设为首页 电子邮箱 联系我们

本刊最新招聘信息请见“通知公告”!  本刊投稿系统试运行中,欢迎投稿!如投稿有问题,可直接将稿件发送至zgyy8888@163.com

 
网站首页杂志简介编委会成员本刊稿约编辑部照片过刊目录广告合作读者论坛联系我们
位置:首页 >> 电子期刊 >> 正文
临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用的效果评价
作者:白颖 王家伟 
单位:100730 首都医科大学附属北京同仁医院药学部 
关键词:心脏起搏器 人工 抗菌药物 临床药师 
分类号:R 617
出版年,卷(期):页码:2017,12(11):1624-1627
摘要:

【摘要】目的    评价临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用的效果。方法    选择2015年6月至2016年5月于首都医科大学附属北京同仁医院接受永久性心脏起搏器植入术的患者110例。根据临床药师是否干预患者围术期抗菌药物使用,将所有患者分为未干预组(57例)和干预组(53例)。比较2组患者围术期抗菌药物使用的效果。结果    干预组头孢呋辛和克林霉素(头孢过敏)使用比例明显高于未干预组[88.7%(47/53)比70.2%(40/57)、9.4%(5/53)比0.0%(0/57)],头孢西丁使用比例明显低于未干预组[0.0%(0/53)比17.5%(10/57)],差异均有统计学意义(均P<0.05)。干预组药物选择、给药时机、预防用药疗程和预防用药合理率明显高于未干预组[98.1%(52/53)比70.2%(40/57)、100.0%(53/53)比87.7%(50/57)、56.6%(30/53)比22.8%(13/57)、52.8%(28/53)比14.0%(8/57)],差异均有统计学意义(均P<0.05)。干预组抗菌药物预防用药疗程短于未干预组[(2.3±0.8)d比(3.0±0.6)d],差异有统计学意义(P<0.001)。结论    临床药师干预永久性心脏起搏器植入术患者围术期抗菌药物使用,可以提高药物选择、用药时机、预防用药疗程和预防用药的合理率,缩短用药疗程,在一定程度上提高了医院合理用药水平。

Effect of perioperative use of antibacterials interfered by clinical pharmacist on permanent heart pacemaker implantation
Bai Ying, Wang Jiawei
Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Corresponding author: Wang Jiawei, Email: jwwang1298@sina.com
【Abstract】Objective    To evaluate the effect of perioperative use of antibacterials intervented by clinical pharmacist on permanent heart pacemaker implantation. Methods    Totally 110 patients who had permanent heart pacemaker implantation from June 2015 to May 2016 in Beijing Tongren Hospital, Capital Medical University were enrolled; 53 patients had perioperative use of antibacterials intervented by clinical pharmacist(observation group); 57 patients were grouped as control group. Clinical effects of perioperative use of antibacterials were analyzed. Results    Use rates of cefuroxime and clindamycin in observation group were significantly higher than those in control group[88.7%(47/53) vs 70.2%(40/57), 9.4%(5/53) vs 0.0%(0/57)]; cefoxitin use rate in observation group was significantly lower than that in control group[0.0%(0/53) vs 17.5%(10/57)](P<0.05). Rational rates of drug choice, administration time, medication course and preventive medication in observation group were significantly higher than those in control group[98.1%(52/53) vs 70.2%(40/57), 100.0%(53/53) vs 87.7%(50/57), 56.6%(30/53) vs 22.8%(13/57), 52.8%(28/53) vs 14.0%(8/57)](P<0.05). The medication course in observation group was significantly shorter than that in control group[(2.3±0.8)d vs (3.0±0.6)d](P<0.001). Conclusion    Clinical pharmacist intervention helps improve rational use of antibacterials in patients with permanent heart pacemaker implantation.
【Key words】Pacemaker, artificial;Antimicrobial agent;Clinical pharmacist

基金项目:
作者简介:
参考文献:

