導語(yu)：兒科抗菌藥(yao)物超藥(yao)品使用說明書使用現況一文來(lai)源于(yu)網友上傳(chuan)，不代表本(ben)站觀點(dian)，若需要(yao)原創(chuang)文章可咨(zi)詢客服老(lao)師，歡迎參考。

摘要：目的分析兒科抗菌藥物超藥品使用說明書使用現況，以(yi)(yi)為(wei)(wei)臨(lin)床規范、安(an)全用(yong)(yong)(yong)藥(yao)(yao)(yao)合(he)理(li)(li)(li)化建議提供可靠依據。方法選(xuan)取(qu)鄲城縣人民醫院２０２１年１月(yue)(yue)至２０２２年５月(yue)(yue)含(han)抗菌藥(yao)(yao)(yao)物處方４８６份(fen)進行研究(jiu)，分析不(bu)合(he)理(li)(li)(li)應(ying)用(yong)(yong)(yong)現況(kuang)(kuang)。結(jie)果抗菌藥(yao)(yao)(yao)物包括口服劑型３５０例(li)（以(yi)(yi)頭孢克洛為(wei)(wei)主，占比２３.６６％）與靜(jing)脈給(gei)藥(yao)(yao)(yao)劑型２３５例(li)（以(yi)(yi)頭孢呋(fu)辛鈉為(wei)(wei)主，占比１８.７２％）。含(han)抗菌藥(yao)(yao)(yao)物處方用(yong)(yong)(yong)藥(yao)(yao)(yao)涉及疾病類型較(jiao)多，主要為(wei)(wei)呼吸系統感染，占比為(wei)(wei)８２.７１％。含(han)抗菌藥(yao)(yao)(yao)物處方內單一用(yong)(yong)(yong)藥(yao)(yao)(yao)３６９例(li)［２３６例(li)單一口服（４８.５６％），１３３例(li)單一靜(jing)脈（２７.３７％）］，二聯用(yong)(yong)(yong)藥(yao)(yao)(yao)主要為(wei)(wei)序貫(guan)用(yong)(yong)(yong)藥(yao)(yao)(yao)，以(yi)(yi)靜(jing)脈用(yong)(yong)(yong)藥(yao)(yao)(yao)頭孢呋(fu)辛鈉、口服頭孢呋(fu)辛酯為(wei)(wei)主，占比１１.１１％。抗菌藥(yao)(yao)(yao)物處方中合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)為(wei)(wei)３３４例(li)，占比６８.７２％，不(bu)合(he)理(li)(li)(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)為(wei)(wei)１５２例(li)，占比３１.２８％；用(yong)(yong)(yong)藥(yao)(yao)(yao)不(bu)合(he)理(li)(li)(li)原(yuan)因以(yi)(yi)無(wu)指征用(yong)(yong)(yong)藥(yao)(yao)(yao)為(wei)(wei)主，其次為(wei)(wei)不(bu)合(he)理(li)(li)(li)的用(yong)(yong)(yong)法用(yong)(yong)(yong)量(liang)與藥(yao)(yao)(yao)物選(xuan)擇(ze)。結(jie)論兒科抗菌藥(yao)(yao)(yao)物存在(zai)應(ying)用(yong)(yong)(yong)不(bu)合(he)理(li)(li)(li)狀(zhuang)況(kuang)(kuang)，以(yi)(yi)無(wu)指征用(yong)(yong)(yong)藥(yao)(yao)(yao)、用(yong)(yong)(yong)法用(yong)(yong)(yong)量(liang)不(bu)合(he)理(li)(li)(li)及藥(yao)(yao)(yao)物選(xuan)擇(ze)不(bu)合(he)理(li)(li)(li)等為(wei)(wei)主。

關鍵詞：抗菌藥(yao)物；處方點(dian)評；不合理用(yong)藥(yao)；現(xian)況(kuang)；合理建(jian)議

抗(kang)菌(jun)藥(yao)(yao)(yao)物(wu)(wu)為(wei)抑制或滅殺病原(yuan)菌(jun)的(de)藥(yao)(yao)(yao)物(wu)(wu)，用于預(yu)防感染、治療(liao)感染，使用廣泛［１］。兒(er)童因(yin)生(sheng)理(li)未發育(yu)完善，致使免疫(yi)功能欠佳，進而極(ji)易產生(sheng)感染類疾病［２］。相關報道顯示，兒(er)科(ke)(ke)門診中不(bu)合理(li)使用抗(kang)菌(jun)藥(yao)(yao)(yao)物(wu)(wu)處(chu)方約３０％［３］。兒(er)童腎、肝未發育(yu)成熟，部分(fen)藥(yao)(yao)(yao)物(wu)(wu)于排泄、代謝、分(fen)布及(ji)吸收(shou)等具有特(te)殊(shu)性，若抗(kang)菌(jun)藥(yao)(yao)(yao)應(ying)用不(bu)合理(li)，易引起(qi)菌(jun)群失調、耐藥(yao)(yao)(yao)菌(jun)、增加(jia)二重感染和不(bu)良反應(ying)等，對兒(er)童生(sheng)長產生(sheng)嚴(yan)重的(de)負面影(ying)響［４－５］。為(wei)了解兒(er)科(ke)(ke)含(han)抗(kang)菌(jun)藥(yao)(yao)(yao)物(wu)(wu)處(chu)方的(de)應(ying)用狀況，本(ben)研究(jiu)選取兒(er)科(ke)(ke)含(han)抗(kang)菌(jun)藥(yao)(yao)(yao)物(wu)(wu)處(chu)方４８６份，分(fen)析抗(kang)菌(jun)藥(yao)(yao)(yao)物(wu)(wu)應(ying)用現況。

１資料和方法

