中国六城市质子泵抑制剂与氯吡格雷联合应用处方现状研究

Investigation of clopidogrel-proton pump inhibitor combination prescription situation of six cities in China

目的 了解我国质子泵抑制剂（PPI）与氯吡格雷联合应用处方现状。方法 数据来自《医院处方分析合作项目》2010-2013年全国六城市88家医院门诊和住院数据,每家医院每年随机抽取40 d门诊处方和住院医嘱,包括患者基本信息、用药情况、诊断和用药金额等项目,从中提取PPI与氯吡格雷联合使用的数据,用Foxpro 8.0数据库软件进行统计分析。结果 使用氯吡格雷的患者中,氯吡格雷联合PPI所占比例：门诊患者为2.1%～3.6%,住院患者为16.1%～31.6%;奥美拉唑、埃索美拉唑联合氯吡格雷的比例,由2010年的第1位和第2位,下降到2013年的第3位或第4位,而泮托拉唑、雷贝拉唑与氯吡格雷联合的比例逐渐上升到第1位或第2位;心内科、老干科、普通内科及神经内科4个科室,奥美拉唑、埃索美拉唑联合氯吡格雷的比例较高。结论 临床医生已随着相关治疗指南的更迭调整用药行为,关注到PPI与氯吡格雷药物相互作用会引发的心脏病风险,对重点科室应加强宣传教育,为患者优先选择相互作用影响小的药物,以保证治疗效果及兼顾规避用药风险。

Objective To investigate the prescription situation of clopidogrel combined with proton pump inhibitor（PPl）. Methods The data was from Hospital Prescription Analysis of Cooperative Project which included outpatient prescriptions and inpatient medical orders from 88 hospitals of six cities in China. 40-day-prescriptions were ran- domly selected each year from 2010 to 2013, the prescriptions included patients＇ basic information, medication, diagnosis and drug costs, etc. The data of clopidogrel-proton pump inhibitors combination were extracted. The Foxpro 8.0 database software was used. Results In the patients used clopidogrel, patients used clopidogrel-PPI counted for 2. 1% 3.6 % in outpatient, and 16. 1% - 31.6 % in inpatient ; the ranking of proportion of omeprazole ＋ clopidogrel, esomeprazole ＋ clopidogreldecreased from first and second （2010） to third and fourth （2013） , and the proportion of pantoprazole ＋ clopidogrel,rabeprazole ＋ clopidogrel ranked first and second （2013）. The proportion of omeprazole and esomeprazole combined with clopidogrel was high in department of cardiology, department of elderly cadre outpatient, internal medicine and department neurology. Conclusion Clinicians has been adjusting their medication behavior according to new guidelines. They has paid close attention to PPI and clopidogrel interaction which may cause risk of heart diseases. The key departments should strengthen publicity and education： less drugs interaction should be preferred choice to ensure therapeutic effects and avoid risks.