1745例Ⅱ、Ⅲ类切口手术患者使用PPI预防应激性溃疡的调查分析

Investigate the use of PPI to stress ulcer prophylaxis in 1 745 cases of surgical patients receiving aseptic-contaminative and contaminative incision operation

目的评价Ⅱ、Ⅲ类切口手术患者使用质子泵抑制剂(PPI)预防应激性溃疡(SU)的合理性。方法抽取2013年1～4月外科住院的Ⅱ、Ⅲ类切口手术患者病历,对使用PPI预防SU的情况进行回顾性分析。结果共抽取病历1 745份,使用PPI预防SU的540例,总预防用药率为30.95%,其中ICU、普外科、泌尿科、胸外科和神经外科的总预防用药率高于其他科室(除外ICU、胸外科和神经外科与骨科);有高危因素232例,预防用药率为72.41%;无高危因素1 513例,预防用药率为24.59%,其中普外科、泌尿科和胸外科的无高危因素用药率高于其他科室(除外ICU、骨科与胸外科)。在预防SU的药物中,兰索拉唑的使用率高于奥美拉唑和泮托拉唑;术前预防用药率为14.44%,用药剂量过大的占0.93%,预防用药疗程过长的占12.78%。结论临床医生在使用PPI预防Ⅱ、Ⅲ类切口手术患者发生SU时,存在无高危因素用药、用药时机不恰当、疗程过长等现象。因此,需严格限制SU预防用药指征,规范PPI的合理使用。

Objective To study the rationality in the use of proton pump inhibitors （PPI） to stress ulcer（SU） prophylaxis in pa-tients receiving aseptic-contaminative and contaminative incision operation .Methods A retrospective analysis was performed on the use of PPI to SU ,which taken from surgical patients received aseptic-contaminative and contaminative incision operation and hospi-talized from January 2013 to April 2013 .Results Among 1 745 patients in the study ,540（30 .95% ） received a stress ulcer prophy-laxis with PPI .The rate of prophylaxis to ICU ,general surgery ,urology ,thoracic surgery and neurosurgery was higher than other departments（except for between ICU ,thoracic surgery ,neurosurgery and orthopedic） .A total of 232 patients had risk factors , 72 .41% of the patients who received prophylaxis .A total of 1 513 patients did not have risk factors ,24 .59% of the patients who received prophylaxis ,the rate of prophylaxis to general surgery ,thoracic surgery and urology was higher than other departments （except for ICU ,and between thoracic surgery with orthopedics ） .In prevention of SU ,the usage rate of Lansoprazole was higher than that of Omeprazole and Pantoprazole .Preoperative prophylactic usage rate was 14 .44% .Excessive dosage was 0 .93% .Preven-tive medicine treatment longer accounted for 12 .78% .Conclusion The phenomenon such as non-risk factors ,inappropriate of medi-cation time and long course of treatment are existed ,when physicians use the PPI for SU prophylaxis in surgical patients receiving aseptic-contaminative and contaminative incision operation .Therefore ,treatment recommendations for SU prophylaxis are needed to restrict PPI use for justified indications .