１．１一般資料(liao)選取２０２１年１月(yue)至(zhi)２０２２年５月(yue)鄲城縣(xian)人民醫院含(han)抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)處(chu)(chu)方(fang)(fang)４８６份進行(xing)(xing)研究，其中患兒男２７２例，女２１４例，年齡３～１２（７.５４±１.９０）歲，體(ti)質量(liang)指(zhi)數(shu)（ｂｏｄｙｍａｓｓｉｎｄｅｘ，ＢＭＩ）１５.７～２１.２（１８.９６±１.０２）ｋｇ·ｍ－２。納入(ru)標準(zhun)：兒科診療(liao)；患兒用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)處(chu)(chu)方(fang)(fang)中含(han)抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)，且(qie)抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)是注(zhu)射(she)劑型或口服劑型。排除標準(zhun)：臨(lin)床資料(liao)不全(quan)；外用(yong)(yong)(yong)制(zhi)(zhi)(zhi)劑或中藥(yao)(yao)(yao)(yao)制(zhi)(zhi)(zhi)劑抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)。１．２調查(cha)評估(gu)方(fang)(fang)法１．２．１信息(xi)調查(cha)準(zhun)備期間制(zhi)(zhi)(zhi)定調查(cha)表，記(ji)錄抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)信息(xi)，即名稱、用(yong)(yong)(yong)法用(yong)(yong)(yong)量(liang)、規格、聯合(he)狀況、溶媒(mei)等。１．２．２質量(liang)控制(zhi)(zhi)(zhi)創建點評組(zu)，評估(gu)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)情(qing)況、反(fan)饋信息(xi)。１．２．３評估(gu)標準(zhun)依據(ju)《醫療(liao)機構處(chu)(chu)方(fang)(fang)審核規范》［６］、《抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)臨(lin)床應用(yong)(yong)(yong)指(zhi)導原則》［７］、《抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)超說明(ming)書用(yong)(yong)(yong)法專(zhuan)家共識》［８］、藥(yao)(yao)(yao)(yao)品(pin)說明(ming)書等，制(zhi)(zhi)(zhi)定《抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)處(chu)(chu)方(fang)(fang)合(he)理(li)使用(yong)(yong)(yong)點評標準(zhun)與(yu)細則》。從用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)禁(jin)(jin)忌、用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)指(zhi)征(zheng)、配伍禁(jin)(jin)忌、給藥(yao)(yao)(yao)(yao)途徑或選用(yong)(yong)(yong)劑型、用(yong)(yong)(yong)法用(yong)(yong)(yong)量(liang)、藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)選擇、需皮(pi)試(shi)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)、用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)療(liao)效、溶媒(mei)選擇、聯合(he)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)等方(fang)(fang)面進行(xing)(xing)評估(gu)。１．３觀察指(zhi)標（１）含(han)抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)的(de)處(chu)(chu)方(fang)(fang)中涉及的(de)疾病種類、抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)的(de)應用(yong)(yong)(yong)狀況。（２）含(han)抗(kang)菌(jun)(jun)藥(yao)(yao)(yao)(yao)物(wu)(wu)(wu)的(de)處(chu)(chu)方(fang)(fang)中的(de)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)狀況。（３）統計(ji)不合(he)理(li)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)的(de)原因和類型狀況。１．４統計(ji)學(xue)方(fang)(fang)法利用(yong)(yong)(yong)Ｅｘｃｅｌ２０１３實施數(shu)據(ju)錄入(ru)、分(fen)析(xi)，獲得數(shu)據(ju)以例數(shu)（ｎ）或構成比（％）表示(shi)。

２結果

２．１兒(er)科含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)處(chu)方(fang)涉(she)及的(de)疾病種(zhong)類(lei)與抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)應用(yong)(yong)狀(zhuang)況４８６例(li)(li)(li)患(huan)兒(er)中，含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)處(chu)方(fang)涉(she)及的(de)疾病類(lei)型較(jiao)多，主要為呼吸系(xi)統(tong)感(gan)染，占８２.７１％。含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)處(chu)方(fang)內(nei)(nei)應用(yong)(yong)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)包括(kuo)口(kou)服劑(ji)型３５０例(li)(li)(li)（以(yi)頭孢克洛為主，占２３.６６％）與靜脈給(gei)藥(yao)(yao)(yao)(yao)劑(ji)型２３５例(li)(li)(li)（以(yi)頭孢呋辛鈉為主，占１８.７２％）。２．