摘要:
目的 描述因肺炎住院儿童使用肠道微生态制剂的相关特征,评估肠道微生态制剂的临床应用效果。 方法 以上海市儿童医院2012年度因肺炎住院儿童的用药医嘱记录为研究对象,描述性统计药物人群暴露量以及抗菌药物、肠道微生态制剂使用率与治疗开始时间,比较肠道微生态制剂治疗前后使用的抗菌药物品种数量、肠道微生态制剂合用及未合用的住院时间、止泻药治疗比例与时间等。 结果 2 974人次用药医嘱纳入分析,接受抗感染药物治疗者2 948人次(99.1%)、肠道微生态制剂治疗者1 252人次(42.1%)、合并抗菌药物以及肠道微生态制剂治疗者1 246人次(41.9%)。肠道微生态制剂起始治疗时间中位数为住院的第2天、众数为第1天。合并抗感染及菌群调节治疗者中,使用肠道微生态制剂前抗菌治疗时间中位数为3 d,众数为1 d。肠道微生态制剂使用后抗菌治疗中位数为5 d,众数为4 d;肠道微生态制剂菌群调节治疗时间的中位数、众数均为4 d。肺炎住院儿童中使用止泻药者626人次(21.0%),主要集中在新生儿组和婴儿组。抗菌治疗合用肠道微生态制剂、未合用肠道微生态制剂的儿童分别有585人次(47.0%)、34人次(2.0%)接受止泻治疗,有显著性差异(P<0.05)。合用肠道微生态制剂接受止泻治疗时间中位数为4 d,众数为3 d,四分位数Q1、Q3分别为2 d、6 d;未合用肠道微生态制剂接受止泻治疗时间中位数为3 d,众数为1 d,四分位数Q1、Q3分别为1 d、6 d,两组接受止泻治疗的时间没有显著性差异。抗菌治疗合用肠道微生态制剂的住院时间的中位数为7 d,众数为6 d,四分位数Q1、Q3分别为6 d、9 d;未合用肠道微生态制剂的住院时间的中位数、众数均为7 d,四分位数Q1、Q3分别为6 d、9 d,两组住院时间没有显著性差异。 结论 因肺炎住院儿童首次使用肠道微生态制剂主要在入院第2天,以预防使用为主。合用肠道微生态制剂对后续抗菌治疗的时间、止泻治疗时间、总体住院时间没有影响。菌群调节治疗措施对肺炎儿童的治疗协同效果需要进一步研究。
Abstract:
Objective To describe the profile of probiotics utilization in hospitalized pneumonia children and evaluate the effectiveness of probiotics in the treatment of pneumonia in hospitalized children combined with antibiotics. Methods Descriptive data analysis was obtained from the medical records in one children's hospital in one year period. The clinical data including patient characteristics, drug prescribed time, drug use duration, and length of stay was reviewed. Ridit analysis was used to compare the data. Results Data of 2 974 children hospitalized for pneumonia was accessed. Antibiotics were prescribed to 99.1% (n=2 948) of patients, probiotics were prescribed to 42.1% (n=1 252) of patients, and both antibiotics and probiotics were prescribed to 41.9%(n=1 246). The median of the time to start administration of probiotics was the second day of hospitalization and the mode was the first day of hospitalization. For those patients who were prescribed antibiotics combined with probiotics, the median of the duration of administration of antibiotics before accepting probiotics was 3 days and the mode was 1 day. After administrating probiotics, the median of the duration of accepting of antibiotics was 5 days, the mode was 4 days, and the median and the mode of the duration of administration of probiotics were 4 days. 21% (n=626) of all hospitalized patients were administrated anti-diarrheals. The most common age group of them were neonates and infants (82.3%, n=515). The patients with anti-diarrheal who was administrated antibiotics with or without probiotics were 585(47.0%), 34(2.0%), respectively (P<0.05). The median of duration of anti-diarrheals in those administrated antibiotics with probiotics was 4 days, the mode was 3 days and the interquartile range was 2-6 days. For those administrated antibiotics without probiotics, the median of duration of anti-diarrheals was 3 days, the mode was 1 day and the interquartile range was 1-6 days (P>0.05). The median of the length of stay in those administrated antibiotics with probiotics was 7 days, the mode was 6 days and the interquartile range was 6-9 days. For those administrated antibiotics without probiotics, the median and the mode of the length of stay were 7 days and the interquartile range was 6-9 days(P>0.05). Conclusion The time of starting to administrate probiotics was mainly within 2 days combined with antibiotics. The aim of prescribed probiotics was prevention of antibiotic-associated diarrhea. There was no significant difference in the duration of the following antibiotic therapy, the duration of anti-diarrhea therapy, the length of stay between those administrated antibiotics combination with or without probiotics.
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