肾功能不全患者抗菌药物用药干预及分析

目的 评价肾功能不全患者药物抗菌药物选用情况以及临床药师用药干预情况,为保障肾功能不全住院患者合理用药提供参考.方法 收集2015年1～12月住院肾功能不全患者共83例,评价其基本用药情况、抗菌药物使用情况、医嘱不合理及药师干预情况和患者肾功能变化等.结果 入组患者平均年龄81岁,人均用药18种,用药数量最多的患者累计用药37种;入组患者共使用16种抗菌药物,其中使用频次最高的抗菌药物依次为莫西沙星、左氧氟沙星、阿奇霉素、替卡西林克拉维酸、哌拉西林他唑巴坦、头孢曲松等;总计对25例入组患者医嘱进行干预,占总入组人数的30.1％,干预的药物有8种,主要为药物给药剂量不合理.结论 正确评估患者肾功能,依据权威资料为医师提供用药建议,进而保证肾功能不全住院患者用药安全.

Drug intervention and analysis of renal insufficiency inpatients

Objective By evaluating the respiratory drug use in patients with renal insufficiency and clinical drug intervention, we can provide the rational drug use reference for the hospitalized patients. Methods 83 patients with renal insufficiency were collected from January to December in 2015 in our respiratory. The pharmacists evaluated the basic drug use, the antimicrobial agent use, the doctor''s unreasonable advice, the pharmacists intervention and the kidney function of patients, etc. Results The average age of patients was 81. There were 18 kinds drugs of the per capita use, the largest number of total drugs up to 37 kinds. The patients enrolled used 16 kinds of antimicrobial agents, the higher use frequency was Moxifloxacin, Levofloxacin, Azithromycin, Ticarcillin/clavulanic acid, Piperacillin/tazobactam, Ceftriaxone, etc. The number of intervention was 25 cases, accounting for 30.1% of the total group number. There were 8 kinds of drugs intervened, mainly for the dose was not reasonable. Conclusion Evaluating renal function of patients correctly, providing medical advice according to authoritative sources for the physician, all of these can ensure the drug safety of the hospitalized patients with renal insufficiency.