基层医院呼吸系统临床抗菌药物给药研究.docVIP

基层医院呼吸系统临床抗菌药物给药研究摘要：目的调查基层医院呼吸科住院患者抗菌药物的应用情况，分析药效、药动学对制定、优化给药方案的指导意义，为临床合理用药提供依据。方法随机抽查和统计2004年1月至12月无锡市锡山人民医院呼吸科住院患者的病历，了解常用抗菌药物及其用法、用量和临床应用以及病原菌检查，并调查临床医师依据药效、药动学制定、优化给药方案的情况，结合特征患者的病案资料进行分析。结果呼吸科抗菌药物以喹诺酮类和头孢菌素类使用频率较高，在抗菌药物的给药方案上根据病原菌检查选择药物，依据PD/PK制定给药方案较为合理。结论使用抗菌药物前送检标本、依据抗菌药物PD/PK对制定给药方案有重要意义。 关键词：抗菌药物；病原菌；药效学；药动学；合理用药 中图分类号：R978.1文献标识码：A文章编号：1672-979X(2007)07-0021-05 Analysis of Antibacterial Drug Utilization in Respiratory Apparatus in Primary Hospital XIE Sheng-xin, HUA Jie （Xishan Peoples Hospital of Wuxi City, Wuxi214011, China） Abstract：Objective To reveal the leading significance of pharmacodynamics and pharmacokinetics in formulating and optimizing antibacterial dosage regimen by investigating antibacterial utilization in respiratory apparatus in our hospital and to provide a basis for clinical rational administration. Methods Two hundred medical records of the inpatients in the Respiratory Department from January to December of 2004 were checked randomly. The following items were observed and counted: antibacterial category，application，dosage，pathogenic bacteria detection，dosage regimen，and inpatients characteristics. Results Quinolones and cephalosporins were applied most frequently in the Respiratory Department in our hospital. It is reasonable to institute an antibacterial dosage regimen according to pathogenic bacteria and PK/PD (pharmacokinetics pharmacodynamics). Conclusion It is important to collect and examine specimen before applying antibacterial drug and to formulate a dosage regimen according to pathogenic bacteria and PK/PD. Key words：antibacterial drug; pathogenic bacteria;pharmacodynamics ; pharmacokinetics ;rational administration 在医院用药中抗菌药物是应用范围最广，消耗量最大，而且相对比较贵的一大类药物。抗菌药物的大量使用，尤其是不合理使用，直接导致了细菌耐药性。因而提倡合理用药是解决细菌耐药性行之有效的办法，临床合理用药的核心是对药物的疗效、不良反应、药物的价格等诸多因素的优化。而抗菌药物与其他药物的不同之处在于其靶点是致病菌，药物-人体-致病菌是确定抗菌药给药方案的三大要素[1]，用药前送检标本，药效学和药动学则是决定三要素相互用作关系的重要依据。所以，在明确药物的安全性、价格等因素的情况下优化给药方案，充分发挥药物疗效，减少不良反应是合理用药的关键，同时也减少了治疗费用。 1资