我院骨科患者围术期质子泵抑制剂预防应激性溃疡的合理性分析  

Analysis of the Rationality of Perioperative PPIs in the Prevention of Stress Ulcer in Orthopedic Department of Our Hospital

作　　者：楚建杰 樊婷婷 姚敏娜 王艳华 宁泽琼 王明明 张伟 李韦韦 文爱东 

机构地区：[1]第四军医大学第一附属医院药剂科,西安710032

出　　处：《中国药房》2017年第32期4483-4487,共5页China Pharmacy

基　　金：国家高技术研究发展计划(863计划)课题(No.2012AA02A603);军队"十一五"重大专项课题(No.06D007)

摘　　要：目的:分析我院骨科围术期患者使用质子泵抑制剂(PPIs)预防应激性溃疡的合理性,以期为临床合理使用PPIs提供参考。方法:抽取2016年11月1-30日骨科出院手术患者病历,统计PPIs使用情况、患者基本情况、手术情况及是否存在应激性溃疡发生的应激源和危险因素,综合分析PPIs使用的合理性。结果:664例手术患者中有210例使用了PPIs,74例使用了H2受体拮抗药(H2RA),总预防用药率达42.77%;手术类型主要为骨折内固定术(74例,35.24%)和椎间盘切除术或髓核摘除术(38例,18.11%)。210例使用了PPIs的患者中,100%选择了PPIs注射剂,其中68例(32.38%)患者不具备预防用药指征,128例(60.95%)患者给药时机错误,74例(35.24%)患者给药频次错误,44例(20.95%)患者预防用药疗程超过3 d。结论:骨科患者围术期使用PPIs预防应激性溃疡时,存在适应证、品种选择、用法用量、疗程等方面的严重不合理现象,临床医师和监管者应高度重视,避免PPIs的过度应用。OBJECTIVE： To analyze the rationality of proton pump inhibitors （PPIs） in the prevention of stress ulcer in periop- erative orthopedic patients of our hospitals, and to provide reference for ratioual use of PPIs in clinic. METHODS ： The medical records of discharged orthopedic patients were selected during Jan. lst-30th in 2016. Those records were analyzed statistically in re- spects of the use of PPIs, general information of patients, operation situation, the stressors and risk factors of stress ulcer. The ratio- nality of the use of PPIs was analyzed comprehensively. RESULTS： Among 664 surgical patients, PPIs were used in 210 cases, and H2 receptor antagonist （H2RA） were used in 74 cases, with prophylactic rate of 42.77%. The main types of operation were frac- ture fixation （74 cases, 35.24% ）, discectomy and discectomy （38 cases, 18.11% ）. Among 210 patients receiving PPIs, all of them used PPIs, among which 68 cases （32.38%） had no medication indications, 128 cases （60.95%） were medication timing error, 74 cases （35.24%） were administration frequency error and 44 cases （20.95%） were more than 3 d prophylactic drug use. CONCLUSION： When orthopedic patients use PPIs for the prevention of stress ulcer, there are serious irrational phenomena in indications, species selection, usage and dosage, treatment course and so on. Clinicians and regulators should pay great attention to it so as to avoid the excessive application of PPIs.

关 键 词：质子泵抑制剂 应激性溃疡 围术期 合理用药 

分 类 号：R969.3[医药卫生—药理学]