本文選題：頭孢菌素 + 皮試�。� 參考：《鄭州大學》2017年碩士論文

【摘要】：背景由于頭孢菌素在臨床上應用廣泛,是否對其進行皮膚過敏試驗目前在臨床上爭論不休,但國內(nèi)外并沒有直接證據(jù)支持其是否進行皮試。我院頭孢菌素的使用量極大,尤其在外科病區(qū),且對我院及其他幾家市級醫(yī)院的初步調(diào)查發(fā)現(xiàn),各個醫(yī)院對于頭孢菌素皮試的要求各不相同,院內(nèi)各科室對其要求不盡相同,有的科室采用原藥皮試,有的科室采用頭孢唑林鈉替代皮試,有些采用青霉素替代皮試,甚至有些科室不進行皮試,且其皮試液的配置濃度要求也各不相同,國內(nèi)各對各種頭孢菌素的皮試要求也不同,頭孢菌素皮試問題亟待我們重視及出臺相應的策略規(guī)范化其管理。目的1、對我院頭孢菌素注射劑皮試情況及皮試成本進行調(diào)查分析,初步判斷我院頭孢菌素皮試的基本情況。2、制定頭孢菌素類藥物臨床皮膚過敏試驗評估量表初表,為后期應用于臨床奠定基礎(chǔ)。方法1、采用回顧性分析的方法,統(tǒng)計出我院常用的8種頭孢菌素注射劑[頭孢硫脒(1.0 g)、頭孢硫脒(0.5 g)、頭孢替安(1.0 g)、頭孢替安(0.5 g)、頭孢他啶(0.5 g)、頭孢米諾(0.5 g)、頭孢米諾(1.0 g)、頭孢曲松鈉(1.0 g)]皮試情況,皮試相關(guān)費用,以及由于頭孢菌素過敏反應所產(chǎn)生的相關(guān)費用,并對頭孢菌素皮試費用與過敏反應的相關(guān)費用進行比較。2、以前期文獻研究及臨床經(jīng)驗作為基礎(chǔ),按患者自身因素及藥物因素兩方面設(shè)定調(diào)查指標,制定調(diào)查問卷,運用德爾菲法對20名專家進行問卷調(diào)查。結(jié)果1、我院100 330例使用這8種頭孢菌素注射劑患者的皮試率為82.49%,原藥皮試陽性率為6.27%,直接成本為3 434 411.72元,間接成本為141 985.12元,醫(yī)保承擔的費用為259 096.28元,全社會承擔的費用為3 576 396.84元;從全社會角度分析,頭孢菌素注射劑皮試成本為(447 049.61±247 395.07)元,皮試所減少的過敏反應成本為(298 545.76±263 160.29)元,皮試成本明顯高于通過皮試所減少的過敏反應成本,差異有統(tǒng)計學意義(P0.05)。2、兩輪專家積極系數(shù)分別為100%及90.0%,專家權(quán)威程度為0.763,協(xié)調(diào)系數(shù)分別為0.56及0.617,專家意見趨于一致,最終確定患者自身因素13個指標,藥物因素5個指標。
[Abstract]:Background because cephalosporins are widely used in clinical practice, whether to conduct skin allergy tests is controversial in clinical practice, but there is no direct evidence at home and abroad to support their skin tests. The use of cephalosporins in our hospital is very great, especially in the surgical area, and the preliminary investigation of our hospital and several other municipal hospitals shows that the requirements for cephalosporin skin test are different in each hospital, and the requirements for the cephalosporin skin test are different in different departments and departments of the hospital. Some departments use raw drug skin test, some departments use cefazolin sodium instead of skin test, some use penicillin instead of skin test, and even some departments do not carry out skin test, and the concentration requirements of skin test solution are different. All kinds of cephalosporins have different skin test requirements in our country. The problem of cephalosporin skin test is urgent for us to pay attention to and make corresponding strategies to standardize the management of cephalosporins. Objective 1. To investigate and analyze the skin test of cephalosporin injection and the cost of skin test in our hospital, to judge the basic condition of cephalosporin skin test in our hospital, and to make a preliminary scale for evaluating the clinical skin allergy test of cephalosporins. To lay the foundation for clinical application in later stage. Method 1. Retrospective analysis was used. Eight commonly used cephalosporin injections [cefathiramidine 1.0 g, cefathiraz 0.5 g, ceftiamil 1.0 g, ceftiamil 0.5 g, ceftazidime 0.5 g, cefminox 0.5 g, cefmino 1.0 g, ceftriaxone 1.0 g) were recorded. The related expenses of skin test and related expenses caused by cephalosporin allergic reaction were compared with those of allergic reaction. 2. Based on the previous literature research and clinical experience, the cost of skin test was compared with that of anaphylaxis. According to the patients' own factors and drug factors, the questionnaire was established, and 20 experts were investigated by Delphi method. Results 1. The skin test rate was 82.49, the positive rate of the original drug was 6.27, the direct cost was 3 434 411.72 yuan, the indirect cost was 141 985.12 yuan, the cost of medical insurance was 259 096.28 yuan. The cost of skin test of cephalosporin injection was 447 049.61 鹵247,395.07 yuan, and the cost of allergic reaction reduced by skin test was 298 545.76 鹵263 160.29 yuan. The cost of skin test was significantly higher than that of allergic reaction reduced by skin test. The difference was statistically significant (P 0.05). The positive coefficient of two rounds of experts was 100% and 90.0%, the degree of expert authority was 0.763, and the coordination coefficient was 0.56 and 0.617 respectively. Finally, 13 indexes of patients' own factors and 5 indexes of drug factors were determined.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R956
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本文編號：1873744