Objective:To estabilish a safe medication mode of linezolid by using PDCA cycle management method,and then optimize the dosage regimen of linezolid and improve the standard-reaching rate of steady-state minimum concentration(Cssmin)and area under the plasma concentration-time curve from time 0-24 h(AUC24)within the target range,so as to reduce adverse drug reactions(ADRs)such as linezolid induced thrombocytopenia(LIT)in critical illness patients.Methods:199 critical illness patients,treated with linezolid and monitored for Cssmin,were selected from the Intensive Care Unit and Emergency Intensive Care Unit of the Affiliated Suzhou Hospital of Nanjing Medical University from July 2020 to June 2022.Patients who did not use PDCA cycle management method for pharmaceutical care from July 2020 to June 2021 were set as the control group(n=87),and patients who used PDCA cycle management method for pharmaceutical care from July 2021 to June 2022 were set as the intervention group(n=112).The adjustment of the dosage regimen of linezolid,the standard-reaching rate of Cssmin and AUC24,and the occurrence of ADRs such as LIT were analyzed and compared between the two groups.Results:The proportion of patients adjusting linezolid's dosage regimen in the intervention group was much higher than that in the control group(53.57%vs 29.88%,P=0.012).The proportion of patients in the intervention group with Cssmin in the target range of 2-7 mg/L after the initial regimen of linezolid was significantly higher than that in the control group(46.43%vs 12.64%,P＜0.001),while the proportion of patients in the intervention group with Cssmin＞10 mg/L after the initial regimen of linezolid was significantly lower than that in the control group(25.00%vs 58.62%,P＜0.001).The proportion of linezolid's AUC24 within 100～300 mg·h/L in the intervention group was significantly higher than that in the control group(51.78%vs 26.43%,P=0.012),while the proportion of linezolid's AUC24＞350 mg·h/L after the initial regimen in the intervention group was significantly lower than that in the control group(14.94%vs 55.35%,P＜0.001).After treatment with linezolid,21 cases of LIT occurred in the control group,while only 12 cases in the intervention group,the difference was statistically significant(P=0.003).The incidence of other ADRs was also lower in the intervention group than in the control group(0.89%vs 6.90%,P= 0.031).Conclusion:Through the implementation of PDCA cycle management,the standard-reaching rate of linzolid Cssmin and AUC24 was significantly improved,while the incidence of LIT and other ADRs was significantly decreased,thus increasing the medication safety of patients.
关键词
利奈唑胺/PDCA循环法/药学服务模式/药学干预/治疗药物监测/稳态谷浓度
Key words
linzolid/PDCA cycle management method/pharmaceutical care model/pharmacists intervention/ther-apeutic drug monitoring/steady-state minimum concentration
维普
万方数据