基于循证医学的妇产科超说明书用药处方审核实践  

Practice of Off-label Drug Prescription Review in Obstetrics and Gynecology Based on Evidence-based Pharmacy

作　　者：祁骏升 计雅纯 刘宇[1] 李娟[1] Qi Junsheng;Ji Yachun;Liu Yu;Li Juan(Tongji Hospital affiliated to Tongji Medical College,Huazhong Lniversily of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院药学部,武汉430030

出　　处：《药物流行病学杂志》2021年第11期739-743,共5页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:分析我院妇产科门诊超说明书用药情况,探讨超说明书用药的处方审核模式。方法:通过美康药师审方干预系统(PASS)统计我院2019年1~3月妇科门诊、产科门诊、生殖医学门诊中所有超说明书用药的医嘱,对科室分布、用药类型、药品品种等信息进行统计分析,并从循证药学角度评价合理性。结果:调查期内超说明书用药处方1273张,医嘱共1443条,涉及药品71种;妇科门诊超说明书用药最普遍(65.6%),其次是生殖医学中心(25.0%)和产科门诊(9.4%)。主要超说明书用药类型包括超剂量用药(44.91%)、超适应证用药(35.62%)、超给药途径用药(6.10%)、超适应人群用药(13.37%)。常见超说明书药品:二甲双胍、米非司酮、雌二醇地屈孕酮/炔雌醇环丙孕酮/屈螺酮炔雌醇、那屈肝素钙/低分子肝素钙/达肝素钠、阿司匹林、多糖铁复合物、来曲唑、辅酶Q;、重组人生长激素、螺内酯、枸橼酸西地那非。超说明书处方中判定为合理处方944张,合理率为74.16%。结论:超说明书用药情况在妇产科门诊时有发生,但并非都是不合理用药,药师应建立基于循证药学的处方审核模式评价超说明书用药方案的合理性,提升药学服务质量,保障患者用药安全。Objective:To investigate and analyze the off-label drug uses in outpatient department of obstetrics and gynecology in our hospital,so as To explore the prescription review mode of off-label drug use.Methods:The prescription of off-label drug uses were picked out from outpatient department of gynecology,outpatient department of obstetrics and reproductive medicine center during January-March 2019 by PASS-Prescription Automatic Screening System,the off-label drug use were analyzed by distribution of sampled prescription in clinical departments and types of off-label drug uses,and evaluated its rationality from the perspective of evidence-based pharmacy.Results:Totally 1273 prescriptions,1443 medication records and 71 kinds of drugs were involved in off-label uses;off-label drug was the most common in outpatient gynecology department(65.6%),followed by reproductive medicine center(25.0%)and obstetrics department(9.4%).Main types of off-label drug uses included overdose of drug(44.91%),medication without indication(35.62%),changing administration method(35.62%)and inappropriate population(13.37%).Of all the related off-label drugs,metformin,mifepristone,dydrogesterone tablets/ethinylestradiol and cyproterone acetate tablets/drospirenone and ethinylestradiol tablets,calcium narcan heparin/low molecular weight heparin calcium/dheparin sodium,aspirin,polysaccharide-iron complex capsules,letrozol tablets,coenzyme Q;,recombinant human growth hormone,spironolactone and sildenafil citrate were frequently-used categories.Among the off-label prescriptions,944 prescriptions were judged to be reasonable,with a rational rate of 74.16%.Conclusion:The frequency of off-label drug use is relatively high in outpatient department of obstetrics and gynecology in our hospital,but most of them are not irrational.Pharmacists should establish a prescription review model based on evidence-based pharmacy to evaluate the rationality of off-label drug regimen,so as to carry on the rational use of drugs in order to guarantee medical safety.And

关 键 词：处方审核 循证药学 超说明书用药 合理用药 

分 类 号：R95[医药卫生—药学]