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目的:探索潜在耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)感染患者关于万古霉素治疗药物监测(therapeutic drug monitoring,TDM)的价值观和意愿,并为中国万古霉素治疗药物监测指南的建立提供参考。方法:纳入中国5个省市的潜在MRSA感染的患者,调查其对万古霉素输注方式、是否给予负荷剂量及TDM必要性三项干预措施的的观点。使用视觉模拟评分(Visual Analogue Score,VAS)测量患者在安全、有效、经济、适当等方面评价药物治疗方案和措施的价值观。对于离散型变量和连续型变量分别采用χ~2检验和秩和检验。结果:本研究共纳入167名患者,其中有22名(13.17%)儿童。134名(80.24%)患者认为如果存在MRSA感染在治疗期间有必要进行万古霉素TDM,高医保报销比例患者与低医保报销比例患者间认为有必要进行万古霉素TDM的比例差异有统计学意义(65.77%vs 55.36%,P<0.05)。有104名(62.28%)患者更倾向于持续输注,儿童与其他人的差异有统计学意义(86.36%vs 58.62%,P<0.05。109名(65.27%)患者倾向于不接受万古霉素负荷剂量。患者对临床疗效的意愿强度为9,肾毒性意愿强度为9,花费意愿强度为5,负担意愿强度为5,其他因素的意愿强度为4。患者的医保类型(中位数5 vs 6.5,P<0.05)及收入(中位数6 vs 4,P<0.01)可能潜在影响患者在花费方面的价值观。结论:潜在MRSA感染患者对万古霉素治疗及万古霉素TDM的价值观和意愿在不同情况下出现较大差异。其可能是临床医生做临床决策的一个重要因素。在临床指南的建立过程中应考虑患者的价值观和偏好。
OBJECTIVE: To explore the value and willingness of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection for vancomycin treatment drug monitoring (TDM) and to evaluate the value of vancomycin treatment drug Monitoring guidelines for the establishment of reference. METHODS: Patients with potential MRSA infections were enrolled in five provinces and municipalities of China to investigate the impact of vancomycin infusion on three interventions: loading dose and TDM necessity. The use of Visual Analogue Score (VAS) measures the value of the patient’s evaluation of medication regimens and measures in terms of safety, efficacy, affordability, and appropriateness. For discrete variables and continuous variables were used χ ~ 2 test and rank sum test. Results: A total of 167 patients were enrolled in this study, of whom 22 (13.17%) were children. 134 patients (80.24%) considered that there was a significant difference in the proportion of vancomycin-TDM among patients with high Medicare reimbursement and those with a low Medicare reimbursement rate if MRSA infection was necessary for vancomycin TDM during treatment (65.77% vs 55.36%, P <0.05). 104 (62.28%) patients were more likely to have continuous infusion, and the difference between children and other people was statistically significant (86.36% vs 58.62%, P <0.05.109 (65.27%) Patients tended not to receive vancomycin Load dose.The patient’s willingness to clinical effect was 9, the willingness to kidney toxicity was 9, the willingness to spend 5, the willingness to load 5, and the willingness of other factors to be 4. The type of medical insurance for patients (median 5 vs 6.5, P <0.05), and income (median 6 vs 4, P <0.01) could potentially influence patient cost values.CONCLUSIONS: The value and willingness of patients with underlying MRSA for vancomycin treatment and vancomycin TDM Which may be one of the most important factors for clinicians to make clinical decisions.Patients’ values and preferences should be considered in the establishment of clinical guidelines.