某院住院患者麻醉性镇痛药品处方分析

Analysis of Narcotic Drug Prescriptions in A Hospital Inpatients

目的调研某院住院癌痛患者麻醉性镇痛药品使用情况,为安全合理应用麻醉性镇痛药品提供参考。方法依据世界卫生组织(WHO)"癌症三阶梯止痛原则"以及NCCN、ESMO等权威指南、国家卫计委癌症疼痛诊疗规范2011年版,以限定日剂量(DDD)为指标的分析方法,对该院2017年6月1日～11月30日住院药房麻醉药品的8 303份有效处方进行统计分析。结果芬太尼透皮贴(4.2 mg/贴) DDDs值最高,盐酸哌替啶注射液(100 mg/支) DDDs值最小。硫酸吗啡缓释片(30 mg/片)的DUI值为1.14,盐酸羟考酮缓释片(40 mg/片)为1.75,芬太尼透皮贴(4.2 mg/贴)为1.18,芬太尼透皮贴(8.4 mg/贴)为2.35。结论该院麻醉性镇痛药品使用结构基本合理,某些药品的DUI值偏大,可能是该院麻醉性镇痛药品大部分用于已经耐受阿片类药物的晚期癌痛患者所致。

OBJECTIVE To investigate the application of narcotic drugs among the cancer inpatients and rationalize the usage of the drugs. METHODS The study was designed according to the WHO three-step ladder for cancer pain relief,clinical guidelines for cancer pain relief by Ministry of Health of PRC and other authoritative guidelines by NCCN or ESMO. The drug DDD（ defined daily dose） and DUI（ drug utilization index） of 8 303 narcotic drug prescriptions of inpatients in Sun Yat-sen University Cancer Center from June to November in 2017 were analyzed. RESULTS Ordering by DDD,Fentanyl transdermal patch（4.2 mg/patch） was at the top of the list,while Pethidine hydrochloride injection was in the end. However,DUI of Morphine sulfate sustained-release tablets（30 mg/tablet）was 1. 14,DUI of Oxycodone hydrochloride Sustained-Release Tablets（40 mg/tablet） was 1. 75,DUI of Fentanyl transdermal patch（ 4. 2 mg/patch） was 1. 18,DUI of Fentanyl transdermal patch（ 8. 4 mg/patch） was 2. 35. CONCLUSION The usage of narcotic drugs in the hospital is almost rational,except for a fraction with aberrant DUI. The aberrant might result from the application on the terminal cancer patients with opioid tolerance.