围术期住院患者应用抑酸药预防应激性溃疡效果回顾性分析

A retrospective study on the use of acid-suppressive drugs in the prevention of stress ulcer in perioperative patients

目的:通过分析首都医科大学宣武医院外科手术患者预防应激性溃疡的用药情况,研究围术期患者应用抑酸药(PPIs和H2RAs)预防应激性溃疡的合理性,为临床合理应用抑酸药提供理论依据。方法:随机抽取宣武医院2015年1、4、7和10月外科手术病例,依据应激性溃疡预防用药相关指南进行评价分析。结果:整体预防用药率为55.25%(179/324),平均预防用药天数为(4.55±3.06)d。其中168例(93.85%)使用PPIs;174例(97.21%)为静脉给药;172例(96.10%)为术后给药。1例(0.31%)发生应激性溃疡出血;10例(3.09%)在应用抑酸药后发生肺炎,用药疗程为(5.50±3.75)d,预防用药合理率为45.99%(149/324)。其中预防用药组合理率为17.88%(32/179),无指征预防用药增加了住院总费用、总药费,但不能减少平均住院日和药物不良反应(ADR)风险。结论:宣武医院预防应激性溃疡存在抑酸药PPIs过度使用及用法用量、给药途径、停药时机不合理现象,建议临床医师在应用抑酸药时应严格掌握应激性溃疡适应证,保证抑酸药的合理应用。

Objective： This study retrospectively analyzed the acid-suppressive drugs（PPIs and H2 RAs） used for SU prophylaxis in perioperative patients and judged the rational use of acid-suppressive drugs for SU prophylaxis, and then provide the basis for the irrational application of acid-suppressive drugs. Methods： A retrospective case survey was conducted to collect 360 cases from January, April, July and October of 2015, and then we have a statistical analysis of the use of acid-suppressive drugs for SU prophylaxis. Results： The overall prevention rate was 55.25%（179/324） and the average number of days for preventive medication was（4.55±3.06） days. Of these, 168（93.85%） used PPIs; 174（97.21%） were intravenous; 172（96.10%） were postoperative. A total of 1 patient（0.31%） developed SU hemorrhage; 10 cases（3.09%） suffer pneumonia after using acid-suppressive drugs and medication course are（5.50±3.75） days. The rational rate of prophylaxis was 45.99%（149/324）. Among them, the combination rate was 17.88%（32/179）, and the total cost of hospitalization was not increased, but the average hospitalization date and ADR risk were not reduced. Conclusion： The hospital has phenomena of overuse of acid-suppressive drugs, especially PPIs. Other irrational phenomena included in usage and dosage, route of administration, withdrawal time. It is recommended that the clinical application of anti-acid drugs should be strictly grasp the stress ulcer indications.