用管理提供参考。方法:实行多学科参与的药物新管理模式,分析北京老年医院ICU 2018-2020年干预前后出院患者的碳青霉烯药物应用情况。采用属性AHM赋权法对制定的各项干预效果评价指标进行赋权,再使用加权逼近理想解排序法(TOPSIS)对抽取病例进行分析与评价。结果:干预前碳青霉烯类药物的使用率为32.16%,干预后下降至23.37%(P<0.05);干预前特殊使用级别的抗菌药物使用率为48.06%,干预后下降至39.78%(P<0.05);干预前的使用强度为6.69,干预后下降至3.98(P<0.05);点评病例中与最优方案接近程度大于80%的病例由干预前的18例(30.00%)上升至干预后的49例(81.67%)(P<0.05),送检率由干预前的41.67%显著上升至干预后的83.33%(P<0.05)。结论:使用AHM-TOPSIS法对此类药物的合理性进行评价,结果更加科学、准确;多学科管理ICU碳青霉烯类药物应用的管理模式促进了碳青霉烯类药物在临床上的合理应用。

Objective To study the application of the comprehensive multidisciplinary management model of carbapenems in the intensive care unit(ICU),and to construct an evaluation system for the rationality of these drugs,so as to provide reference for the rational use of these drugs in clinical practice.Methods A new drug management model of multidisciplinary participation was implemented,and the application of carbapenems in discharged patients before and after intervention in the ICU of Beijing Geriatric Hospital from 2018 to 2020 were analyzed.Each evaluation index of intervention effect was weighted,and then Technique for Order Preference by Similarity to an Ideal Solution(TOPSIS)was used to analyze and evaluate the selected cases.Results The use rate of carbapenems before the intervention was 32.16%,which significantly decreased to 23.37%after the intervention(P<0.05);also the use rate of antimicrobial drugs for special use before the intervention was 48.06%,which significantly decreased to 39.78%after the intervention(P<0.05);the intensity of use was significantly reduced from 6.69 before the intervention to 3.98 after the intervention(P<0.05);among the commented cases,the degree of closeness to the optimal plan was greater than 80%,which increased from 18 cases(30.00%)before the intervention to 49 cases(81.67%)after the intervention(P<0.05);the pre-intervention submission rate was 41.67%,while the post-intervention submission rate was 83.33%(P<0.05).Conclusion Using AHM-TOPSIS method to evaluate the rationality of such drugs,the results of this evaluation method are more scientific and accurate,and it is suitable for the rationality evaluation of drugs in a wider range.The management model of multidisciplinary management of carbapenems in the intensive care unit promotes the rational application of carbapenems in clinical practice.