２兒(er)科含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)處(chu)方(fang)中的(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)狀(zhuang)況４８６例(li)(li)(li)患(huan)兒(er)內(nei)(nei)，含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)的(de)處(chu)方(fang)中單(dan)一(yi)(yi)用(yong)(yong)藥(yao)(yao)(yao)(yao)３６９例(li)(li)(li)［２３６例(li)(li)(li)單(dan)一(yi)(yi)口(kou)服（４８.５６％）；１３３例(li)(li)(li)單(dan)一(yi)(yi)靜脈（２７.３７％）］，二聯用(yong)(yong)藥(yao)(yao)(yao)(yao)主要為序貫(guan)用(yong)(yong)藥(yao)(yao)(yao)(yao)，以(yi)靜脈用(yong)(yong)藥(yao)(yao)(yao)(yao)頭孢呋辛鈉和口(kou)服頭孢呋辛酯為主，占比為１１.１１％。見(jian)表(biao)３、４。２．３不(bu)(bu)合(he)(he)理(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)的(de)原(yuan)(yuan)因、類(lei)型狀(zhuang)況８０例(li)(li)(li)患(huan)兒(er)內(nei)(nei)，含(han)(han)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)物(wu)處(chu)方(fang)內(nei)(nei)合(he)(he)理(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)為３３４例(li)(li)(li)，占比為６８.７２％，不(bu)(bu)合(he)(he)理(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)為１５２例(li)(li)(li)，占比為３１.２８％；不(bu)(bu)合(he)(he)理(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)的(de)原(yuan)(yuan)因以(yi)無指征用(yong)(yong)藥(yao)(yao)(yao)(yao)為主，其次是不(bu)(bu)合(he)(he)理(li)的(de)用(yong)(yong)法用(yong)(yong)量、藥(yao)(yao)(yao)(yao)物(wu)選擇。見(jian)表(biao)５。

３討論

世(shi)界衛(wei)生(sheng)(sheng)(sheng)組織發(fa)布的(de)(de)(de)(de)(de)(de)相(xiang)(xiang)關(guan)報告顯示，抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)耐(nai)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)性(xing)(xing)(xing)已(yi)對(dui)(dui)人類(lei)(lei)健(jian)康產生(sheng)(sheng)(sheng)嚴重威脅(xie)。抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)在(zai)(zai)兒(er)(er)(er)(er)科(ke)(ke)(ke)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)廣泛，其引起的(de)(de)(de)(de)(de)(de)不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)也(ye)較(jiao)多(duo)(duo)［９］。研究(jiu)顯示，國(guo)內小兒(er)(er)(er)(er)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)發(fa)生(sheng)(sheng)(sheng)率約為(wei)(wei)(wei)(wei)１２.９％，其中(zhong)(zhong)引起不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)較(jiao)多(duo)(duo)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)是(shi)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)［１０］。近幾年，隨(sui)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)種(zhong)類(lei)(lei)與用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)量(liang)(liang)的(de)(de)(de)(de)(de)(de)增(zeng)(zeng)加(jia)，慢(man)慢(man)出現(xian)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)的(de)(de)(de)(de)(de)(de)現(xian)象，要(yao)求(qiu)提(ti)高(gao)(gao)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)管(guan)理(li)(li)［１１］。處(chu)(chu)(chu)方點(dian)評(ping)是(shi)完善(shan)(shan)醫(yi)(yi)(yi)(yi)院醫(yi)(yi)(yi)(yi)療(liao)(liao)質(zhi)(zhi)量(liang)(liang)的(de)(de)(de)(de)(de)(de)重要(yao)途徑，通過評(ping)判處(chu)(chu)(chu)方中(zhong)(zhong)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)性(xing)(xing)(xing)，為(wei)(wei)(wei)(wei)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)提(ti)供建議。對(dui)(dui)于(yu)(yu)(yu)(yu)醫(yi)(yi)(yi)(yi)院兒(er)(er)(er)(er)科(ke)(ke)(ke)含(han)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)處(chu)(chu)(chu)方實施(shi)點(dian)評(ping)，有(you)助于(yu)(yu)(yu)(yu)改(gai)善(shan)(shan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)、保(bao)(bao)障(zhang)的(de)(de)(de)(de)(de)(de)安全性(xing)(xing)(xing)。