【摘要】 目的 探讨抗菌药物临床应用路径管理对儿童社区获得性肺炎(CAP)住院患儿抗菌药物合理应用的效果和意义。方法 200例CAP住院患儿为研究对象,随机分为对照组和观察组,各100例。对照组抗菌药物的选用和治疗以临床经验决定,观察组实施抗菌药物临床应用路径管理模式。比较两组抗菌药物治疗前病原学送检率及阳性检出率、抗菌药物使用强度、住院时间、住院费用、药费、抗菌药物费用及疗效。结果 观察组患儿治疗前病原学送检率及阳性检出率分别70.00%(70/100)、34.29%(24/70),对照组患儿分别为69.00%(69/100)、27.54%(19/69)。两组患儿治疗前病原学送检率及阳性检出率比较,差异无统计学意义(χ~2=0.024、0.741, P=0.878、0.389>0.05)。观察组患儿中非限制使用级、限制使用级、特殊使用级抗菌药物用药频度(DDDs)分别占总DDDs的46.21%、52.73%、1.06%,对照组分别为32.91%、66.50%、0.59%。观察组患儿总DDDs为244.82,总住院天数为613 d,抗菌药物使用强度(AUD)为39.94 DDDs；对照组患儿总DDDs为272.50,总住院天数为677 d, AUD为40.25 DDDs。观察组患儿AUD略低于对照组患儿。观察组患儿住院时间6.00(2.00)d短于对照组的7.00(1.75)d,住院费用3893.00(1419.84)元、药费1451.64(779.93)元、抗菌药物费用502.75(364.90)元低于对照组的4381.54(1422.50)、1713.00(744.19)、638.00(351.79)元,差异均具有统计学意义(P<0.05)。两组患儿有效率均为100.00%；观察组患儿治愈率89.00%高于对照组患儿的78.00%,差异有统计学意义(P<0.05)。结论 实施抗菌药物临床应用路径管理模式能够促进儿童CAP抗菌药物的合理使用,明显缩短住院时间,降低住院费用,有效提高医疗质量,值得临床推广。更多还原

【Abstract】 Objective To discuss the effect and significance of implementing clinical application pathway management on the rational use of antimicrobial drugs for hospitalized children with communityacquired pneumonia(CAP). Methods A total of 200 hospitalized children with CAP were studied and randomly divided into a control group and an observation group, with 100 cases in each group. In the control group, the selection and treatment of antimicrobial drugs was determined by clinical experience, while the observation group implemented clinical application pathway of antibacterial drugs. Both groups were compared in terms of rates of sample submission and pathogen positive detection before antimicrobial treatment, antibacterial use density,hospitalization time, costs of hospitalization, drug cost, costs of antimicrobial drugs, and efficacy. Results Before treatment, the rates of sample submission and pathogen positive detection in the observation group were 70.00%(70/100) and 34.29%(24/70), which were 69.00%(69/100) and 27.54%(19/69) in the control group. Before treatment, there was no statistically significant difference in rates of sample submission and pathogen positive detection between the two groups(χ~2=0.024, 0.741; P=0.878, 0.389>0.05). The defined daily dose system(DDDs)of non-restricted-use, restricted-use, and special-use antibiotics in the observation group accounted for 46.21%,52.73%, and 1.06% of the total DDDs, while those in the control group were 32.91%, 66.50%, and 0.59%. In the observation group, the total DDDs was 244.82, the total hospitalization time was 613 d, and the antibiotics use density(AUD) was 39.94 DDDs; in the control group, the total DDDs was 272.50, the total hospitalization time was 677 d, and the AUD was 40.25 DDDs. The AUD of the observation group was slightly lower than that of the control group. In the observation group, the hospitalization time was 6.00(2.00) d, which was shorter than 7.00(1.75) d in the control group; the costs of hospitalization was 3893.00(1419.84) yuan, the drug cost was 1451.64(779.93)yuan, and the costs of antimicrobial drugs was 502.75(364.90) yuan, which were lower than 4381.54(1422.50),1713.00(744.19), and 638.00(351.79) yuan in the control group; the differences were all statistically significant(P<0.05). The effective rate in both groups was 100.00%. The cure rate of the observation group was 89.00%,which was higher than 78.00% of the control group, and the difference was statistically significant(P<0.05).Conclusion The implementation of clinical application pathway of antibacterial drugs can promote rational drug use in children with CAP, significantly shorten the hospitalization time and costs of hospitalization, and effectively improve the quality of medical treatment, which is worthy of clinical promotion.更多还原