72例重症患者抗真菌治疗分析与合理用药建议

Analysis of antifungal therapy in 72 critically ill patients and suggestion for rational medication

目的:分析72例重症患者抗真菌治疗情况,从临床药学角度提出抗真菌治疗优化策略。方法:采用回顾性研究方法,收集72例接受抗真菌治疗的重症患者的年龄、性别、急性生理与慢性健康评分、ICU在院时间、转归资料,统计分析抗真菌药物用法用量、病原学送检及培养结果、G试验/GM试验送检及结果、合并使用抗细菌药物等数据。结果:52例真菌培养结果报告为阳性,达侵袭性真菌病临床诊断标准,非无菌部位检出占84.93%(62/73),白色念珠菌占58.57%(41/70)。抗真菌治疗疗程(11.47±10.74)d,抗真菌治疗前已使用抗细菌药物(15.42±17.02)d。抗真菌药物单用率87.5%(63/72),单用氟康唑占52.78%(38/72)。抗真菌治疗合理率44.44%(32/72),40例不合理,其中24例存在1项不合理、16例存在2项不合理,不合理条目数总计56条。根据72例重症患者抗真菌治疗现状,从临床药学角度提出3点优化建议。结论:重症患者抗真菌治疗存在诊断困难、疗程偏短、药物用量不合理等问题,应遵循早期、足量、足疗程的原则制定个性化用药方案,且在治疗过程中应实施药学监护。

Objective:To analyze the antifungal treatment outcomes in 72 critically ill patients and propose optimization strategies from a clinical pharmacy perspective.Methods:A retrospective research approach was used,and data on age,gender,acute physiology and chronic health evaluation scores,ICU stay duration,outcomes,and other relevant information for 72 critically ill patients undergoing antifungal treatment were collected.A statistical analysis was conducted on the usage,dosage,microbiological testing,culture results,G test/GM test submissions,and concurrent use of antibacterial drugs.Results:Fungal culture results were positive in 52 cases,meeting clinical diagnostic criteria for invasive fungal disease.Non-sterile site detections accounted for 84.93%(62/73),with Candida albicans comprising 58.57%(41/70).The duration of antifungal treatment was(11.47±10.74)days,with antibacterial drugs used for(15.42±17.02)days before antifungal treatment.The monotherapy rate for antifungal drugs was 87.5%(63/72),with fluconazole monotherapy accounting for 52.78%(38/72).The rationality rate for antifungal treatment was 44.44%(32/72),with 40 cases deemed irrational.Among them,24 had one irrationality,and 16 had two irrationalities,totaling 56 irrational entries.Based on the current status of antifungal treatment in 72 critically ill patients,three optimization suggestions were proposed from a clinical pharmacy perspective.Conclusion:Challenges in antifungal treatment for critically ill patients include diagnostic difficulties,short treatment durations,and irrational dosages.Individualized medication plans should adhere to the principles of early,sufficient,and complete treatment,with pharmaceutical care implemented throughout the treatment process.