Page 112 - 202011

临床药师在ICU感染性休克患者抗感染治疗中的作用 Δ

1 #
廖玉芳 ，李 飞 ，闫建华 ，司 可（1.重庆市黔江中心医院药学部，重庆 409099；2.重庆市黔江中心医院检
1＊
2
3
验科，重庆 409099；3.重庆市黔江中心医院重症医学科，重庆 409099）
中图分类号 R978.1；R969.3 文献标志码 A 文章编号 1001-0408（2020）11-1382-05
DOI 10.6039/j.issn.1001-0408.2020.11.17

摘 要 目的：探讨临床药师在重症加强护理病房（ICU）抗感染性休克治疗中的作用。方法：回顾性收集2018年1－12月重庆市
黔江中心医院ICU收治的感染性休克患者180例，按照临床药师是否全程参与抗感染治疗分为干预组（92例）和对照组（88例）。
两组患者均根据临床诊断给予常规治疗，在此基础上，临床药师全程参与干预组的抗感染治疗，包括参与药学查房、制订抗感染方
案、指导护士落实抗感染方案、为患者提供药学监护等。评价两组患者有效性、安全性和抗菌药物临床应用指标（如重点监控药品
使用比例、疗程、费用等）。结果：干预组患者治愈率（98.91％）显著高于对照组（93.18％），不良反应发生率（8.70％）显著低于对照
组（23.86％）；抗菌药物使用种类更加合理（如干预组和对照组患者碳青霉烯类使用比例分别为20.65％、36.36％，喹诺酮类使用比
例分别为15.22％、28.41％）；干预组患者抗菌药物使用时间[（15.18±2.25）d]显著短于对照组[（19.84±3.81）d]，人均抗菌药物费
用[（2 846.99±712.48）元]显著低于对照组[（3 991.26±577.82）元]，以上差异均有统计学意义（P＜0.05或P＜0.01）。结论：临床药
师全程参与ICU感染性休克患者的抗感染治疗，为患者提供药学服务，可提高抗感染疗效，减少药品不良反应及药源性疾病的发
生，优化抗菌药物的应用指标及降低医疗费用。
关键词 临床药师；重症加强护理病房；感染性休克；抗感染；药学服务

Role of Clinical Pharmacists in Anti-infective Therapy for Patients with Septic Shock in ICU
LIAO Yufang ，LI Fei ，YAN Jianhua ，SI Ke（1. Dept. of Pharmacy，Chongqing Qianjiang Central Hospital，
2
1
1
3
Chongqing 409099，China；2. Dept. of Clinical Laboratory，Chongqing Qianjiang Central Hospital，Chongqing
409099，China；3. Dept. of Critical Care，Chongqing Qianjiang Central Hospital，Chongqing 409099，China）
ABSTRACT OBJECTIVE：To explore the role of clinical pharmacists in anti-infective therapy in patients with septic shock in the
ICU. METHODS：A total of 180 patients with septic shock were retrospectively collected from ICU of Chongqing Qianjiang
Central Hospital during Jan.-Dec. 2018. According to whether clinical pharmacists participated in anti-infective therapy in the whole
process，the patients were divided into intervention group（92 cases）and control group（88 cases）. Both groups were given routine
treatment according to clinical diagnosis；on this basis，clinical pharmacists participated in the whole anti-infective therapy of the
intervention group，including participating in pharmaceutical rounds，formulating anti-infective programs，guiding nurses to
implement anti-infective plan，and providing pharmaceutical care for patients. The effectiveness，safety and antibiotics clinical use
indexes（such as proportion，treatment course and cost of key monitored drugs）were evaluated in 2 groups. RESULTS：The cure
rate of intervention group（98.91％）was significantly higher than that of control group（93.18％），while the incidence of ADR in
the intervention group （8.70％） was significantly lower than control group （23.86％）. The use of antibiotics types was more
rational（the proportion of carbapenems used in intervention group and control group were 20.65％，36.36％；those of quinolones
were 15.22％，28.41％，respectively）；the duration of antibiotics use in the intervention group [（15.18±2.25）d] was significantly
shorter than control group [（19.84±3.81）d]. The cost of antibiotics per capita [（2 846.99±712.48）yuan] was significantly lower
than control group [（3 991.26±577.82）yuan]，with statistical significance of all above（P＜0.05 or P＜0.01）. CONCLUSIONS：
Clinical pharmacists participating in the anti-infective treatment of ICU patients with septic shock and providing pharmaceutical
care，can improve the anti-infective effect，reduce adverse drug reactions and drug-induced diseases，optimize the use of antibiotics
and reduce medical cost.
KEYWORDS Clinical pharmacist；ICU；Septic shock；Anti-infection；Pharmaceutical care

感染性休克是临床表现为严重感染导致低血压持 续存在，且经充分的液体复苏仍难以纠正的急性循环衰

Δ 基金项目：重庆市黔江区科技计划项目（No.黔科计2018005） 竭。感染性休克可迅速导致严重的组织器官功能损伤，
＊主管药师，硕士。研究方向：临床药学。电话：023-79240186。 主要致死原因为多器官功能衰竭，患者的平均病死率可
E-mail：117411799@qq.com 达42.9％，因此早期识别并启动抗感染治疗可降低严重
# 通信作者：副主任药师。研究方向：临床药学。电话：023-
79240186。E-mail：17563241@qq.com 感染和感染性休克的病死率 [1-2] 。感染性休克患者的抗

·1382 · China Pharmacy 2020 Vol. 31 No. 11 中国药房 2020年第31卷第11期