9种慢性病的临床指南中的潜在药物相互作用研究

Study on the Potential Drug Interaction in Clinical Guidelines for 9 Chronic Diseases

目的:提高医务人员对潜在药物相互作用(以下简称"药物相互作用")的认识,减少因药物相互作用导致的药品不良事件,为慢性病临床指南制定提供参考。方法:依据《中国居民营养与慢性病调查报告》与相关文献,选取9种常见慢性病(高血压、2型糖尿病、血脂异常、抑郁、原发性肺癌、类风湿性关节炎、缺血性脑卒中、慢性心力衰竭和慢性阻塞性肺疾病)对应的由中华医学会或国家卫生和计划生育委员会牵头制订的最新的临床指南,评估指南中药物相互作用方面的完善程度。检索Micromedex、Stock-ley’s Drug Interactions、Medscape、Adverse Drug Interactions:A Handbook for prescribers和药品说明书等数据库或资料,以与其他慢性病共存可能性最大及发病率最高的高血压、2型糖尿病、血脂异常疾病的临床指南为中心,统计这3种慢性病的指南推荐药物与除自身外的8种慢性病指南推荐药物之间相互作用的数量(包括轻/中度及严重药物相互作用),同时统计具有严重相互作用数量较多的药物。结果:尚无指南提及共患病推荐药物之间相互作用。高血压、2型糖尿病、血脂异常临床推荐药物与除自身外的8种疾病临床指南推荐治疗药物之间具有轻/中度药物相互作用的数量分别为759、681、68个,具有严重药物相互作用的数量分别为262、17、37个。存在严重相互作用数量较多的药物为地高辛(24个)、阿司匹林(22个)、利尿剂(12种药物,14～17个)等。结论:当患者同时患有多种慢性病时,临床药师用药需关注药物相互作用的问题,本研究选取的慢性病临床指南仍待完善药物相互作用的内容。

OBJECTIVE:To reduce ADEs due to potential drug interaction(short for drug interaction)by improving medical staffs’recognition,and to provide reference for making clinical guidelines for chronic disease.METHODS:According to the Survey Reprots on Chinese Resident’s Nutrition and Chronic Disease and related literatures,nine common chronic diseases(hypertension,type 2 diabetes mellitus,dyslipidemia,depression,primary lung cancer,rheumatoid arthritis,ischemic stroke,chronic heart failure and chronic obstructive pulmonary disease)and latest corresponding clinical guidelines,developed by the Chinese Medical Association or National Health and Family Planning Commission were selected to evaluate the improvement of drug interaction in the guidelines.Retrieving Micromedex,Stockley’s Drug Interactions,Medscape,Adverse drug interactions:A Handbook for prescribers and drug instructions,centered on the clinical guidelines for hypertension,type 2 diabetes and dyslipidemia,which were most likely to coexist with other chronic diseases and had the highest incidence,the number of drug interactions(mild/medium and severe drug interaction)of drugs recommended by 3 chronic disease guidelines and 8 other guidelines were counted,and drugs with a large number of severe drug interactions were also counted.RESULTS:There was no guideline to discussing the interaction between recommended drugs for comorbidity.The number of mild/mediuem drug reactions recommended by clinical guidelines for hypertension,type 2 diabetes,dyslipidemia and other 8 disease were 759,681 and 68,respectively;those of severe drug interaction were 262,17 and 37,respectively.The drugs with a high number of severe drug interactions were digoxin(24),aspirin(22),diuretics(12 kinds of drugs,14-17).CONCLUSIONS:When patients suffer from multiple chronic diseases,clinical pharmacists should pay attention to drug interactions.Selected clinical guidelines for chronic diseases still need to be completed the content of drug interactions.