摘要
目的:参考国内外诊治指南对照分析64例急性胰腺炎病人使用抗菌药物的情况。方法:随机抽取第二军医大学长海医院2006年1月1日-12月31日诊断为急性胰腺炎的住院病案64份,其中重症急性胰腺炎(SAP)病历35份,轻症急性胰腺炎(MAP)病历29份,对抗菌药物的品种、使用频率、联合方案、疗程、病原学检查、疗效、金额等进行回顾性调查分析。结果:头孢菌素类或头孢菌素类/酶抑制剂+甲硝唑为SAP主要联合用药方案,喹诺酮类+甲硝唑是MAP主要联合用药方案。SAP组首次病原学检查报告时间为入院后(14±6.36)d(细菌)和(10.5±10.73)d(真菌),铜绿假单胞菌和金黄色葡萄球菌为主要检出菌,真菌为白念珠菌和热带念珠菌。抗菌药物平均使用天数SAP组为(19.27±13.78)d,MAP组为(8.31±4.87)d。SAP人均抗菌药费为10 951.08元,MAP人均抗菌药费为1 053.71元。结论:与国内外诊治指南对照,SAP组抗菌药物选用、治疗方案选择、治愈率等均相近,MAP组抗菌药物使用中存在无指征用药、用药过度问题。致病菌谱的改变、耐药菌株的出现和继发真菌感染,使得SAP的治疗难度和复杂性增加,仍须进一步探索和细化临床诊治指南,提高治愈率,降低并发感染的致死率。
Objective： To analyze the utilization of antibacterial agents in the patients with acute pancreatitis and compare with the standard therapeutic guidelines issued by several countries. Methods： The medical records of 64 inpatients, of whom 35 were diagnosed as severe acute pancreatitis （SAP） and 29 as mild acute pancreatitis （MAP）, were randomly collected from January 1 to December 31,2006, in Changhai Hospital, Second Military Medical University. The data were studied and analyzed in terms of varieties of drugs, frequency of use, combination regimen, therapeutic duration, etiologic diagnosis, therapeutic effectiveness and cost. Results： The cephalosporins and the cephalosporins/enzyme inhibitor combined with metronidazole were the first choice of treatment regimen for SAP, and the quinolones combined with metronidazole were the main treatment for MAP. Etiologic diagnosis reports were first obtained in （14±6.36） d for bacteria and （10.5±10.73） d for fungi after admission. Pseudomonas aeruginosa and Staphylococcus aureus were the main pathogenic bacteria. Candida albicans and Candida tropicalis were the main fungi identified. The average duration of use of antibacterials were （19.27±13.78） d for SAP and （8.31±4.87） d for MAP. Mean cost of antibacterials per person was 10 951.08 yuan for SAP and 1 053.71 yuan for MAP. Conclusion： Compared with the therapeutic guidelines abroad and at home, there are similar types of antibacterial agents and therapeutic regimens selected and similar effective rate in the patients with SAP, but there are still some problems in the treatment of MAP, such as drug administration with no indication and overuse of antibacterials. The difficulty and complexity of the treatment of SAP are increased with the change of spectrum of pathogens, the emergence of drug-resistant bacteria and secondary infection of fungi. Standard therapeutic guidelines still need to be improved to provide reference for clinical use in order to increase the curative rate and decrease the mortality of complicated infection.
出处
《药学服务与研究》
CAS
CSCD
2008年第1期55-58,共4页
Pharmaceutical Care and Research
关键词
胰腺炎
急性
抗菌药
合理用药
pancreatitis,acute
anti-bacterial agents
reasonable drug use