本研究(jiu)顯示，４８６例患(huan)兒(er)(er)(er)(er)含(han)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)處(chu)(chu)(chu)方中(zhong)(zhong)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)的(de)(de)(de)(de)(de)(de)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)主要(yao)為(wei)(wei)(wei)(wei)口(kou)(kou)(kou)服(fu)(fu)(fu)劑型，與“能口(kou)(kou)(kou)服(fu)(fu)(fu)不(bu)(bu)(bu)(bu)注(zhu)射、能肌(ji)注(zhu)不(bu)(bu)(bu)(bu)靜(jing)注(zhu)”的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)原(yuan)則一致。靜(jing)脈給(gei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)可(ke)(ke)快速(su)起效，但(dan)兒(er)(er)(er)(er)童(tong)對(dui)(dui)靜(jing)脈給(gei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)較(jiao)為(wei)(wei)(wei)(wei)敏(min)感(gan)(gan)(gan)和(he)(he)抗(kang)(kang)(kang)(kang)(kang)拒(ju)，且可(ke)(ke)能出現(xian)靜(jing)脈炎、急性(xing)(xing)(xing)肺水腫等(deng)［１２－１３］。基于(yu)(yu)(yu)(yu)以(yi)(yi)上(shang)結果(guo)(guo)，聯(lian)合(he)(he)(he)(he)(he)(he)(he)ＤＤＤｓ結果(guo)(guo)可(ke)(ke)知，兒(er)(er)(er)(er)科(ke)(ke)(ke)中(zhong)(zhong)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)頭(tou)孢克洛及(ji)阿(a)奇霉(mei)素(su)的(de)(de)(de)(de)(de)(de)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)頻率較(jiao)高(gao)(gao)，原(yuan)因(yin)(yin)可(ke)(ke)能是(shi)由于(yu)(yu)(yu)(yu)頭(tou)孢克洛、阿(a)奇霉(mei)素(su)具有(you)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)普廣特點(dian)及(ji)不(bu)(bu)(bu)(bu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)皮試等(deng)有(you)關(guan)，和(he)(he)兒(er)(er)(er)(er)科(ke)(ke)(ke)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)要(yao)求(qiu)符合(he)(he)(he)(he)(he)(he)(he)。對(dui)(dui)于(yu)(yu)(yu)(yu)病(bing)情(qing)嚴重及(ji)病(bing)程長者(zhe)，多(duo)(duo)采用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)序(xu)貫療(liao)(liao)法(fa)，自靜(jing)脈給(gei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)變為(wei)(wei)(wei)(wei)口(kou)(kou)(kou)服(fu)(fu)(fu)時(shi)，要(yao)求(qiu)口(kou)(kou)(kou)服(fu)(fu)(fu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)(ying)為(wei)(wei)(wei)(wei)相(xiang)(xiang)同的(de)(de)(de)(de)(de)(de)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)，而靜(jing)脈制(zhi)(zhi)劑無(wu)(wu)口(kou)(kou)(kou)服(fu)(fu)(fu)劑型時(shi)，口(kou)(kou)(kou)服(fu)(fu)(fu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)需(xu)具備高(gao)(gao)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)利用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)度、耐(nai)受性(xing)(xing)(xing)良(liang)(liang)好等(deng)［１４］。本研究(jiu)中(zhong)(zhong)序(xu)貫用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)為(wei)(wei)(wei)(wei)同類(lei)(lei)型的(de)(de)(de)(de)(de)(de)注(zhu)射劑和(he)(he)口(kou)(kou)(kou)服(fu)(fu)(fu)制(zhi)(zhi)劑，基本與序(xu)貫療(liao)(liao)法(fa)有(you)關(guan)要(yao)求(qiu)相(xiang)(xiang)符。