循证药学在碳青霉烯类药物临床使用中的应用

目的：查找循证医学及循证药学证据，解决临床用药问题，比较关罗培南和亚胺培南的安全性以及美罗培南的输注方法改进。方法：检索数据库包括Medline／Pubmed，Cochrane central、《荷兰医学文摘》、科学引文索引扩展版数据库（SCI—E）、Current Content Connect和中国生物医学文献数据库（CBMdisc）、CNKI、维普数据库、万方数据库。查找相关的系统评价，随机对照实验等，并对所获得的证据进行质量评价。结果：检索到系统评价4篇，安全性比较的随机对照试验3篇，输注方法的随机对照试验2篇。美罗培南的肝损害发生率略高于亚胺培南，并且不良反应发生与药物应用剂量无关。美罗培南对难治性耐药茵应用的方式和剂量应为3h连续静脉滴注，并且在随后的临床实践中应用。结论：对难治性耐药菌应采用美罗培南3h连续静脉滴注。

Application of Evidence-Based Pharmacy in Clinical Practice of Carbapenem

Objective： To search evidence of evidence-based pharmacy to resolve clinical problems, compare the salty of meropenem imipenem and cilastatin＇ s and promote the infusion scheme of meropenem imipenem. Method： The Medline/Pubmed, Embase, Cochranecentral, SCI-E, Current Content Connect, CBMdisc, CNKI, Vip and Wanfang database were retrievaled to find related systematic review and randomized control trial, and the datas were evaluated. Result： 4SRs, 3RCTs about security and 2RCTs about infusion scheme were obtained. Hepatic lesion ratios of meropenem was higher than that of imipenem/cilastatin＇ s and has no relation with drug dosage. Three-hour infusion was used to treatment of drug resistance bacterias and get satisfying outcome. Conclusion： Three-hour infusion of meropenem is recommended to combat refractory drug resistance bacterias after the proper dosage is determined.