[1]张澍,华伟,黄德嘉,等.植入性心脏起搏器治疗——目前认识和建议(2010年修订版)[J].中华心律失常学杂志,2010,14(4):245-259. DOI: 10.3760/cma.j.issn.1007-6638.2010.04.001.
Zhang S, Hua W, Huang DJ, et al. Current knowledge and recommendations of implantable pacemaker therapy(update 2010)[J]. Chinese Journal of Cardiac Arrhythmias, 2010,14(4):245-259. DOI: 10.3760/cma.j.issn.1007-6638.2010.04.001.
[2]Kennergren C. Management of cardiovascular implantable electronic devices infections in high-risk patients[J]. Arrhythm Electrophysiol Rev, 2015,4(1):53-57. DOI: 10.15420/aer.2015.4.1.53.
[3]Podoleanu C, Deharo JC. Management of cardiac implantable electronic device infection[J]. Arrhythm Electrophysiol Rev, 2014,3(3):184-189. DOI: 10.15420/aer.2014.3.3.184.
[4]Tarakji KG, Ellis CR, Defaye P, et al. Cardiac implantable electronic device infection in patients at risk[J]. Arrhythm Electrophysiol Rev, 2016,5(1):65-71. DOI: 10.15420/aer.2015.27.2.
[5]Sohail MR, Henrikson CA, Braid-Forbes MJ, et al. Mortality and cost associated with cardiovascular implantable electronic device infections[J]. Arch Intern Med, 2011,171(20):1821-1828. DOI: 10.1001/archinternmed.2011.441.
[6]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[M].北京:人民卫生出版社,2015:6-23.
Revised Group of Guiding Principle of Clinical Application of Antibacterials. Guiding principle of clinical application of antibacterials 2015[M]. Beijing: People′s Medical Publishing House, 2015:6-23.
[7]Lin YS, Hung SP, Chen PR, et al. Risk factors influencing complications of cardiac implantable electronic device implantation: infection, pneumothorax and heart perforation: a nationwide population-based cohort study[J]. Medicine (Baltimore), 2014,93(27):e213. DOI: 10.1097/MD.0000000000000213.
[8]Kirkfeldt RE, Johansen JB, Nielsen JC. Management of cardiac electronic device infections: challenges and outcomes[J]. Arrhythm Electrophysiol Rev, 2016,5(3):183-187. DOI: 10.15420/aer.2016:21:2.
[9]Imai K. Perioperative management for the prevention of bacterial infection in cardiac implantable electronic device placement[J]. J Arrhythm, 2016,32(4):283-286. DOI: 10.1016/j.joa.2015.06.007.
[10]中国生物医学工程学会心律分会.心律植入装置感染与处理的中国专家共识2013[J].临床心电学杂志,2013,22(4):241-253.
Cardiac Rhythm Branch on Chinese Society of Biomedical Engineering. Chinese expert consensus on infection and treatment of cardiac implantable devices 2013[J]. Journal of Clinical Electrocardiology, 2013,22(4):241-253.
[11]Kempny A, Dimopoulos K, Uebing A, et al. Outcome of cardiac surgery in patients with congenital heart disease in England between 1997 and 2015[J]. PLoS One, 2017,12(6):e0178963. DOI: 10.1371/journal.pone.0178963.
[12]Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European  Society of Cardiology (ESC). Endorsed by: European  Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)[J]. Eur Heart J, 2015,36(44):3075-3128. DOI: 10.1093/eurheartj/ehv319.
[13]谭琛,崔俊玉,任晓庆,等.永久性心脏起搏器植入术后感染患者的临床资料分析[J].中国循证心血管医学杂志,2013,5(4):360-362. DOI: 10.3969/j.1674-4055.2013.04.011.
Tan C, Cui JY, Ren XQ, et al. Analysis on clinical materials in patients with post-operation infection after implantation of permanent pacemaker[J]. Chinese Journal of Evidence-Bases Cardiovascular Medicine, 2013,5(4):360-362. DOI: 10.3969/j.1674-4055.2013.04.011.
[14]张萌,王蕾,王斌.壳聚糖止血敷料用于永久性心脏起搏器植入术后的效果观察[J].中国医药,2013,8(11):1547-1548. DOI: 10.3760/cma.j.issn.1673-4777.2013.11.011.
Zhang M, Wang L, Wang B. Effect of chitosan hemostatic dressings on permanent cardiac pacemaker implantation[J]. China Medicine, 2013,8(11):1547-1548. DOI: 10.3760/cma.j.issn.1673-4777.2013.11.011.
[15]龙仙萍,王冬梅,汪松,等.361例心脏起搏器植入术患者并发症发生情况及处理策略分析[J]. 实用心脑肺血管病杂志, 2015,23(5):87-89. DOI: 10.3969/j.issn.1008-5971.2015.05.027.
Long XP, Wang DM, Wang S, et al. Incidence of complications in 361 patients undergoing pacemaker implantation and its treatment strategy[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2015,23(5):87-89. DOI: 10.3969/j.issn.1008-5971.2015.05.027.
[16]毛国璋,金辉,张殿堂,等.成人心脏外科术后感染调查及危险因素分析[J].中国心血管病研究,2009,7(11):822-823. DOI: 10.3969/j.issn.1672-5301.2009.11.009.
Mao GZ, Jin H, Zhang DT, et al. An epidemiologic analysis on nosocomial infection and its risk factors after cardiac surgery of adult patients[J]. Chinese Journal of Cardiovascular Review, 2009,7(11):822-823. DOI: 10.3969/j.issn.1672-5301.2009.11.009.
[17]Gandhi T, Crawford T, Riddell J. Cardiovascular implantable electronic device associated infections[J]. Infect Dis Clin North Am, 2012,26(1):57-76. DOI: 10.1016/j.idc.2011.09.001.

服务与反馈:
文章下载】【加入收藏
copyright © 《中国医药》杂志编辑部
地址:北京市朝阳区安贞路2号首都医科大学附属北京安贞医院北楼二层    
电话:010-64456116     传真:010-64428528    邮编:100029
网址:www.chinamedicinej.com     Email: zgyy8888@163.com
当您在使用本网站投稿遇到困难时,请直接将稿件投送到编辑部邮箱zgyy8888@163.com
 京ICP备10041176号-1