基于系统化处方评估的药学干预在剖宫产术后抗菌药物不合理使用管理中的作用

摘要

目的 探讨基于系统化处方评估的药学干预在剖宫产术后抗菌药物不合理使用管理中的作用.方法 选择2013年3月至2016年5月在中国医科大学附属第一医院行剖宫产术的患者共364例,按入院先后时间分为对照组(176例)和干预组(188例),对照组给予常规药学指导,干预组给予基于系统化处方评估的药学干预.统计2组患者抗菌药物品种选择、联合用药、单次剂量、用药频数、溶剂选择的合理率;统计2组患者的用药时机、持续用药时间及住院费用、药品费用、抗菌药物费用等医疗费用.结果 干预组患者的药物选择、联合用药、用药频数合理率均高于对照组[92.6％ (174/188)比38.6％ (68/176),100.0％ (9/9)比37.9％ (11/29),94.7％ (178/188)比21.6％ (38/176)],差异均有统计学意义(均P＜0.05).干预组患者结扎脐带前给药的应用率低于对照组[0.0％ (0/188)比6.8％ (12/176)],术后持续用药时间短于对照组[(2.5±1.0)d比(4.3±1.3)d],差异均有统计学意义(均P ＜0.05).干预组患者的住院费用、药品费用、抗菌药物费用均低于对照组患者[(4 419 ±349)元比(5 392 ±641)元,(838±137)元比(1 039±181)元,(79 ±30)元比(217 ±91)元],差异均有统计学意义(均P＜0.05).结论 基于系统化处方评估的药学干预可有效提高剖宫产术后抗菌药物的合理使用率,并降低医疗费用.%Objective To investigate the effect of pharmaceutical intervention based on systematic assessment of prescription on antibiotics irrational use after cesarean section.Methods A total of 364 patients who had cesarean section from March 2013 to May 2016 in the First Hospital of China Medical University were divided into intervention group (n =188) and control group (n =176) according to order of admission.The control group had routine pharmaceutical instruction;the intervention group had pharmaceutical intervention based on systematic assessment of prescription.Rational use rates of antibiotics [including drug variety,drug combination,single dose,frequency of drug use,solvent],timing of drug administration,duration of drug use and medical expenses(including hospitalization expense,drug expense,antibiotics expense) were analyzed.Results Rational rates of drug variety,drug combination and frequency of drug use in intervention group were significantly higher than those in control group [92.6％ (174/188) vs 38.6％ (68/176),100.0％ (9/9) vs 37.9％ (11/29),94.7％ (178/188) vs 21.6％ (38/176)] (P ＜ 0.05).The rate of drug administrating before umbilical cord ligation in intervention group was significantly lower than that in control group [0.0％ (0/188) vs 6.8％ (12/176)] (P ＜ 0.05).The duration of postoperative drug use in intervention group was significantly shorter than that in control group [(2.5 ± 1.0) d vs (4.3 ± 1.3) d] (P ＜ 0.05).Expenses of hospitalization,drug and antibiotics in intervention group were significantly lower than those in control group [(4 419 ± 349) yuan vs (5 392 ±641)yuan,(838 ± 137)yuan vs (1 039 ± 181)yuan,(79 ±30)yuan vs (217 ±91)yuan] (P ＜0.05).Conclusion Pharmaceutical intervention based on systematic assessment of prescription can effectively improve rational use of antibiotics after cesarean section and reduce medical costs.