我院产科患者妊娠期用药情况分析
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摘要
目的:分析我院产科患者妊娠期用药特点,为促进产科合理用药提供参考。方法:利用医院信息系统,随机抽取在我院2015年1月-2017年12月生产妇女的处方。每月抽取30例记录其生产方式及妊娠结局,汇总其妊娠期在我院的所有用药情况,对新生儿结局和妊娠不同时期用药病例数、品种数、用药频度进行统计分析,并对妊娠不同时期用药进行合理性评价。结果:共收集有效患者1 076例,患者年龄在21～30、31～34、35岁及以上的分别为528、343、205例,剖宫产分娩、自然分娩的分别为462、614例,单胎、双胎的分别为1 041、35例。新生儿评分(APGAR)8～10分者1 089例、4～7分者20例、0～3分者2例,低出生体质量儿96例,出生发育异常者4例。患者妊娠期用药率高达96.65%(1 040/1 076),其中孕早期、孕中期、孕晚期患者的药品使用率分别为55.19%(574/1 040)、99.42%(1 034/1 040)、57.98%(603/1 040)例,涉及药品137种。用药频度前3的药品分类,孕早期分别为消化道和代谢方面的药物、扶正剂(中成药)、生殖系统的性激素和调节剂;孕中期分别为消化道和代谢方面的药物、泌尿生殖系统药和性激素、心血管系统药物;孕晚期分别为消化道和代谢方面的药物、血液和造血器官药物、除性激素和胰岛素外的全身激素制剂。妊娠早期存在不合理用药情况,生产结局存在发育异常情况,但发育异常与用药相关性未能确定。结论:产科患者妊娠期用药率较高,用药频度以孕中期最高,不同时期用药类别基本符合妊娠期流行病学特点。但妊娠期用药存在一些不合理用药问题,存在安全隐患,有待进一步整治;妊娠不良结局与用药的相关性未能确定,有待大样本数据证实。
OBJECTIVE:To analyze the characteristics of pregnancy medication in obstetric patients of our hospital,and to provide reference for promoting rational drug use in obstetric department. METHODS:Using hospital information system,30 prescriptions of women who produced in our hospital were randomly selected monthly from Jan. 2015 to 30 th,2017. The modes of production and pregnancy outcomes were recorded. The drugs used during pregnancy in our hospital were summarized. Statistical analysis was made on the number of cases,varieties and frequency of drug use in neonatal outcomes and different stages of pregnancy. The rationality of drug use in different stages of pregnancy was evaluated. RESULTS:Totally 1 076 valid prescriptions were collected,including 528,343 and 205 cases aged 21-30,31-34,35 and above,462 cases with cesarean and 614 patients with spontaneous labor,1 041 cases with single fetus and 35 cases with twins,1 089 neonates with APGAR score of 8-10,20 neonates with 4-7,and 2 neonates with 0-3,96 neonates with low birth weight and 4 neonates with abnormal. The rate of drug use during pregnancy was as high as 96.65%(1 040/1 076). The utilization rate of drugs were 55.19%(574/1 040),99.42%(1 034/1 040)and 57.98%(603/1 040)in the first,second and third trimesters of pregnancy,involving 137 drugs. Classification of top 3 drugs in the list of frequency were drugs for digestive tract and metabolic diseases for Fuzheng agent(Chinese patent medicine)and for sex hormones and regulators of reproductive system in the first trimesters of pregnancy,and for digestive tract and metabolism, urinary and reproductive system and cardiovascular system in the second trimesters, for digestive tract and metabolism,blood and hematopoietic organs and systemic hormones except sex hormones and insulin in the third trimesters. There were unreasonable use of drugs in the first trimester and there were also abnormalities outcomes of birth,but the correlation between abnormalities and drugs used during pregnancy could not be determined in the study. CONCLUSIONS:The rate of drugs used during pregnancy was high,and the value of DDDs was highest in the second trimester;the types of drugs used in different periods basically accord with the epidemiological characteristics of pregnancy. However,there are some unreasonable medication problems and potential safety hazards in medication during pregnancy,which need to be further rectified. The correlation between adverse pregnancy outcomes and drugs used during pregnancy has not been determined,and needs to be studied with large sample data.
