碳青霉烯类抗菌药物致药品不良反应报告

摘要

目的:了解碳青霉烯类抗菌药物致药品不良反应(adverse drug reaction,ADR)的特点,促进临床合理用药.方法:检索中国知网(CNKI)、万方医学网、中文科技期刊数据库(维普)1990-2016年公开发表的关于碳青霉烯类抗菌药物致ADR的文献159篇,分析引起ADR的药品、患者性别及年龄、原发病、ADR发生时间、ADR累及器官和(或)系统及临床表现、临床转归等.结果:纳入文献159篇,共430例患者,涉及5种碳青霉烯类抗菌药物,以亚胺培南西司他丁为主,其次为美罗培南;男性254例,女性158例,不详18例,>60岁者多发;患者原发病主要涉及呼吸系统,其次为循环系统和消化系统;ADR主要发生于患者用药后48～<120 h(156例,占36.28％),其次为24～<48 h(133例,占30.93％);ADR累及器官和(或)系统排序居前3位的分别为神经系统(214例,占49.77％)、消化系统(88例,占20.47％)以及皮肤及其附件(63例,占14.65％);死亡患者5例(占1.16％),余患者症状好转或消失.结论:临床应重视对碳青霉烯类抗菌药物的用药监护,治疗过程中严格监测,以减少ADR的发生,促进临床合理用药.%OBJECTIVE:To investigate the characteristics of adverse drug reactions(ADR)induced by carbapenem antibiotics,so as to promote rational drug application in clinic.METHODS:159 published literatures about carbapenem antibiotics from 1990 to 2016 were retrieved from China National Knowledge Infrastructure(CNKI),Wanfangmed Online and China Scientific Journal Datab(VIP),and were further analyzed according to ADR-induced drugs,patients' genders and ages,primary diseases,occurrence time of ADR,involved organs and(or)systems and clinical features,clinical prognoses,etc.RESULTS:430 patients of 159 literatures were selected,with 5 carbapenem drugs involved,in which imipenem cilastatin sodium caused the most ADR,followed by meropenem.Among the 430 patients,254 were males,158 were females and 18 were unclear,mostly aged over 60.The primary diseases mainly involved respiratory system with circulatory system and digestive system in secondly.The occurrence time of ADR was mainly 48-120 h after medication(156 cases,accounted for 36.28％),the secondly was within 48 h(133 cases,accounted for 30.93％).The top three involved organs and(or)systems were respectively nervous system(214 cases,accounted for 49.77％),digestive system(88 cases,accounted for 20.47％)and skin and its accessories(63 cases,accounted for 14.65％).5 patients were dead,the rest were improved or recovered.CONCLUSIONS:Pharmaceutical care of carbapenem antibiotics should be paid high attention and strict monitoring should be carried out during treatment,so as to reduce ADR and promote clinical rational drug application.