摘要
目的探讨制定徐州医科大附属医院急性卒中患者卒中相关性肺炎(SAP)的药物治疗模式,从而促进临床合理用药。方法通过收集本院神经内科2019年5—10月急性缺血性脑卒中患者的病例资料,设计Word文档和Excel表格收集患者的情况。根据病原学监测与药敏试验结果总结徐州医科大学附属医院SAP的致病菌的分布及其耐药性,并通过单因素与多因素Logistic回归分析本院SAP患者可能的危险因素,制定本院SAP危险因素评分标准与危险程度分级。对新入院的急性缺血性脑卒中患者进行SAP危险程度分级并进行分级管理,规范患者的药物治疗。对2020年2月—4月收治的50例急性缺血性脑卒中患者进行前瞻性研究。结果从研究对象分布情况得到SAP的发生率为24%;病原菌的分布是以耐甲氧西林葡菌球菌(23.8%)、鲍曼不动杆菌(16.3%)、金黄色葡萄球菌(13.9%)、肺炎克雷伯菌(12.2%)为主,真菌占据7%。SAP的多因素Logistic回归分析结果显示,患有糖尿病、合并COPD、有充血性心力衰竭、白细胞高、美国国立卫生研究院卒中量表(NIHSS)评分>6分均是SAP的危险因素。依据SAP危险因素评分标准和分级对新入院急性缺血性脑卒中患者进行干预,经过治疗后最终SAP的发生率为16%,远远低于临床药师干预前的24%。结论根据病原菌的分布特点和SAP危险程度分级来规范急性缺血性脑卒中患者的药物治疗,降低SAP的发病率与死亡率,降低细菌耐药性的产生,促进临床合理用药。促进合理用药工作的推广应用,从而建立临床药师工作模式及医院合理用药长效改进机制,更好地为患者的生命健康服务。
Objective The purpose of this study was to develop a pharmacological treatment pattern for stroke-associated pneumonia(SAP)in acute stroke patients in our hospital so as to promote rational clinical use of drugs.Methods The clinical data of 330 cases of acute stroke admitted from May to October 2019 were collected.Pathogen surveillance and antimicrobial susceptibility test were conducted.Univariate and multivariate Logistic regression analyses was performed to identify the risk factors of SAP.Prospective study was conducted on 50 cases od acute stroke admitted from February to April 2020.Results The incidence of SAP in our hospital was 24% obtained from the distribution of study subjects;the distribution of pathogenic bacteria was dominated by methicillin-resistant Staphylococcus(23.8%),Acinetobacter baumannii(16.3%),Staphylococcus aureus(13.9%),Klebsiella pneumoniae(12.2%)and fungi occupied 7%.Multifactorial Logistic regression analysis of SAP showed that Diabetes mellitus,COPD,congestive heart failure,high WBCs and a NIHSS score>6 on the National Institute of Health stroke scale were all risk factors for SAP.The final incidence of SAP in newly admitted acute stroke patients after treatment was 16%,much lower than the 24% incidence before clinical pharmacist intervention according to the SAP risk factor scoring criteria and grading.Conclusion The distribution characteristics of pathogenic bacteria and the classification of SAP risk level were used to standardize the pharmacological treatment of acute stroke patients in our hospital,to reduce the morbidity and mortality of SAP,to reduce the development of bacterial drug resistance and to promote the rational use of clinical drugs.This will promote the application of rational drug use in our hospital,thus establishing a working model of clinical pharmacists and a long-term improvement mechanism for rational drug use in hospitals and better serving the life and health of patients.
作者
韩勋峰
丑晓华
吕冬梅
HAN Xunfeng;CHOU Xiaohua;LYU Dongmei(Department of Pharmacy,Second Affiliated Hospital of Xuzhou Medical University,Jiangsu Xuzhou 221000,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第3期361-364,373,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
江苏省药学会-奥赛康医院药学基金科研课题(编号:A201821)。
关键词
脑卒中
卒中相关性肺炎
病原菌分布
抗菌药物
Acute stroke
Stroke associated pneumonia
Pathogen distribution
Antibiotics