目(mu)前，臨床(chuang)(chuang)對(dui)(dui)于(yu)(yu)(yu)(yu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)已(yi)經實施(shi)大(da)量(liang)(liang)宣(xuan)教(jiao)工(gong)作，且獲得較(jiao)大(da)成(cheng)績，但(dan)于(yu)(yu)(yu)(yu)兒(er)(er)(er)(er)科(ke)(ke)(ke)疾(ji)(ji)病(bing)，如(ru)感(gan)(gan)(gan)染(ran)(ran)(ran)類(lei)(lei)疾(ji)(ji)病(bing)的(de)(de)(de)(de)(de)(de)有(you)關(guan)治(zhi)療(liao)(liao)中(zhong)(zhong)，因(yin)(yin)醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)或父母(mu)的(de)(de)(de)(de)(de)(de)因(yin)(yin)素(su)，仍具有(you)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)狀(zhuang)(zhuang)況(kuang)。對(dui)(dui)于(yu)(yu)(yu)(yu)感(gan)(gan)(gan)染(ran)(ran)(ran)類(lei)(lei)疾(ji)(ji)病(bing)者(zhe)，給(gei)予合(he)(he)(he)(he)(he)(he)(he)理(li)(li)、及(ji)時(shi)治(zhi)療(liao)(liao)對(dui)(dui)于(yu)(yu)(yu)(yu)增(zeng)(zeng)加(jia)療(liao)(liao)效、改(gai)善(shan)(shan)預后起著(zhu)積極(ji)效果(guo)(guo)。國(guo)內對(dui)(dui)于(yu)(yu)(yu)(yu)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)臨床(chuang)(chuang)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)存在(zai)(zai)明確規(gui)定(ding)(ding)，針(zhen)(zhen)(zhen)對(dui)(dui)無(wu)(wu)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)指征的(de)(de)(de)(de)(de)(de)疾(ji)(ji)病(bing)，不(bu)(bu)(bu)(bu)可(ke)(ke)擅自應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)。與成(cheng)人相(xiang)(xiang)比，兒(er)(er)(er)(er)童(tong)身體(ti)(ti)素(su)質(zhi)(zhi)欠(qian)佳(jia)，各項(xiang)機能發(fa)育未成(cheng)熟，若隨(sui)意應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)，可(ke)(ke)導(dao)(dao)致耐(nai)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，且可(ke)(ke)能出現(xian)嚴重不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)和(he)(he)毒(du)(du)副作用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)，影響兒(er)(er)(er)(er)童(tong)健(jian)康。長時(shi)間(jian)(jian)大(da)量(liang)(liang)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)可(ke)(ke)有(you)效抑制(zhi)(zhi)或滅(mie)殺病(bing)原(yuan)菌(jun)(jun)(jun)(jun)(jun)，同時(shi)也(ye)可(ke)(ke)抑制(zhi)(zhi)或滅(mie)殺正常定(ding)(ding)植菌(jun)(jun)(jun)(jun)(jun)，繼(ji)而引發(fa)二重感(gan)(gan)(gan)染(ran)(ran)(ran)。需(xu)了解不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)情(qing)況(kuang)，針(zhen)(zhen)(zhen)對(dui)(dui)性(xing)(xing)(xing)制(zhi)(zhi)定(ding)(ding)干(gan)預措施(shi)以(yi)(yi)降低不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)率。本研究(jiu)顯示，兒(er)(er)(er)(er)科(ke)(ke)(ke)含(han)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)處(chu)(chu)(chu)方存在(zai)(zai)不(bu)(bu)(bu)(bu)足，具體(ti)(ti)為(wei)(wei)(wei)(wei)４８６例患(huan)兒(er)(er)(er)(er)的(de)(de)(de)(de)(de)(de)含(han)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)處(chu)(chu)(chu)方中(zhong)(zhong)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)處(chu)(chu)(chu)方為(wei)(wei)(wei)(wei)１５２例，占３１.２８％，不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)原(yuan)因(yin)(yin)以(yi)(yi)無(wu)(wu)指征用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)為(wei)(wei)(wei)(wei)主，其次為(wei)(wei)(wei)(wei)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)選擇(ze)(ze)和(he)(he)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)法(fa)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)量(liang)(liang)。（１）無(wu)(wu)指征用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)。