围手术期非甾体抗炎药合理使用情况的多中心回顾性研究

Appropriate Use of Non-steroidal Anti-inflammatory Drugs during the Perioperative Period: a Retrospective Multicenter Study

目的调查围手术期非甾体抗炎药(nonsteroidal anti-inflammatory drugs,NSAIDs)的临床应用情况,为合理选择及使用此类药物提供参考。方法本项目为一项多中心、回顾性研究,包括3个部分:①通过问卷调研各机构NSAIDs的临床应用概况;②由疼痛专科临床药师组成专家组,经过多次讨论对药物评价标准形成共识;③随机抽查2016年第4季度至2017年第1季度围手术期使用NSAIDs的病例,严格按照点评标准对药物使用合理性进行评价。结果本项目在16家综合性三级医院开展,共抽查病例960份。其中,NSAIDs为15家(93. 8%)机构围手术期常用的镇痛药物,使用金额排序前3位的NSAIDs依次为氟比洛芬酯注射液、注射用帕瑞昔布钠及塞来昔布胶囊。10家(62. 5%)机构未常规干预NSAIDs的不合理使用,仅有2家(12. 5%)机构制定了NSAIDs使用规范。抽查病例的总体不合理率为23. 3%(n=224),存在的主要问题为超疗程使用及NSAIDs联用,分别涉及10家医院98例病例(10. 2%)及11家医院76例病例(7. 9%)。其他问题为:26例病例(2. 7%)超禁忌症使用药物,24例病例(2. 5%)给药方式不正确。结论 NSAIDs在围手术期使用广泛,但面临使用规范缺失、临床干预不足及不合理使用现象较多的问题。因此,需及时采用措施,推进药学工作介入,规范临床用药。

OBJECTIVE To evaluate the appropriateness of nonsteroidal anti-inflammatory drugs( NSAIDs) used in the perioperative period. METHODS This was a retrospective multicenter study with three stages:①characterization of the application of NSAIDs through questionnaires;②establishment of an expert group and development of the standard for prescription evaluation;③random enrollment of cases using NSAIDs during the perioperative period from October 2016 to March 2017 and evaluation of prescriptions. RESULTS The study was conducted in 16 tertiary-care hospitals and included 960 cases. NSAIDs were commonly used in 15 hospitals( 93. 8 %) during the perioperative period. Flurbiprofen axetil injection,parecoxib sodium injection and celecoxib capsule were NSAIDS with the top three expenses. Ten( 62. 5 %) hospitals did not routinely intervene for the irrational use of NSAIDs,and only two( 12. 5 %) hospitals established the regulatory regime of NSAIDs. The overall irrational rate was 23. 3 %( n = 224). Too long continuous medication duration and inappropriate combination of NSAIDs were the main problems,involving 98 cases( 10. 2 %) in 10 hospitals and 76 cases( 7. 9 %) in 11 hospitals,respectively. Other problems were: 26 cases( 2. 7 %) used drugs beyond contraindication, and 24 cases( 2. 5 %) administrated drugs in irrational route. CONCLUSION NSAIDs are widely used in the perioperative period. Lack of regulatory regime,insufficient clinical intervention and irrational prescriptions are the current status of NSAIDs usage. Therefore,it is necessary to take powerful measures and effective pharmaceutical intervention to improve the use of NSAIDs.