摘要
目的：了解某医院连续3年治疗消化性溃疡药物的使用情况及用药趋势；评价质子泵抑制剂注射剂的使用合理性,了解其不合理使用现状,分析不合理使用的影响因素,为促进质子泵抑制剂的合理使用提供科学依据。
方法：
1.采用用药金额和用药频度排序法,对某三甲医院2008年～2010年治疗消化性溃疡药物的用药金额、用药频度及日均费用进行统计和分析。
2.以某三甲医院2010年住院病人为研究对象,对2010年1月1日～2010年12月31日期间至少使用过1次质子泵抑制剂注射剂的完整住院病历,经单纯随机抽样,进行病历回顾性调查,评价质子泵抑制剂注射剂使用的合理性。
3.通过SPSS16.0软件统计,单因素非条件logistic回归进行质子泵抑制剂注射剂不合理用药影响因素的单因素分析,采用后退法进行多因素非条件logistic回归分析,筛选质子泵抑制剂注射剂不合理用药影响因素。
结果：
1.2008年～2010年治疗消化性溃疡药的用药金额逐年增加,年增长率分别为31.59%和42.59%。H2受体拮抗剂所占比例持续萎缩,质子泵抑制剂在临床使用中占主导地位,其品种最多,品种数、用药金额逐年增加,连续3年稳居第一,其用药金额年增长率分别为31.74%和44.11%。
2.2008年用药频度排序前5名的依次为泮托拉唑针、奥美拉唑针、雷尼替丁针、泮托拉唑胶囊和埃索美拉唑镁片,2009年及2010年用药频度排序前5名的药品一致,依次为泮托拉唑针、奥美拉唑针、泮托拉唑胶囊、埃索美拉唑镁片和雷尼替丁胶囊。
3.质子泵抑制剂注射剂的合理性评价共调查1920病例,其中男性53.5%(1028/1920)、女性46.5%(892/1920)；年龄最小者1岁,最大者93岁,平均47.13岁。
4.结果显示,在所有使用质子泵抑制剂注射剂的病例中,只有9.9%(190/1920)的病例使用合理,高达90.1%(1730/1920)使用不合理。
5.质子泵抑制剂注射剂的不合理使用主要表现为用药指征不合理,占所调查病例的76.3%(1465/1920)。质子泵抑制剂注射剂的使用以预防性用药为主,91.4%(1755/1920)的病例以预防性用药为目的,而以预防应激性溃疡为目的病例占所调查病例的50.3%(967/1920),预防性用药的用药指征不合理率为71.7%(1376/1920)。质子泵抑制剂注射剂的用法不合理也较明显,奥美拉唑注射剂(洛赛克)有75.0%(171/228)的病例未按说明书规定使用专用溶媒静注。
6.多因素非条件Logistic回归分析研究与用药指征不合理相关的影响因素,结果显示入院情况与用药指征不合理负相关,是否合并NSAIDs、是否合并抗凝药、是否进行内镜检查与用药指征不合理正相关。即入院情况一般者较入院时危、急者不合理率高,合并NSAIDs、合并抗凝药、进行内镜检查者较未合并使用药物、未做内镜检查者不合理率低。
结论：
1.质子泵抑制剂注射剂在临床广泛使用,其用药频度远远高于质子泵抑制剂口服制剂及其他类治疗消化性溃疡药,这可能与其无指征用药所引起的滥用有关。
2.质子泵抑制剂注射剂的使用绝大多数是以预防为目的,无适应症预防用药情况非常普遍。
3.入院情况一般者较入院时危、急者不合理率高,合并NSAIDs、合并抗凝药、进行内镜检查者较未合并使用药物、未做内镜检查者不合理率低。
4.建议建立质子泵抑制剂的合理用药指南。改变临床医生的用药态度和处方行为,加强用药干预,以改善质子泵抑制剂的不合理使用现状。
Objective:To investigate the current situation and developing trend of antiulcer drugs in our hospital for successive 3 years; to evaluate the intravenous proton pump inhibitions prescribing in our hospital, and analyze the influential factors of inappropriate utilization, in order to offer the scientific evidence for appropriate use of proton pump inhibitions.
Methods:
1. Antiulcer drugs used in our hospital from 2008 to 2010 were analyzed statistically in respect of sales value, DDDs and DDC.
2. Take our hospital in 2010 in-patient as object of study, choose completive integrated cases used intravenous proton pump inhibitions at least once, by pure random sampling, retrospective review the cases to assess appropriateness of intravenous proton pump inhibitor prescribing.
3. SPSS(version 16.0)was used for statistical analyses.Univariate analysis was used to examine the associations between individual predictors and the appropriate use of intravenous proton pump inhibitions. Multivariate analysis adopts the backward methods (with odds ratio and 95% confidence intervals) was performed using logistical regression analysis.
Results:
1. The consumption sum of antiulcer drug showed an upward trend from 2008 to 2010, the annual incremental rate were 31.59% and 42.59%, respectively. Consumption costs proportion of histamine-2 receptor blockers decreased year by year, proton pump inhibitors had a absolutely superiority in clinic, with kinds and consumption costs increased year by year, and continually ranked first for 3 years, the annual incremental rate were 31.74% and 44.11%, respectively.
2. DDDs of the drugs ranking in the first 5 places of 2008 were pantoprazole injections, omeprazole injections, ranitidine injections, pantoprazole oblatums and esomeprazole tabletst, DDDs of the drugs ranking in the first 5 places of 2009 and 2010 were pantoprazole injections, omeprazole injections, pantoprazole oblatums, esomeprazole tabletst and ranitidine oblatums.
3.1920 cases were investigated for evaluate the appropriate use of the intravenous proton pump inhibitions. Among 53.5%(1028/1920) males and 46.5%(892/1920) females, in which the youngest is 1 years old, the oldest is 93 years old, the average is 47.13 years old.
4. In all cases,9.9%(190/1920) had appropriately used intravenous proton pump inhibitions,90.1%(1730/1920) inappropriate.
5. Improper indication is the main reason of inappropriate use of intravenous proton pump inhibitions, account for 76.3%(1465/1920).The main reason of the utilization is for prophylaxis,91.4%(1755/1920). 50.3%(967/1920) for stress ulcer prophylaxis,71.7%(1376/1920) of prophylactic use with improper indication. There was a certain degree of irrational use on usage,75.0%(171/228) of intravenous omeprazole (luosaike) were not according to the directions to use the special dissolvent for intravenous injection.
6. Multi-variate unconditional Logistic regression indicates the risk factors of improper indication, admission condition were negative correlate with improper indication, if co-medication of NSAIDs, if co-medication anticoagulation, if endoscopy were positive correlate with improper indication, which means the common admission condition related with higher rate of inappropriate use, co-medication anticoagulation, co-medication anticoagulation, endoscopy related with lower rate of inappropriate use.
Conclusion:
1. Intravenous PPIs were widespread used in clinic, DDDs outclass the peroral proton pump inhibitions and other antiulcer drugs, that might relate with the overuse of PPIs.
2. The majority use of Intravenous PPIs were for prophylaxis, prophylaxis with unreasonable indications were common.
3. The common admission condition related with higher rate of inappropriate use, co-medication anticoagulation, co-medication anticoagulation, endoscopy related with lower rate of inappropriate use.
4. It is suggested to establish guidelines on rational use of PPIs, change the attitude and prescribing behaviors of physicians, enhance interventional measures, in order to change the situation of inappropriate utilization.
引文
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