63例院内药物性肝损害的临床分析与经济学评价  

Clinical Analysis and Economic Evaluation of 63 Cases of Nosocomial Drug-induced Liver Injury

作　　者：姚苏宁[1] 严小惠[1] 周菊芝[1] 胡毅坚[2] 

机构地区：[1]宁波天一职业技术学院,宁波市315100 [2]宁波市第一医院,宁波市315000

出　　处：《中国药房》2010年第30期2796-2798,共3页China Pharmacy

基　　金：宁波市自然科学基金(2007A610066)

摘　　要：目的:为探索主动预防、及早发现和合理处置院内药物性肝损害(DILI)提供参考。方法:随机抽取2008～2009年某三级甲等综合医院内4975份住院病历,对住院后DILI发生率、因DILI而造成的医疗费用、延长的住院时间及DILI的预防进行回顾分析与经济学评价。结果:DILI发生63例,发生率为1.27%;其中可预防的DILI10例,占总DILI的15.87%。例均DILI增加医疗费用3220.26元,延长住院时间4.38d;例均可预防的DILI增加医疗费用6239.85元,延长住院时间8.30d。引起肝损害的药物前3名依次为抗感染药(含抗结核药)占41.27%、抗肿瘤药占28.57%、降压降脂药占7.94%。DILI的分型:肝细胞损伤型65.08%,胆汁淤积型25.40%,混合型9.52%。结论:DILI在住院患者中发病率较高,且处理的医疗成本较高,但其中一部分是可预防的,DILI的早期识别和及时停药、合理处置具有临床和经济学的双重价值。OBJECTIVE：To provide reference for prevention of nosocomial drug-induced liver injury（DILI）,early diagnosis of DILI and appropriate disposal of DILI.METHODS：4 975 medical records were randomly collected from a grade three class A hospital during 2008～2009.The incidence of DILI,hospitalization costs,extended time of hospital stay and prevention of DILI were analyzed retrospectively and economic evaluation was carried out.RESULTS：DILI occurred in 63 cases with the incidence rate of 1.27%.Among these cases,10 cases（15.87%） were preventable.For each DILI,average increased medical cost was 3 220.26 yuan and average extended time of hospital stay was 4.38 d.For the preventable DILI,the average increased medical cost was 6 239.85 yuan,and average extended time of stay was 8.30 d.The top 3 drugs which caused liver injury were anti-infective drugs（including antitubercular agent,41.27%）,antineoplastic agents（28.57%） and cardiovascular drugs（7.94%）.Types of DILI were as follows：live cell injury accounted for 65.08%,cholestasis accounted for 25.40%,and mixed type accounted for 9.52%.CONCLUSION：DILI is characterized with high incidence rate among patients and high medical cost.Some of DILI cases are preventable.Therefore,There is advantage both in clinical and economic aspects to reduce the incidence rate of preventable DILI by emphasizing rational use of drugs.

关 键 词：药物性肝损害 回顾性分析 经济学评价 

分 类 号：R956[医药卫生—药学] R595.3