临床药师干预对中枢神经系统感染患者万古霉素用药效果的影响

目的探究临床药师干预中枢神经系统感染患者万古霉素用药的临床效果。方法选择金昌市中西医结合医院2016年10月-2019年10月收治的85例接受万古霉素治疗的中枢神经系统感染患者,依据患者用药期间是否有临床药师参与分为临床药师干预组(n=45)和对照组(n=40)。比较两组患者万古霉素用药情况及治疗效果,分析两组脑脊液炎症指标、肝功能指标以及肾功能指标水平变化差异。结果两组患者万古霉素用药时间和用药总量比较差异有统计学意义(P<0.05),临床药师干预组血药初始浓度稳定于治疗窗内患者比例(93.33%)显著高于对照组(70.00%),达到潜在中毒浓度患者比例(24.44%)显著低于对照组(47.50%)(P<0.05);临床药师干预组患者治疗总有效率(91.11%)显著高于对照组(67.50%)(P<0.05);两组患者治疗后脑脊液基质金属蛋白酶-9(MMP-9)、降钙素原(PCT)、白细胞介素(IL)-1β以及C-反应蛋白(CRP)等炎症指标水平均下降(P<0.05),且临床药师干预组患者上述指标降低幅度优于对照组(P<0.05);临床药师干预组患者肝功能指标碱性磷酸酶(ALP)、谷草转氨酶(AST)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、总胆红素(TBIL)水平显著低于对照组(P<0.05);临床药师干预组患者肾功能指标尿素氮、肌酐以及24 h尿蛋白水平显著低于对照组,白蛋白水平显著高于对照组(P<0.05)。结论临床药师参与中枢神经系统感染患者万古霉素用药干预可有效控制感染,提高万古霉素用药合理性,促进患者病情改善,减少药物所致不良反应以及肝肾毒副作用。

Impact of clinical pharmacist intervention on therapeutic effect of vancomycin on patients with central nervous system infection

OBJECTIVE To explore the impact of clinical pharmacist intervention on therapeutic effect of vancomycin on patients with central nervous system infection. METHODS A total of 85 patients with central nervous system infection who were treated with vancomycin in the Jinchang Integrated Hospital of Traditional Chinese and Western Medicine from Oct 2016 to Oct 2019 were enrolled in the study and divided into the clinical pharmacist intervention group with 45 cases and the control group with 40 cases according to the status of clinical pharmacists′ intervention during treatment.The status of use of vancomycin and therapeutic effects were compared between the two groups of patients, and the levels of cerebrospinal fluid inflammatory factors, liver function indexes and renal function indexes were observed and compared between the two groups. RESULTS There were significant differences in the time of use of vancomycin and total dosage between the two groups(P<0.05).The proportion of the patients with stable initial blood drug concentration within the treatment window was significantly higher in the clinical pharmacist intervention group(93.33%) than in the control group(70.00%), and the proportion of the patients with potential poisoning concentration was 24.44% in the clinical pharmacist intervention group, significantly lower than 47.50% in the control group(P<0.05).The total effective rate of treatment of the clinical pharmacist intervention group was 91.11%, significantly higher than 67.50% of the control group(P<0.05).The levels of cerebrospinal fluid inflammatory factors matrix metalloproteinase-9(MMP-9),procalcitonin(PCT),interleukin(IL)-1βand C-reactive protein(CRP) of the two groups were reduced after the treatment(P<0.05), and the levels of above indexes were reduced more significantly in the clinical pharmacist intervention group than in the control group(P<0.05).The levels of liver function indexes alkaline phosphatase(ALP),aspartate aminotransferase(AST),direct bilirubin(DBIL),alanine aminotransferase(ALT) and total bilirubin(TBIL) of the clinical pharmacist intervention group were significantly lower than those of the control group(P<0.05).The levels of renal function indexes urea nitrogen, creatinine and 24 h urine protein of the clinical pharmacist intervention group were significantly higher than those of the control group(P<0.05). CONCLUSION The clinical pharmacists′ intervention to the use of vancomycin may effectively control the infection, improve the rationality of medication, facilitate the improvement of illness condition and reduce the incidence of adverse reactions and side effects of liver and kidney toxicity induced by drugs.