药学监护对重症肺炎合并急性肾损伤患者万古霉素治疗效果的影响

目的：分析在临床药师干预下治疗重症肺炎合并肾功能损伤患者的疗效差别,探讨药学监护工作对万古霉素治疗效果的影响。方法：重症监护室102例MRSA肺炎合并肾功能损伤患者,均使用万古霉素,随机分为两组,监护组有临床药师提供药学监护,对照组无临床药师参与。比较两组疗效和不良反应等差异。结果：监护组与对照组万古霉素初始稳态浓度达到治疗窗率分别为70.0%和45.8%;两组有效率分别为74.1%和56.2%,不良反应发生率分别为9.3%和20.8%。上述数据比较,差异均有统计学意义（P〈0.05）。治疗后监护组54例患者平均肌酐清除率为（80.7±10.1）ml·min-1,高于对照组的（68.4±12.7）ml·min-1（P〈0.05）;监护组平均住院总费用为（42 302.2±2 465.4）元,药品总费用为（18 105.3±1 416.5）元,均分别低于对照组的（46 801.8±2 542.1）元和（22 886.1±1 446.7）元,差异有统计学意义（P〈0.05）。结论：临床药师参与重症患者给药方案的制定实施药学监护,能提高用药的合理性,改善预后,降低药物不良反应,减少费用支出。

Influence of Effect of Vancomycin by Pharmaceutical Care in Patients with Severe Pneumonia Complicated with Acute Renal Injury

Objective：To Analyse the difference of treatment effect on severe pneumonia complicated with acute renal injury by clinical pharmacist intervention, and discuss the influence on the effect of vancomycin by pharmaceutical care. nethods：102 cases of MRSA pneumonia patients with acute renal injury in intensive care unit, all used vancomycin, were randomly divided into two groups. Clinical pharmacists to participate in the group for monitoring group, no clinical pharmacists to participate in the group for the control group , By comparision of the differences in efficacy and adverse reac- tions in both groups. Results：The initial steady-state-concentrations of vancomycin treatment window rate Were 70.0% and 45.8% respectivelyin the monitoring group and the Control group , resulting in significant differences（ P 〈 0.05 ）, and the treatment effectiveness were 74.1% and 56.2% respectively, resulting in significant differences （P 〈0.05） ;incidence of adverse reactions were 9.3% and 20.8% respectively, resulting in significant differences （P〈 0.05）. Guardianship after monitoring group of 54 cases with average creatinine clearance was （80.7 ±10.1 ） ml· min- 1, which was higher than the control group of （68.4 ± 12.7 ） ml ·min - 1. The difference was statistically significant （ P 〈 0.05 ） ; Monitoring group of average hospitalization cost was （42 302.2 ± 2 465.4） yuan, lower than the control group （46 801.8 ±2 542.1 yuan）, the difference was statistically significant （P 〈 0.05） ;Monitoring group of drugs to the total cost was （18 105.3 ± 1 416.5 ） yuan, lower than the control group （22 886.1 ± 1 446.7 yuan）, the difference was statistically significant （ P 〈 0.05 ）. Conclusion： Clinical pharmacist involvement in patients with severe drug programme development and implementation of pharmaceutical care can improve the rationality of drugs used to improve efficacy and reduce adverse drug reactions.