抗菌药物使用的改进与药源性发热发生率降低的相关性  

Relationship Between Improvement on Antibacterials Use and Lowered Incidence of Drug-induced Hyperthermia

作　　者：张渊[1] 方忠宏[2] 方欢[2] 刘玉娟[2] 姜玲海[2] 吕小群[2] 

机构地区：[1]上海市第一人民医院临床药学科,上海200080 [2]复旦大学附属金山医院药剂科,上海201508

出　　处：《医药导报》2017年第4期434-438,共5页Herald of Medicine

摘　　要：目的以在医疗实践中获取的药源性发热(DIH)数据,进行对照性的DIH回顾性研究,说明DIH发生率与抗菌药物过度使用的相关性。方法依次查阅复旦大学附属金山医院骨科,在两个不同时段的住院患者的病历,记录DIH病例的相关数据资料,然后进行对比研究。Ⅰ组:有效病例229例,住院时间为2011年2月-4月,在抗菌药物用药显著改进之前。Ⅱ组:有效病例342例,住院时间为2012年7月-9月,在抗菌药物使用显著改进后。DIH纳入标准:(1)术后第4天口温≥37.6℃;(2)无感染证据;(3)发热和可疑药物的用药有时间相关性:用药时发热,停药3 d内体温正常;(4)无其他疾病原因的发热;(5)出院时口温≤37.6℃。DIH排除标准:(1)可能的病理性发热,例如癌症患者;(2)住院时间不超过手术后3 d的;(3)无手术者,(4)有严重创伤者,例如,内脏或中枢神经系统损伤。结果所有致DIH药物皆为注射剂。Ⅱ组与Ⅰ组相比,抗菌药物使用时间,总DIH发生率及抗菌药物的DIH发生率均有显著降低(P<0.01),其对比数据分别为:(1.7±1.7)比(4.6±1.8)d,7.3%比30.1%,和1.5%比25.3%。结论 DIH的发生率与药物种类,特别是抗菌药物过度使用有相关性,因用药方案不同而变化。抗菌药物的DIH较中药注射剂的DIH严重,且抗菌药物使用减少与DIH发生率降低呈正相关,安全用药应从抗菌药物合理应用做起。Objective To conduct a retrospective study about drug-induced hyperthermia （ DIH） based on DIH data obtained in medical practice, and elucidate the relationship between DIH incidence and antibacterials overuse. Methods To investigate successively the medical records of inpatients from orthopaedics department in Fudan university affiliated Jinshan hospital at two different periods, and data of DIH cases were extracted to perform a comparative study. The period for 229 effective cases of group I was from Feb. 1 to Apr. 30, 2011,before significant improvement on antibacterials use. The period for 342 effective cases of group II was from Jul. 1 to Sep. 30,2012, after the effective enforcements of regulation on antibacterials use. Inclusion criteria for DIH were：①an oral temperature ≥ 37. 6℃ since postoperative day 4 , （2）no evidence of infection, （3）a time relationship between fever and the administration of causative drugs ： a fever occurring with drug administration and disappearing after drug cessation within 3 days,@no other causes for the fever, （5）oral temperature ≤37. 6 ℃, until leaving hospital. Exclusion criteria for DIH were listed below：①possible pathological fever,e. g . , in cancer, ②hospitalization within 3 days,③no surgery,④severe trauma,for example,visceral or central nervous system injury. Results All causative drugs were for injection. By comparison, duration of antibacterial administration is significantly shorter in group II than in group I （1. 7 ± 1. 7 vs. 4. 6 ± 1. 8days,P 〈 0. 01 ）,and total DIH incidence and antibacterials related DIH incidence were significantly lower in group II than in group I （7. 3% vs. 30. 1 % , 1.5% vs. 25. 3% , both P 〈 0. 01） . Conclusion DIH incidence is related with drug type especially with antibacterials overuse, and changed with drug program. DIH was more serious for injection of antibacterials than injection of traditional Chinese medicine. Decrease of antibacterials usa

关 键 词：抗菌药物 发热 药源性 发热 术后 抗菌药物预防用药 中药注射剂 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]