浅谈雾化吸入的合理性

Rationality of atomizing inhalation

目的评估本院雾化吸入的给药情况,为临床合理用药提供参考。方法通过用药工作站调取本院神经外科、胸心外科、耳鼻喉科、肺病科、普外科5个科室2017年11月雾化的患者信息,共筛选出178例在院使用雾化患者,结合电子病历和手工检索,回顾性从雾化用药的药理、疾病分布、患者基础情况分析雾化吸入合理性,评估雾化吸入的相关指标。合理用药系统随机筛选出5个科室雾化和非雾化患者各100名,筛选出临床医师选择雾化吸入治疗干预的必要因素。结果各科室选择雾化治疗患者各不相同,选用雾化用药有吸入激素、抗生素、支气管扩张剂、化痰药等,选择雾化方式主要有氧气和超声雾化两种,根据患者病情联合用药选择也各不相同。选择雾化吸入的必要因素有吸烟史,BMI指数较高患者也就是肥胖患者,既往治疗史(化疗、胸部手术、外伤、长期激素)患者,肺部基础疾病如哮喘、慢性阻塞性肺疾病患者、低肺功能患者、全麻插管患者、机械通气患者、术后肺炎患者。结论雾化吸入各科室选择不同,仍存在一些给药频次多,联合用药使用不合理,存在非雾化药雾化等现象。临床药师应加强临床医师的处方审核,优化最佳雾化吸入给药方案,确保合理使用。

Objective To assess the atomizing inhalation in our hospital and provide a reference for the clinical rational use of drugs. Methods Patient＇s information on atomizing in November 2017 was acquired from the medication workstation, including the department of neurosurgery, thoracic surgery, otolaryngology, lung diseases and general surgery. A total of 178 patients undergoing atomization in the hospital were selected. By both electronic medical records and manual retrieval, the rationality of atomizing inhalation and the evaluation indexes related to aerosol inhalation were reviewed from aerosol drug pharmacology, disease distribution and the circumstances patients. From the five departments, 100 patients of atomization and non-atomization were randomly selected by the reasonable drug system, and the essential factors for aerosol inhalation intervention were screened. Results In these departments, various aerosol inhalation therapies were chosen for different patients. Aerosol inhalation agents included inhaled hormones, antibiotics, bronchodilators, expectorant drugs and so on, and the two main atomizations were oxygen and ultrasonic nebulization. Drug combination was also selected according to patients＇ condition. The essential factors for the choice of inhalation included smoking history, patients with a high BMI index, obesity patients with previous treatment history （chemotherapy, thoracic surgery, trauma, and long-term hormones）, patients with underlying lung diseases such as asthma, COPD, patients with low pulmonary function, patients with general anesthesia intubation, patients with mechanical ventilation or postoperative pneumonia. Conclusion Various departments choose different atomizations. Some problems such as excessive dosage frequency, irrational use of drug combinations, atomizing with non-atomized drugs and so on. Clinical pharmacists should strengthen the prescription review and optimize the best inhalation medication program.