OBJECTIVE:To analyze the characteristics of pregnancy medication in obstetric patients of our hospital,and to provide reference for promoting rational drug use in obstetric department. METHODS:Using hospital information system,30 prescriptions of women who produced in our hospital were randomly selected monthly from Jan. 2015 to 30 th,2017. The modes of production and pregnancy outcomes were recorded. The drugs used during pregnancy in our hospital were summarized. Statistical analysis was made on the number of cases,varieties and frequency of drug use in neonatal outcomes and different stages of pregnancy. The rationality of drug use in different stages of pregnancy was evaluated. RESULTS:Totally 1 076 valid prescriptions were collected,including 528,343 and 205 cases aged 21-30,31-34,35 and above,462 cases with cesarean and 614 patients with spontaneous labor,1 041 cases with single fetus and 35 cases with twins,1 089 neonates with APGAR score of 8-10,20 neonates with 4-7,and 2 neonates with 0-3,96 neonates with low birth weight and 4 neonates with abnormal. The rate of drug use during pregnancy was as high as 96.65%(1 040/1 076). The utilization rate of drugs were 55.19%(574/1 040),99.42%(1 034/1 040)and 57.98%(603/1 040)in the first,second and third trimesters of pregnancy,involving 137 drugs. Classification of top 3 drugs in the list of frequency were drugs for digestive tract and metabolic diseases for Fuzheng agent(Chinese patent medicine)and for sex hormones and regulators of reproductive system in the first trimesters of pregnancy,and for digestive tract and metabolism, urinary and reproductive system and cardiovascular system in the second trimesters, for digestive tract and metabolism,blood and hematopoietic organs and systemic hormones except sex hormones and insulin in the third trimesters. There were unreasonable use of drugs in the first trimester and there were also abnormalities outcomes of birth,but the correlation between abnormalities and drugs used during pregnancy could not be determined in the study. CONCLUSIONS:The rate of drugs used during pregnancy was high,and the value of DDDs was highest in the second trimester;the types of drugs used in different periods basically accord with the epidemiological characteristics of pregnancy. However,there are some unreasonable medication problems and potential safety hazards in medication during pregnancy,which need to be further rectified. The correlation between adverse pregnancy outcomes and drugs used during pregnancy has not been determined,and needs to be studied with large sample data.
引文
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[10]US PREVENTIVE SERVICES TASK FORCE,BIBBINS-DOMINGO K,GROSSMAN DC,et al.Folic acid supplementation for the prevention of neural tube defects:USpreventive services task force recommendation statement[J].JAMA,2017,317(2):183-189.
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[12]温丽,郭珍,胡际东,等.汉族女性妊娠期高血压疾病的流行病学及发病机制研究[J].医学研究杂志,2017,46(5):128-131.
[13]何静.国内外妊娠期糖尿病高危因素的研究进展[J].中国全科医学,2016,19(B12):241-244.
[14]刘希婧,周容.再生育妇女妊娠并发症的风险评估及对策[J].实用妇产科杂志,2017,33(2):97-100.
[15]李云端.妊娠期肝内胆汁淤积症的诊治进展[J].中外医学研究,2017,15(7):158-159.
[2]HOTHAM N,HOTHAM E.Drugs in breastfeeding[J].Australian Prescriber,2015,38(5):156-160.
[3]张延菲,吴志刚.上海市某三级甲等妇产科专科医院2013-2015年抗菌药物类基本药物使用分析[J].中国药房,2016,27(33):4668-4670.
[4]陈彬,吴斌,程华丰.门诊糖尿病患者降糖类药物利用情况分析[J].上海交通大学学报(医学版),2015,35(12):1877-1881.
[5]王浩然,斌兰,李秀荣.8713张门诊镇静催眠药处方用药分析[J].中国医院用药评价与分析,2015,15(9):1215-1218.
[6]杨勇,陈诚,刘心霞.妊娠期药物在母体和胎儿的药动学特点与用药安全[J].医药导报,2017,36(9):951-955.
[7]WILMER E,CHAI S,KROUMPOUZOS G.Drug safety:pregnancy rating classifications and controversies[J].Clin Dermatol,2016,34(3):401-409.
[8]XU Q,CHEN J,WEI Z,et al.Sex hormone metabolism and threatened abortion[J].Med Sci Monit,2017.DOI:10.12659/MSM.904500.
[9]围受孕期增补叶酸预防神经管缺陷指南工作组.围受孕期增补叶酸预防神经管缺陷指南[J].中国生育健康杂志,2017,28(5):401-410.
[10]US PREVENTIVE SERVICES TASK FORCE,BIBBINS-DOMINGO K,GROSSMAN DC,et al.Folic acid supplementation for the prevention of neural tube defects:USpreventive services task force recommendation statement[J].JAMA,2017,317(2):183-189.
[11]SOCIETY of OBSTETRICIANS and GYNAECOLOGI-STS of CANADA.Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies[J].J Obstet Gynaecol Can,2015,37(6):534-549.
[12]温丽,郭珍,胡际东,等.汉族女性妊娠期高血压疾病的流行病学及发病机制研究[J].医学研究杂志,2017,46(5):128-131.
[13]何静.国内外妊娠期糖尿病高危因素的研究进展[J].中国全科医学,2016,19(B12):241-244.
[14]刘希婧,周容.再生育妇女妊娠并发症的风险评估及对策[J].实用妇产科杂志,2017,33(2):97-100.
[15]李云端.妊娠期肝内胆汁淤积症的诊治进展[J].中外医学研究,2017,15(7):158-159.