2020-2023年某院注射用硫酸黏菌素临床应用合理性分析  

Rationality of clinical application colistin sulfate for injection in a hospital from 2020 to 2023

作　　者：迟玉龙 曾金茹 张娜[1] 章晨 梁蓓蓓[1] 蔡芸[1] CHI Yu-long;ZENG Jin-ru;ZHANG Na;ZHANG Chen;LIANG Bei-bei;CAI Yun(Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院医疗保障中心药剂科药物临床研究室,北京100853 [2]中国人民解放军总医院医疗保障中心研究生院,北京100853

出　　处：《中华医院感染学杂志》2024年第12期1795-1800,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(82073894);解放军总医院杰出青年科学家培养基金资助项目(2020-JQPY-004);新药验证基金资助项目(4246Z512)。

摘　　要：目的 分析注射用硫酸黏菌素的临床应用情况,为促进该药的合理应用提供参考.方法 通过解放军总医院信息管理系统,选取2020年8月-2023年4月住院并使用硫酸黏菌素患者的基本信息、病原学检查、药物用法用量、联合用药、治疗结局及不良反应等.结果 共纳入173例患者,其中男性125例,女性48例;硫酸黏菌素主要用于治疗多药耐药肺炎克雷伯菌、鲍氏不动杆菌和铜绿假单胞菌导致的肺部、血流及泌尿系统感染,联合用药以联合碳青霉烯类居多;静脉滴注、雾化吸入及二者联合给药方式分别为73例(42.20%)、52例(30.06%)和48例(27.74%);不合理用药主要表现为疗程不足及溶媒选择不当等;硫酸黏菌素抗感染总有效率为37.09%(56/151),不良反应发生率为4.62%(8/173),主要表现为急性肾损伤、腹泻及药物性肝损伤.结论 该院硫酸黏菌素使用基本合理,肾毒性等不良反应风险较低,并未发生雾化吸入引起的呼吸道相关不良反应.需重点关注用药疗程过短及溶媒选择.OBJECTIVE To analyze the clinical application of colistin sulfate for injection,to provide reference for promoting the rational application of this drugs.METHODS Through the information management system of the General Hospital of the People's Liberation Army(PLA),the basic information,pathogenic examination,usage and dosage of colistin sulfate,co-administration,therapeutic outcomes,and adverse reactions of patients who were hospitalized and treated with colistin sulfate from Aug.2020 to Apr.2023 were selected.RESULTS A total of 173 patients were enrolled,including 125 males(72.25%)and 48 females(27.75%).Colistin sulfate was mainly used for the treatment of pulmonary,bloodstream,and urinary tract infections caused by multidrug-resistant Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa,and the combination of drugs was predominantly combined with carbapenems.Intravenous drips,nebulized inhalation and the combination of the two modes of administration were 73 cases(42.20%),52 cases(30.06%)and 48 cases(27.75%),respectively.Irrational use of medication was mainly manifested as insufficient course of treatment and improper choice of menstruum,et al.The overall effective rate of colistin sulfate treatment was 37.09%(56/151),and the incidence of adverse reactions was 4.62%(8/173),which were mainly characterized by acute kidney injury,diarrhea,and drug-induced liver injury.CONCLUSION The use of colistin sulfate in this hospital was reasonable,with a low risk of adverse effects such as nephrotoxicity,and no respiratory-related adverse effects from nebulized inhalation.Attention should be focused on the short duration of medication and the choice of menstruum.

关 键 词：硫酸多黏菌素E 合理用药 雾化吸入 急性肾损伤 不良反应 

分 类 号：R181.35[医药卫生—流行病学]