某三甲教学医院普通外科住院患者使用质子泵抑制剂预防应激性黏膜病变的调查分析  

Use of PPIs in preventing stress related mucosal diseases in the general surgery department of a 3A teaching hospital

作　　者：余资 邢建峰[2] 王思文[1] 贺银丽 梁丽 

机构地区：[1]西安交通大学第一附属医院药学部,西安710061 [2]西安交通大学药学院,西安710061

出　　处：《中南药学》2017年第10期1463-1466,共4页Central South Pharmacy

摘　　要：目的分析某三甲教学医院普通外科质子泵抑制剂(PPIs)的使用情况,指导普通外科合理使用PPIs。方法收集该院2016年9-12月普通外科住院患者病历,统计分析PPIs用于预防应激性黏膜病变(SRMD)的使用情况,从适应证、给药剂量、给药频次、溶剂及溶剂量、给药途径、给药时机、给药疗程等方面进行合理性评价。结果共收集511份病例资料,预防使用PPIs的有343份,使用率为67.1%。使用PPIs的患者中有适应证的240例,预防使用率为83.3%;无适应证的103例,预防使用率为46.2%;PPIs用于术后预防SRMD使用率为76.4%。其中结肠癌、直肠癌、胃癌等消化系统肿瘤的预防使用率高于静脉曲张及血栓形成、乳腺癌、甲状腺癌等疾病。预防使用PPIs药物中奥美拉唑的使用率高于泮托拉唑、兰索拉唑及埃索美拉唑;PPIs静脉给药占98.8%;PPIs给药疗程不适宜为30.3%。结论该院普通外科使用PPIs预防SRMD存在无适应证用药、给药途径不适宜、给药时机不适宜、疗程不适宜等现象。因此,需要加强PPIs使用管理,限制其预防用药指征,促进PPIs在普通外科的合理使用。Objective To investigate rational use of proton pump inhibitors （PPIs） in the general surgery department and promote the rational use of PPIs in a 3A teaching hospital department. Methods Clinical use of PPIs to prevent stress related mucosal diseases was analyzed in a 3A teaching hospital from September to December 2016. The rationality of the indications, dosage of administration, frequency of administration, solvent, route of administration, time of administration and course of treatments were evaluated. Results A total of 511 patients were collected, 343 （67.1%） used PPIs for prophylaxis： among them 240 patients had indications, and 83.3% received prophylaxis; while the other 103 patients did not have indications, and 46.2% received prophylaxis for prevention. 76.4% of the patients use PPIs for the prevention of stress related mucosal disease （SRMD） after the operation. Utilization ratio of prophylactic administration for digestive system tumor, including colon cancer, rectal cancer, and stomach cancer was higher than that for varicose veins and thrombosis, breast cancer, and thyroid carcinomas. The prophylactic usage rate of omeprazole was higher than that of pantoprazole, lansoprazole and esomeprazole. About 98.8% of the patients were given PPIs intravenously, and about 30.3% of the patients＇course of treatment was inappropriate. Conclusion There still exist some problems in the general surgery department in the use of PPIs for prophylaxis, such as no indications, inappropriate administration route, inappropriate drug administration time, inappropriate course of treatment, etc. We need to strengthen the management of PPIs usage, limit the prophylactic usage indication, and promote the rational usage of PPIs in the general surgery departmentg.

关 键 词：普通外科 质子泵抑制剂 合理用药 应激性黏膜病变 

分 类 号：R969.3[医药卫生—药理学]