临床药师参与白内障围术期预防性用药的作用分析  

Clinical pharmacists intervention in prophylactic drug use in cataract operation

作　　者：张晓燕[1] 李乐[2] 罗世伟[2] 陈梦平[3] 王娟[1] ZHANG Xiao-yan;LI Le;LUO Shi-wei;CHEN Meng-ping;WANG Juan(Department of Clinical Pharmaceutics,Zhengzhou Second People’s Hospital,Zhengzhou 450006;Department of Clinical Laboratory,Zhengzhou Second People’s Hospital,Zhengzhou 450006;Department of Ophthalmology,Zhengzhou Second People’s Hospital,Zhengzhou 450006)

机构地区：[1]郑州市第二人民医院药务科,郑州450006 [2]郑州市第二人民医院检验科,郑州450006 [3]郑州市第二人民医院眼科,郑州450006

出　　处：《中南药学》2020年第8期1428-1431,共4页Central South Pharmacy

基　　金：常州四药临床药学科研基金(No.CZSYJJ15013)。

摘　　要：目的探讨临床药师对白内障围术期预防使用抗菌药物干预的效果。方法临床药师对2013年1月-2016年12月白内障手术预防用药患者的信息进行回顾性分析,制订《眼科手术预防性抗菌药物管理制度》,并按照该制度对2017年1月-2018年12月施行白内障手术患者的围术期预防性用药进行干预,分别就干预前后抗菌药物眼用制剂的用药频度(DDDs)、药敏结果、继发感染情况及经济学指标等进行统计分析。结果临床药师干预后,白内障手术全身预防用药率、术后眼内炎发生率、平均药品费用和平均住院日均呈下降趋势;依据临床药师"白内障手术围术期首选喹诺酮类眼用制剂"的建议,该类药物的预防用药的比率和年均DDDs增长明显,干预后加替沙星、左氧氟沙星的年均DDDs分别由29.97×10~4、13.28×10~4上升至71.58×10~4、25.89×10~4;加替沙星的耐药率虽较干预前有所增加(χ~2=12.755,P<0.001),但对结膜囊常见定植菌的敏感性依然较高(耐药率<30%)。结论临床药师依据药效-药代动力学模型和药学信息情报优势,结合药物经济学、微生物学、临床知识等多学科知识,在医疗治疗团队中不断深化和体现药师价值。Objective To discuss the role of clinical pharmacists in prophylactic use of antibacterial during perioperative period of cataract surgery.Methods Clinical pharmacists retrospectively analyzed on the information of patients with preventive medication use during cataract surgery from January 2013 to December 2016,and formed the management system of preventive antibiotics in ophthalmic surgery.According to the system,perioperative prophylactic medication was used for patients who underwent cataract surgery from January 2017 to December 2018.The defined daily dose (DDDs),drug sensitivity,secondary infection and economic indexes of antibacterial ophthalmic preparation were analyzed.Results After the pharmacists intervention,the incidence of systemic prophylactic drugs,endophthalmitis after cataract surgery,average drug cost and average hospitalization days decreased.According to clinical pharmacists,quinolone ophthalmic preparations should be the first choice during the perioperative period of cataract surgery.Prophylactic drug use rate and annual average DDDs of these drugs were increased significantly.After the intervention,the average annual DDDs of gatifloxacin and levofloxacin increased from 29.97×10~4 and 13.28×10~4 to 71.58×10~4 and 25.89×10~4 respectively.The resistance rate of gatifloxacin was higher than that before the intervention,with significant difference (χ~2=12.755,P<0.001).The sensitivity of gatifloxacin to common colonies in conjunctival sac was still high (drug resistance rate<30%).Conclusion Based on pharmacodynamics-pharmacokinetics model and information advantages,clinical pharmacists embody their value in the medical treatment team with the knowledge of pharmacoeconomics,microbiology,and other disciplines.

关 键 词：白内障 眼用制剂 抗菌药物 用药频度 耐药性 

分 类 号：R988.1[医药卫生—药品] R969[医药卫生—药学]