兒(er)(er)(er)(er)科(ke)(ke)(ke)的(de)(de)(de)(de)(de)(de)疾(ji)(ji)病(bing)類(lei)(lei)型多(duo)(duo)為(wei)(wei)(wei)(wei)病(bing)毒(du)(du)感(gan)(gan)(gan)染(ran)(ran)(ran)引起，大(da)量(liang)(liang)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)對(dui)(dui)控(kong)制(zhi)(zhi)疾(ji)(ji)病(bing)無(wu)(wu)效。此(ci)外(wai)，本研究(jiu)中(zhong)(zhong)約８２.７１％的(de)(de)(de)(de)(de)(de)患(huan)兒(er)(er)(er)(er)為(wei)(wei)(wei)(wei)呼吸系(xi)統疾(ji)(ji)病(bing)，以(yi)(yi)上(shang)呼吸道(dao)感(gan)(gan)(gan)染(ran)(ran)(ran)、肺炎為(wei)(wei)(wei)(wei)主，多(duo)(duo)為(wei)(wei)(wei)(wei)病(bing)毒(du)(du)感(gan)(gan)(gan)染(ran)(ran)(ran)，少數是(shi)支原(yuan)體(ti)(ti)／細菌(jun)(jun)(jun)(jun)(jun)感(gan)(gan)(gan)染(ran)(ran)(ran)，故使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)無(wu)(wu)法(fa)縮短療(liao)(liao)程，甚至還可(ke)(ke)能導(dao)(dao)致繼(ji)發(fa)細菌(jun)(jun)(jun)(jun)(jun)感(gan)(gan)(gan)染(ran)(ran)(ran)，加(jia)劇病(bing)情(qing)。（２）用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)法(fa)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)量(liang)(liang)超說(shuo)明書。主要(yao)是(shi)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)間(jian)(jian)或用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑量(liang)(liang)偏高(gao)(gao)或偏低等(deng)。部(bu)分醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)為(wei)(wei)(wei)(wei)避免患(huan)兒(er)(er)(er)(er)往返醫(yi)(yi)(yi)(yi)院的(de)(de)(de)(de)(de)(de)麻煩(fan)，短期內用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑量(liang)(liang)大(da)。另外(wai)，患(huan)兒(er)(er)(er)(er)家屬依從(cong)性(xing)(xing)(xing)欠(qian)佳(jia)，也(ye)可(ke)(ke)干(gan)擾用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)間(jian)(jian)隔時(shi)間(jian)(jian)，導(dao)(dao)致用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)。（３）藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)選擇(ze)(ze)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)。用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)起點(dian)過高(gao)(gao)或選擇(ze)(ze)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)不(bu)(bu)(bu)(bu)適(shi)合(he)(he)(he)(he)(he)(he)(he)等(deng)為(wei)(wei)(wei)(wei)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)選擇(ze)(ze)的(de)(de)(de)(de)(de)(de)主要(yao)體(ti)(ti)現(xian)，比如(ru)部(bu)分患(huan)者(zhe)被確診(zhen)為(wei)(wei)(wei)(wei)急性(xing)(xing)(xing)支氣管(guan)炎后，在(zai)(zai)未行細菌(jun)(jun)(jun)(jun)(jun)培養、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)敏(min)試驗(yan)(yan)的(de)(de)(de)(de)(de)(de)情(qing)況(kuang)下，醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)經驗(yan)(yan)性(xing)(xing)(xing)選頭(tou)孢類(lei)(lei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)治(zhi)療(liao)(liao)，使(shi)病(bing)原(yuan)菌(jun)(jun)(jun)(jun)(jun)對(dui)(dui)于(yu)(yu)(yu)(yu)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)耐(nai)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)性(xing)(xing)(xing)持續(xu)升高(gao)(gao)，治(zhi)療(liao)(liao)難度增(zeng)(zeng)加(jia)。針(zhen)(zhen)(zhen)對(dui)(dui)以(yi)(yi)上(shang)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)狀(zhuang)(zhuang)況(kuang)，結合(he)(he)(he)(he)(he)(he)(he)臨床(chuang)(chuang)經驗(yan)(yan)等(deng)總結以(yi)(yi)下干(gan)預措施(shi)。