目的 分析天津醫(yī)科大學(xué)第二醫(yī)院住院患者特殊級(jí)抗菌藥物的使用情況，探討管理中存在的問題與對(duì)策，促進(jìn)臨床合理用藥。方法 采用回顧性分析法，通過HIS信息系統(tǒng)調(diào)取2015—2016年天津醫(yī)科大學(xué)第二醫(yī)院住院患者特殊級(jí)抗菌藥物的使用數(shù)據(jù)及資料，進(jìn)行比較分析。并使用魚骨圖探討特殊級(jí)抗菌藥使用中存在問題與對(duì)策。結(jié)果 2015—2016年特殊級(jí)抗菌藥物臨床使用率基本穩(wěn)定，特殊級(jí)抗菌藥物用藥頻度（DDDs）控制在合理范圍內(nèi)，注射用頭孢噻利、利奈唑胺注射液用量增長，科室分布變化不大，聯(lián)合用藥現(xiàn)象較為普遍，以2種藥物聯(lián)用為主，且聯(lián)合用藥呈下降趨勢(shì)。使用魚骨圖分析得出特殊級(jí)抗菌藥物臨床使用中存在藥物選擇、療程劑量、藥物配伍、聯(lián)合用藥4個(gè)方面問題。結(jié)論 天津醫(yī)科大學(xué)第二醫(yī)院特殊級(jí)抗菌藥物的使用較為合理，但也存在部分問題。需要通過醫(yī)師、藥師各司其職，依賴醫(yī)院行政干預(yù)，借助信息系統(tǒng)輔助管理，發(fā)現(xiàn)問題解決問題，使特殊級(jí)抗菌藥物臨床使用逐步合理。

Objective To analyze the application of special class antimicrobial drugs in inpatients of the Second Hospital of Tianjin Medical University, and to discuss the problems existing in the management of the special class antimicrobial drugs, so as to offer reference for clinical rational use. Methods Retrospective analysis was adopted, the application data of the special class antimicrobial drugs in inpatients of the Second Hospital of Tianjin Medical University from 2015 to 2016 was extracted from the hospital information system (HIS). The changes and tendency of application were compared and analyzed. The problems existing in the application of the special class antimicrobial drugs and the solutions for the problems were discussed by fish-bone diagram. Results The usage ratio of special class antimicrobial drugs was basically stable from 2015 to 2016, and the DDDs were still maintained in a reasonable range. The usage of Cefoselis for injection and Linezolid Injection increased and the department distribution kept steadily. While combination was relatively common, most with two kinds of drugs combination, and it had a down trend. In the procedure of drawing fish-bone diagram, the application regularity of the special class antimicrobial drugs was confronted mainly with problems of four aspects. The main types of unreasonable medicine were drug choice, medicinal course and dosage, drug compatibility, and drug combination. Conclusion The use of special class antimicrobial drugs in the Second Hospital of Tianjin Medical University from is reasonable on the whole, yet there are still some problems. Thus both doctors and pharmacists should perform their roles, with the help of intervening measures by the hospital and the use of information management system, to promote the application of special class antimicrobial drugs to be more reasonable.