医院头孢菌素和头霉素类药物皮试的规范化管理与成效  

Standardized management and effectiveness of skin tests for cephalosporins and cephamycins in hospital

作　　者：田晓芳 韩芙蓉[2] 刘玲玲[1] 李兵[3] 张晓红[1] TIAN Xiaofang;HAN Furong;LIU Lingling;LI Bing;ZHANG Xiaohong(Department of Pharmacy,Liangxiang Hospital of Beijing Fangshan District,Beijing 102400,China;不详)

机构地区：[1]北京市房山区良乡医院药剂科,102400 [2]首都医科大学附属北京同仁医院药学部,北京市100730 [3]中国医学科学院北京协和医学院药用植物研究所,北京市100193

出　　处：《临床合理用药杂志》2023年第22期31-34,39,共5页Chinese Journal of Clinical Rational Drug Use

基　　金：国家自然科学基金(81803666);北京市房山区良乡医院2022年院级科研课题(2022-08);北京市房山区良乡医院2020年院级科研课题(2020-12)。

摘　　要：目的分析医院头孢菌素和头霉素类药物皮试的规范化管理与成效。方法利用医院信息管理系统(HIS)、合理用药管理系统,收集北京市房山区良乡医院2020年8月—2021年5月(管理前)和2021年8月—2022年5月(管理后)使用头孢菌素和头霉素类注射剂的住院患者资料,统计头孢菌素和头霉素类药物的皮试率、皮试阳性率、皮试成本及使用量占比。通过HIS和国家药品不良反应监测系统,查询与头孢菌素和头霉素类相关的过敏反应发生情况,统计速发型过敏反应发生率。结果管理后皮试率为23.21%,低于管理前的94.17%(χ^(2)=5747.13,P<0.001),皮试阳性率和速发型过敏反应发生率比较差异均无统计学意义(P>0.05)。皮试管理后可节约皮试成本325861.46元,其中直接成本202788.18元、间接成本123073.28元;患者、医院、医保节约皮试成本分别为55156.16元、69811.85元、143553.02元。皮试管理前后,头孢菌素和头霉素类药物使用量占比由40.46%升至47.46%,三代头孢及酶抑制剂复合制剂使用量占比由20.51%升至28.18%,碳青霉烯类使用量占比由7.19%降至5.75%。皮试管理后仍行皮试1732例次,其中使用非说明书规定进行皮试1513例次(87.36%),以产科(770例,50.89%)、妇科(403例,26.64%)为主。结论医院规范化管理皮试方法安全有效,管理后皮试率及皮试成本显著降低,抗菌药物使用结构得到优化,需继续督导执行规范化管理皮试。Objective Analyze the standardized management and effectiveness of skin tests for cephalosporins and cephamycins in hospital.Methods Used the hospital information management system(HIS)and reasonable medication management system,collected data on hospitalized patients who used cephalosporins and cephamycins injections in Liangxiang Hospital of Beijing Fangshan District,from August 2020 to May 2021(before management)and from August 2021 to May 2022(after management),and calculated the skin test rate,positive skin test rate,skin test cost,and usage proportion of cephalosporins and cephamycins drugs.By using HIS and the national adverse drug reaction Monitoring System,query the incidence of allergic reactions related to cephalosporins and cephamycins,and statistics on the incidence of immediate allergic reactions.Results The skin test rate after management was 23.21%,lower than the 94.17%before management(χ^(2)=5747.13,P<0.001),there was no statistically significant difference in the positive skin test rate and the incidence of immediate allergic reactions(P>0.05).The skin test management saved 325861.46 yuan in cost,including 202788.18 yuan in direct cost and 123073.28 yuan in indirect cost;saved 55156.16 yuan,69811.85 yuan and 143553.02 yuan respectively for patients,hospitals and medical insurance.Before and after skin test management,the proportion of cephalosporins and cephamycins used increased from 40.46%to 47.46%,the proportion of third generation cephalosporins and enzyme inhibitor composite preparations used increased from 20.51%to 28.18%,the proportion of carbapenems used decreased from 7.19%to 5.75%.After skin test management,1732 cases of skin tests were still performed,including 1513 cases(87.36%)of non manual skin tests,mainly in obstetrics(770 cases,50.89%)and gynecology(403 cases,26.64%).Conclusion The standardized management of skin tests in hospitals is safe and effective.After management,the skin test rate and cost have significantly decreased,and the structure of antibacterial drug use has been

关 键 词：头孢菌素 头霉素 规范化管理 皮试成效 临床药师 

分 类 号：R95[医药卫生—药学]