质子泵抑制剂在预防外科手术患者围手术期应激性溃疡的应用分析

Study and analysis of proton pump inhibitor in preventing stress ulcer in surgical patients during perioperative period

目的考察外科围手术期质子泵抑制剂(Proton pump inhibitor,PPI)的使用情况,为改进围手术期的合理规范治疗及提升相应的护理工作提供参考。方法随机选取我院外科2018年1-8月出院的手术患者,共526例,统计患者的基本情况、手术情况、PPI使用情况,依据相关的指南及共识,提供合理化规范及改进相应的护理方案。结果526例手术患者均预防性静脉应用PPI,主要包括:奥美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑等。不同手术类别的患者,PPI的用药时间主要是术后给药,合计321例,占61.03%;术前给药的患者合计205例,占38.97%。在住院天数的比较上,肠道及胃部手术患者住院时间较长,PPI用药疗程也较长。合理用药方面的主要问题为用药次数不合理;剂量不合理的主要问题为超预防标准剂量给药;用药途径方面:某些患者能口服,却选择静脉给药,还有未严格按照适应证用药的情况。预防使用PPI的患者中,高危险因素组临床药物的费用、PPI的费用及住院费用,均高于非高危险因素组。但非高危险因素组中PPI在住院总费用和药物总费用的比例均高于高危险因素组。结论加强对围手术期预防性使用PPI的临床应用管理,提供合理化规范及改进相应的护理方案,对于临床治疗具有积极的意义。

Objective To study the use of proton pump inhibitor(PPI)in perioperative period of surgery,so as to provide reference for improving the standardized treatment and promoting the corresponding nursing work.Methods A total of 526 surgical patients discharged from January to August 2018 were randomly selected for this research.The basic information,operation data and PPI use of the patients were counted.According to the relevant guidelines and consensus,reasonable norms and the corresponding improved nursing programs were provided.Results The 526 patients were treated with PPI prophylactically.The PPI commonly used in clinic included omeprazole,lansoprazole,pantoprazole,rabeprazole and so on.In patients with different surgical categories,PPI was mainly administered after operation,accounting for 61.03%(n=321).A total of 205 patients,accounting for 38.97%,were given medication of PPI before operation.The patients undergoing intestinal and gastric surgery had a longer hospitalization time and a longer course of PPI medication.The main problems in rational drug use focused on the irrational frequency of drug use.The main problem of unreasonable dose was to take more medicine than preventive standard.For some patients who could take oral administration,they chose intravenous administration;also,there were patients who were not administrated strictly in accordance with the indications.Among the patients who used PPI for prevention,the cost of clinical drugs,PPI and hospitalization in high risk group were higher than those in non-high risk group.However,the ratios of PPI to total hospitalization expenses and PPI to total drug expenses in non-high risk group were higher than those in high risk group.Conclusion It is of positive significance for clinical treatment to strengthen the clinical application management of prophylactic use of PPI during perioperative period and to provide reasonable norms and improved nursing programs.