基层医院非感染性发热性疾病抗生素应用调查分析
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[摘要] 目的:了解近年来基层医院在非感染性发热性疾病对抗菌药物的应用状况。方法:回顾性调查某二级医院2007～2008年除外感染明确的内科和外科发热性病例560例,调查每例发热患者及相关辅助检查,出院诊断和抗菌药物使用情况。结果:本组560例非感染性发热性疾病患者治疗中未使用抗菌药物治疗者219例(39.11%),使用抗菌药物者341例(60.89%)。560例中体温≥40℃者共145例,全部使用了抗菌药物(100.00%),涉及使用的抗菌药物共6大类13个品种,使用最多的是头孢菌素,以第三代头孢菌素为主,其他依次为喹诺酮类抗菌素、克林霉素及林可霉素、抗结核药、氨基糖苷类抗菌素和美他环素。结论:该基层医院对非抗染性发热性疾病抗生素的不合理使用情况较为突出,建议仍需进一步加强对基层医院医务人员抗菌素药物合理使用的教育、宣传与管理工作,以防止细菌耐药性的产生。
[关键词] 发热;非感染性疾病;抗生素
[中图分类号] R969.3[文献标识码] A [文章编号] 1673-7210(2010)06(a)-180-02
Analysis on application of antibiotic in non-infectious febrile diseases in the grass-roots hospitals
YANG Anzhong, SU Zunwei
(The Second People's Hospital in Neijiang City, Neijiang 641003, China)
[Abstract] Objective: To learn about the application of antimicrobial agents in non-infectious febrile diseases in the grass-roots hospitals in recent years. Methods: We had a retrospective survey of 650 fever cases except for clear medical and surgical cases and to investigate all the fever patents and their related examinations the discharge diagnosis and the use of antibacterial drugs in a second-class hospital from 2007 to 2008. Results: In the 560 patients, suffering from non-infectious febril disease 219 cases (39.11%) were not given antimicrobial agents and 341 cases (60.89%) were given antimicrobial agents in the treatment. 145 patients whose body temperature ≥40℃ in 560 cases were all given antimicrobial agents (100.00%). The used antimicrobial agents, in total had 13 varieties of six categories, cephalosporins, mainly the third generation cephalosporins was used most frequently. Others antibiotics were quinolones, clindamycin and lincomycin, anti-tuberculosis drugs, amino sugar glycosides antibiotics and the united he cyclophilin. Conclusion: In the primary hospital the irrational use of antibiotics for non-anti-infectious febrile disease is more prominent, recommendations in order to prevent the emergence of bacterial resistance, the education, publicity and managerment of the rational use of antibiotic drugs is still needed to further strengthen in the primary hospital medical staff.
[Key words] Fever; Non-infectious diseases; Atibiotic
对于发热性疾病,特别是非感性疾病的发热采用抗生素治疗是不合理应用抗菌素的内容之一。为了了解近年来基层医院对非感染性发热性疾病抗菌素应用状况笔者对某基层医院进行了调查。现报道如下:
1 资料与方法
1.1一般资料
采用回顾性调查方法调查某二级医院2007～2008年除外感染病灶明确的内科和外科发热病例560例,其中男345例,女215例,年龄16～65岁,平均(38.56±3.48)岁。平均住院时间(11.72±2.75) d,最长住院时间29 d。
1.2 调查内容
1.2.1 使用抗菌药物前临床表现及相关检查560例患者自入院前或入院后均有不同程度发热,体温为37.5～41.2℃,平均38.7℃,热程2.5～14 d,均无明显畏寒及寒战,精神及食欲较佳;全部患者血、尿、大便常规均无异常。384例血细菌培养均阴性,349例咽拭子查霉菌均为阴性。476例胸片检查均无异常。
1.2.2 出院诊断疾病560例非感染性发热性疾病病因见表1。
表 1 560例非感染性发热性疾病病因分类
2 结果
2.1 一般结果
本组560例非感染性发热性疾病患者治疗中未使用抗菌药物治疗者219例(39.11%),使用抗菌药物者341例(60.89%)。560例中体温≥40℃者共145例,全部使用了抗菌药物(100.00%),体温为38～39℃者共310例,151例使用抗菌药物(48 ......
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