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目的:了解手术患者使用去甲万古霉素的应用情况,分析其用药合理性及费用。方法:回顾性随机抽取2002年253例使用去甲万古霉素的手术病例,对其使用合理性、不良反应、相关费用比等进行分析。结果:去甲万古霉素使用中的不合理情况存在于多个方面,其中以术前用药不按时(247/253,97.6%,P<0.001)、用药目的不当(235/253,92.9%,P<0.001)以及术后预防用药>2d(225/253,88.9%,P<0.001)为主;作为术前预防感染,去甲万古霉素与其他2～3种抗菌药联用8例,与同其作用拮抗的抗菌药联用11例;III类切口手术中仅1例做了细菌培养;出现1例寒战高热不良反应。去甲万古霉素平均药费1910.32元/例,占每例总药费的30.28%。结论:去甲万古霉素作为治疗革兰阳性细菌感染的最后选择,应严格遵循其适应症,即在手术预防感染中仅适用于耐甲氧西林金葡萄(MRSA)流行区域的某些手术,或在一些危重病人中为了避免感染带来的严重后果而使用该药。在使用期间应监测肾功能及听力,以减少其不良反应及细菌的耐药性。
Objective: To understand the use of norvancomycin in patients undergoing surgery and analyze its rationality and cost. Methods: A total of 253 surgical cases with norvancomycin in 2002 were retrospectively studied. The rationality, adverse reactions, and related cost ratio were analyzed. RESULTS: The unreasonable situation in the use of norvancomycin existed in many aspects. Among them, preoperative medication was not used on time (247/253, 97.6%, P <0.001), and the purpose of medication was improper (235 / 253,92.9% P <0.001) and postoperative prophylaxis> 2d (225 / 253,88.9%, P <0.001). As a preoperative infection prevention, nornicillin and other 2 ~ 3 antibacterials combined with 8 cases, In combination with antimicrobial agents that antagonized their effects, 11 patients were treated with bacterial culture in Class III incision surgery, and 1 patient suffered from chills and hyperthermia. The average cost of vancomycin to 1910.32 yuan / case, accounting for 30.28% of the total drug costs per case. CONCLUSIONS: Norvanomycin, as the final choice for the treatment of Gram-positive bacterial infections, should be guided strictly by its indications of certain surgeries that are only applicable to the endemic area of methicillin-resistant Grape (MRSA) during surgical prophylaxis, Or in some critically ill patients in order to avoid the serious consequences of infection and use the drug. During use should monitor renal function and hearing, in order to reduce its adverse reactions and bacterial resistance.