PCNE分类系统在消化内科老年病人抗生素使用中的应用效果

doi:10.3969/j.issn.1003-9198.2025.06.007

摘要/Abstract

摘要： 目的研究欧洲药学监护联盟网(Pharmaceutical Care Network Europe, PCNE)分类系统在消化内科老年病人抗生素使用中的效果。方法采用随机数表法将2022年4月至2024年4月因消化系统疾病入住安徽医科大学附属阜阳医院消化内科的210例老年病人分为仅接受常规治疗的对照组和在对照组基础上增加基于PCNE分类系统药物干预的干预组,每组各105例。比较2组病人的基线资料、住院时间和感染治愈率。采用logistic回归分析影响老年消化系统疾病病人感染治愈率的因素。结果 2组病人的年龄、性别、基础疾病及感染情况差异均无统计学意义(P>0.05)。干预组共发现110个抗生素相关药物相关问题(DRPs),每个DRPs可从医生和病人两个层面进行干预,其中针对医生的干预共110个,针对病人的干预共34个。干预组医生和病人的DRPs干预接受率为95.14%(137/144),DRPs得到完全解决的比例为90.91%(100/110)。与对照组相比,干预组病人住院时间稍长,差异无统计学意义[(9.8±7.1)d比(8.6±5.3)d,P=0.166],感染治愈率更高,差异有统计学意义(94.29%比82.86%,P=0.016)。多元logistic回归分析显示,在校正了潜在混杂因素后,实施PCNE分类的DRPs干预是老年消化系统疾病病人感染治愈率的保护因素(OR=0.828,95%CI:0.625~0.922,P=0.028)。结论应用基于PCNE分类系统的DRPs干预对消化内科老年病人进行药学干预,可解决病人的抗生素相关DRPs,有助于提高病人的感染治愈率。

关键词: 欧洲药学监护联盟网分类系统, 消化道疾病, 老年人, 药学干预, 抗生素, 药物相关问题

Abstract: Objective To explore the effects of Pharmaceutical Care Network Europe (PCNE) classification system-based pharmaceutical intervention practice for the use of antibiotics in the elderly patients at Department of Gastroenterology. Methods A total of 210 inpatients with digestive system diseases at Department of Gastroenterology from April 2022 to April 2024 were divided into the control group (receiving routine treatment,n=105) and the intervention group(receiving PCNE classification system-based pharmaceutical intervention and routine treatment,n=105) by random number table method. The baseline data, the length of hospital stay and the cure rate of infection were compared between the two groups. Logistic regression analysis was used to explore the influencing factors for cure rate. Results There were no significant differences in the age, gender, type of digestive system disease, and status of infection between the two groups. A total of 110 antibiotics-related drug related problems(DRPs) were found in the intervention group. Each DRP was intervened at both the doctors (n=110) and patients (n=34) level. The acceptance rate of DRPs intervention was 95.14% (137/144). The percentage of DRPs fully resolved was 90.91% (100/110). The length of hospital stay in the intervention group was slightly longer than that in the control group but the difference was not statistically significant [(9.8±7.1) d vs(8.6±5.3) d,P=0.166]. Moreover, the cure rate of infection in the intervention group was higher than that in the control group (94.29% vs 82.86%, P=0.016). Multiple logistic regression analysis showed that the implementation of PCNE classification-based DRPs intervention was a protective factor for the infection cure rate in the elderly patients with digestive system diseases after adjusting for potential confounding factors (OR=0.828, 95%CI:0.625-0.922, P=0.028). Conclusions PCNE classification system-based pharmaceutical intervention can solve the antibiotics-related DRPs, and enhance the cure rate of infection in the elderly patients at Department of Gastroenterology.

Key words: Pharmaceutical Care Network Europe classification system, digestive system diseases, aged, pharmaceutical intervention, antibiotics, drug-related problems

中图分类号:

R194

范慢利, 韩怡. PCNE分类系统在消化内科老年病人抗生素使用中的应用效果[J]. 实用老年医学, 2025, 39(6): 565-569.

FAN Manli, HAN Yi. PCNE classification system-based pharmaceutical intervention practice for the use of antibiotics in elderly patients from the department of gastroenterology[J]. Practical Geriatrics, 2025, 39(6): 565-569.

参考文献

[1] WANG Y, HUANG Y, CHASER C, et al. Global burden of digestive diseases: a systematic analysis of the global burden of diseases study, 1990 to 2019[J]. Gastroenterology, 2023, 165(3): 773-783.e15.
[2] MADHU S G, JAMES E, VENUR P. Appropriateness of antibiotic usage for gastrointestinal disorders in a tertiary care hospital[J]. Eur J Hosp Pharm, 2016, 23(5): 283-287.
[3] HUISKESV J B, CRAMER-VANDER WELLEC M, VANDEN ENDEC H M, et al. Communication about drug-related problems (DRPs) during patients’visits to Dutch physicians and pharmacies[J]. Health Commun, 2020, 35(2): 201-208.
[4] 彭苗苗, 张桂凡. 引入PCNE分类系统对消化内科药物相关问题进行探索与实践[J]. 中南药学, 2022, 20(11): 2683-2688.
[5] CHAND C, CHENJ H, KUOH K, et al. Drug-related problems (DRPs) identified from geriatric medication safety review clinics[J]. Arch Gerontol Geriatr, 2012, 54(1): 168-174.
[6] 陈静, 刘海燕, 李建中, 等. 老年住院病人慢性病共病模式分析[J]. 实用老年医学, 2018, 32(8): 766-769.
[7] EICHENBERGERP M, LAMPERTM L, KAHMANNI V, et al. Classification of drug-related problems with new prescriptions using a modified PCNE classification system[J]. Pharm World Sci, 2010, 32(3): 362-372.
[8] Pharmaceutical Care Network Europe Association Classification for drug related problems V 9.1. The PCNE Classification V 91 [EB/OL]. (2022-02-28)[2024-08-28]. https://www.pcne.org/upload/files/417_PCNE_classification_V9-1_final.pdf.
[9] 国家药品监督管理局药品审评中心. 抗菌药物临床试验技术指导原则[EB/OL]. (2015-04-03)[2024-08-28]. https://www.cde.org.cn/zdyz/domesticinfopage?zdyzIdCODE=b73cb8c787d7d0b62a11b8847419778e.
[10] 丁琦, 阮琼艳. 欧洲医药保健网分类系统在老年科药物监测的应用效果分析[J]. 中国社区医师, 2023, 39(9): 13-15.
[11] 刘长月, 越伟. 抗菌药与癫痫发作的相关性[J]. 中国实用神经疾病杂志, 2023, 26(4): 503-508.
[12] 肖贵英, 李昕, 邓阳, 等. 抗菌药物的肾毒性机制及危险因素研究进展[J]. 中国抗生素杂志, 2022, 47(8): 779-785.
[13] 唐甜甜, 张永红. 网络毒理方法用于抗生素肝毒性预测的研究[J]. 国外医药:抗生素分册, 2022, 43(2): 65-69.
[14] 许伟, 吴剑卿. 衰弱综合征与老年肺部感染[J]. 实用老年医学, 2022, 36(8): 784-787.
[15] 朱丽明. 关注消化科老年患者的精神心理问题[J]. 实用老年医学, 2016, 30(9): 714-716.
[16] 杨涛, 龚婧如, 陆怡, 等. 不同分类系统医院抗菌药物医嘱药物相关问题分析[J]. 中国药业, 2021, 30(24): 121-125.