哌拉西林/他唑巴坦药物评价标准的建立与临床应用合理性分析  

Establishment of drug utilization evaluation criteria and rationality analysis of clinical application of piperacillin/tazobactam

作　　者：柏帅 唐丹琼 许懿 董玉波 BAI Shuai;TANG Danqiong;XU Yi;DONG Yubo(Department of Pharmacy,the 960th Hospital of PLA,Ji'nan 250031,Shandong,China;Department of Pharmacy,the Second Affiliated Hospital of Shandong First Medical University,Taian 271000,Shandong,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院药剂科,山东济南250031 [2]山东第一医科大学第二附属医院药剂科,山东泰安271000

出　　处：《贵州医科大学学报》2025年第3期442-449,共8页Journal of Guizhou Medical University

基　　金：山东省自然科学基金项目(ZR2023MH227)。

摘　　要：目的建立哌拉西林/他唑巴坦药物利用评价(drug utilization evaluation,DUE)标准,分析其用药合理性、安全性和有效性。方法以注射用哌拉西林钠/他唑巴坦钠说明书为基础,参考相关指南、专家共识和文献,并通过专家咨询法制定哌拉西林/他唑巴坦DUE标准;随机抽取使用哌拉西林/他唑巴坦抗感染的患者174例,参照DUE标准对患者的用药指征、用药过程及用药结果、管理指标进行分析评价;根据治疗效果分为有效组(n=150)和无效组(n=24),采用单因素方差分析两组间各指标差异,对有统计学意义的指标进行多因素logistic回归,分析治疗失败危险因素。结果DUE标准共15个项目,其中适应症、遴选适宜性、生命体征及实验室指标、用法、用量、治疗效果、不良反应、处方权符合率分别为99.4%、91.9%、86.2%、91.9%、98.8%、86.2%、91.4%、95.4%;与有效组相比,无效组患者在年龄、院内感染、查尔森(Charlson)合并指数、入住ICU、侵入性操作及定植菌感染方面,差异均有统计学意义(P<0.05);多因素logistic回归分析表明,年龄≥65岁(OR=4.432,95%CI为1.487~13.209,P=0.008)、院内感染(OR=3.525,95%CI为1.069~11.626,P=0.039)、入住ICU(OR=4.275,95%CI为1.505~12.141,P=0.006)、Charlson合并症指数≥3分(OR=5.970,95%CI为1.834~19.433,P=0.003)是独立危险因素。结论建立的哌拉西林/他唑巴坦DUE标准有较强的科学性、实用性和可行性,可为临床合理用药和处方点评提供参考依据。Objective To establish the drug utilization evaluation(DUE)standard for piperacillin/tazobactam,and analyze its rationality,safety,and efficacy.Methods Based on the package insert of piperacillin sodium/tazobactam sodium for injection,with reference to the relevant guidelines,consensus among clinical experts and literature,the DUE standard of piperacillin/tazobactam were established through consultation from experts.Randomly 174 patients who received anti-infection treatment with piperacillin/tazobactam were selected,their medication indications,process and outcomes,and management indicators according to the DUE standard were all analyzed and evaluated.According to the therapeutic effect,patients were divided into the effective group(n=150)and the ineffective group(n=24).Single factor analysis of variance was used to examine the indicators between the two groups,and multiple logistic regression analysis was performed on the indicators with statistical differences to detect the risk factors for treatment failure.Results There were 15 items in DUE standard,in which the coincidence rate of indications,suitability for selection,vital signs and laboratory indicators,usage,dosage,treatment effects,adverse reactions and prescription right were 99.4%,91.9%,86.2%,91.9%,98.8%,86.2%,91.4%,and 95.4%respectively.Compared with the effective group,the ineffective group showed statistically significant differences in age,hospital acquired infections,Charlson's comorbidity index,ICU admission,invasive procedures,and colonization infections(P<0.05).Multivariate logistic regression analysis revealed that age≥65years(OR=4.432,95%CI was 1.487-13.209,P=0.008),hospital acquired infection(OR=3.525,95%CI was 1.069-11.626,P=0.039),admission to ICU(OR=4.275,95%CI was 1.505-12.141,P=0.006),and Charlson comorbidity index≥3 points(OR=5.970,95%CI was 1.834-19.433,P=0.003)were independent risk factors.Conclusion The established DUE standard of piperacillin/tazobactam is scientific,practical and feasible,which can provide reference for clini

关 键 词：哌拉西林/他唑巴坦 β-内酰胺酶抑制剂复方制剂 药物利用评价 合理用药 

分 类 号：R969[医药卫生—药理学]