（１）醫(yi)(yi)(yi)(yi)院定(ding)(ding)期實施(shi)相(xiang)(xiang)關(guan)培訓(xun)，講解抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)最新應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)規(gui)范，培訓(xun)后進行問卷考核。（２）定(ding)(ding)期實施(shi)處(chu)(chu)(chu)方點(dian)評(ping)，公布點(dian)評(ping)結果(guo)(guo)，對(dui)(dui)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)前３名開(kai)具者(zhe)通報，必要(yao)時(shi)將(jiang)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)狀(zhuang)(zhuang)況(kuang)與個人績效掛(gua)鉤，增(zeng)(zeng)加(jia)醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)的(de)(de)(de)(de)(de)(de)重視度。（３）臨床(chuang)(chuang)醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)在(zai)(zai)選擇(ze)(ze)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)時(shi)需(xu)了解其適(shi)應(ying)(ying)(ying)(ying)(ying)證、作用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)特點(dian)、不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)，明確病(bing)原(yuan)菌(jun)(jun)(jun)(jun)(jun)種(zhong)類(lei)(lei)，針(zhen)(zhen)(zhen)對(dui)(dui)性(xing)(xing)(xing)選窄譜、不(bu)(bu)(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)(ying)(ying)少、敏(min)感(gan)(gan)(gan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)治(zhi)療(liao)(liao)。（４）醫(yi)(yi)(yi)(yi)生(sheng)(sheng)(sheng)需(xu)依據患(huan)兒(er)(er)(er)(er)年齡(ling)、腎(shen)肝功能等(deng)，參照說(shuo)明書上(shang)給(gei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)間(jian)(jian)隔準(zhun)確藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)量(liang)(liang)，對(dui)(dui)家屬實施(shi)健(jian)康教(jiao)育，提(ti)高(gao)(gao)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)依從(cong)性(xing)(xing)(xing)，按時(shi)定(ding)(ding)量(liang)(liang)給(gei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)。（５）經檢查等(deng)確認是(shi)細菌(jun)(jun)(jun)(jun)(jun)感(gan)(gan)(gan)染(ran)(ran)(ran)后行抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)治(zhi)療(liao)(liao)。（６）應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)與處(chu)(chu)(chu)方前置的(de)(de)(de)(de)(de)(de)審(shen)核軟件，發(fa)現(xian)、修正不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)之處(chu)(chu)(chu)，增(zeng)(zeng)強監督(du)，確保(bao)(bao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)，增(zeng)(zeng)加(jia)安全性(xing)(xing)(xing)。綜上(shang)所述，兒(er)(er)(er)(er)科(ke)(ke)(ke)含(han)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)處(chu)(chu)(chu)方中(zhong)(zhong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)時(shi)存在(zai)(zai)不(bu)(bu)(bu)(bu)合(he)(he)(he)(he)(he)(he)(he)理(li)(li)的(de)(de)(de)(de)(de)(de)狀(zhuang)(zhuang)況(kuang)，臨床(chuang)(chuang)可(ke)(ke)針(zhen)(zhen)(zhen)對(dui)(dui)性(xing)(xing)(xing)制(zhi)(zhi)定(ding)(ding)干(gan)預措施(shi)以(yi)(yi)保(bao)(bao)障(zhang)安全、合(he)(he)(he)(he)(he)(he)(he)理(li)(li)有(you)效的(de)(de)(de)(de)(de)(de)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗(kang)(kang)(kang)(kang)(kang)菌(jun)(jun)(jun)(jun)(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)(wu)。

作者(zhe)：袁(yuan)川(chuan) 鄧(deng)鵬黎 李峰 安琪 單位(wei)：鄲(dan)城縣人民醫院(yuan)藥(yao)劑科 鄭州大學(xue)第(di)一附屬(shu)醫院(yuan)