ICU患者抗菌药物使用分析  

Analysis of the Use and Reasonable Researching of Anti-infectious Medicine in Patients in ICU.

作　　者：李亚芳[1] 张晓华[1] 

机构地区：[1]浙江省杭州市第一人民医院药剂科,310006

出　　处：《医学研究杂志》2006年第9期78-81,共4页Journal of Medical Research

摘　　要：目的通过对医院ICU患者抗菌药物使用情况的调查分析,指导临床合理用药,提高临床医生合理用药水平。方法采用限定日剂量(DDD),药物利用指数(DUI)及住院天数,分析ICU病人抗菌药物的使用情况。结果多数抗菌药物使用合理,而30.56%的抗菌药物超过DUI≤1的要求。DDD数排序结果,前5位分别为化学合成类(32.14%),氨基糖苷类(13·62%),β-内酰胺类及其酶抑制剂复合制剂(13.20%),抗真菌类(12.66%),头孢菌素类(9.52%)。氟喹诺酮类,头孢三、四代,碳青霉烯类被广泛地使用,药物联用率高达92%,最多的为六联。从抗菌药物使用的种类和比例分布可知,头孢菌素类占首位。菌株耐药发展迅速,左氧氟沙星的耐药率达到54.45%,其次庆大霉素也有51.78%,氨苄西林、环丙沙星、头孢唑啉、头孢曲松和SMZco都在40%以上。结论医师在选用剂量方面,以常规剂量(非适应证剂量)为主,较少考虑如年龄、药物相互作用及适应证剂量等因素。长期使用广谱抗生素,导致菌株耐药、菌群移位、真菌感染等现象普遍存在,使二重感染率高达32%,不容忽视。药物经济学理论在临床实践中较少被应用。Objective Through an investigation and analysis of the using situation of anti - infectious medicine for the patients of ICU in hospital,to provide guidance for the rational antimicrobial use in clinic and strengthen the level of clinical doctors＇reasonable use of the medicine. Methods The anti - infectious medicine used for the patient of ICU in hospital is analysed in respect to defined daily dose （DDD） ,drug utilization index（DUI）. Results An overwhelming majority of anti - infectious medicine＇s utilization is reasonable,but 52. 4% of the anti - infectious medicine is over the demand of DUI ≤ 1. The result of the DDDs：the Chemical Synthesis＇s capacity（32.14% ） , the aminoglycosides（ 13.62% ） ,the β - Lactams and theirβ - Lactamase inhibitors（ 13.20% ） ,the antifungal agents（ 12.66% ） ,the cephalosporins（9.52% ）. The fuloroquinolones,the third and the forth cephalosporins and the carbapenems are used broadly. The medicine＇s unit -rate gets 92%,and six unit is the most of all. It can be seen from the category and distribution of the use of anti -infectious medicine that the cephalosprins is the first. The antimicrobial resistance is developed rapidly. The antimicrobial resistance of levofloxacin is 54. 45% , then gentamicin is 51.78% and ampicillin, ciprofloxacin, cefazolin, ceftriaxone, SMZco are more than 40%. Conclusions In choosing the dose with the normal regulation（ not the dose of indication） , doctors consider less for the factors such as the age, medicine interacion,dose of indication,etc. Using the broad -spectrum usually led to many universal phenomenon such as antimicrobial resistance, bacteria migrated and antimycotic infection, etc. That makes double infection（ 32% ） which cant be neglected. The theory of medicinal economics is less used in the clinic practices.

关 键 词：ICU 抗菌药物 合理应用 

分 类 号：R969.3[医药卫生—药理学]