【摘要】 目的:设计基于"医-药-护-技"多学科协作的万古霉素治疗药物监测创新药学服务模式,评价其对万古霉素治疗有效性和安全性的改善效果及经济性。方法:耐甲氧西林金黄色葡萄球菌感染住院患者121例分为试验组(创新模式)和对照组(传统模式)。测定万古霉素血药浓度,以血药浓度达标率为中间指标,加强用药监护,以临床治疗有效率、不良反应发生率为结局指标,评价创新模式的实施效果;以药师服务时间成本、万古霉素药费、药师建议增加的检查费、不良反应处理成本作为成本指标;计算增量成本效果比。结果:试验组万古霉素血药浓度达标率较对照组明显提高(74.58%vs.33.87%,P=0.000),肾毒性发生率也明显降低(1.69%vs.12.90%,P=0.045),两组临床总体有效率差异无统计学意义(83.05%vs.72.58%,P=0.167)。血药浓度达标率每提高1%的增量成本-效果比为18.86元,肾毒性发生率每降低1%的增量成本-效果比为68.50元。结论:本研究构建的万古霉素治疗药物监测创新药学服务模式,能提高血药浓度达标率,降低不良反应风险,具有一定的经济性。更多还原

【Abstract】 Objective: To design an innovative pharmaceutical care model(PC model) based on a multidisciplinary team of physician-pharmacist-nurse-technician for therapeutic drug monitoring of vancomycin,and to evaluate its effectiveness and economics.Methods: Inpatients with methicillin resistant Staphylococcus aureus infection were included in the study according to inclusion and exclusion criteria,and divided into trial group(PC model) and control group(traditional model) randomly.The blood drug concentration of vancomycin was measured and the achievement rate of standard therapeutic trough level was calculated as the intermediate outcome.The total treatment effective rate and the incidence of adverse reactions were measured as the final outcome.Time cost of pharmaceutical service,drug cost of vancomycin,cost of additional examinations suggested by pharmacists,and treatment cost of adverse reactions of the two models were measured,and the incremental cost-effectiveness analysis(ICER) was conducted.Results: Compared with the traditional model,the PC model increased the achieving rate of vancomycin therapeutic trough level(74.58% vs.33.87%,P = 0.000),decreased the incidence of renal toxicity(1.69% vs.12.90%,P = 0.045),and showed no statistical difference in the treatment effective rate(83.05% vs.72.58%,P = 0.167).The incremental cost-effectiveness ratio(ICER) of increasing the achieving rate of therapeutic trough level by 1% was 18.86 yuan.And the ICER of reducing the incidence of renal toxicity by 1% was 68.50 yuan.Conclusion: The pharmaceutical care model of vancomycin therapeutic drug monitoring can improve the achievement of therapeutic trough level,reduce the risk of adverse reactions,and has certain economy.更多还原