我院骨科患者围手术期预防性使用质子泵抑制药调查

Investigation and Analysis of Perioperative PPIs in the Prevention of Stress Ulcer in Orthopedic Department of Our Hospital

目的:对我院骨科围手术期患者预防性使用质子泵抑制药(PPIs)的用药情况进行调查,评价PPIs预防应激性溃疡的适宜性,为促进临床合理用药提供参考。方法:通过医院信息系统随机抽取我院骨科2018年3月~2019年2月手术患者出院病例793份,统计患者基本信息、PPIs的使用情况、手术情况等,分析PPIs的用药合理性。结果:793例患者的手术类型主要集中在骨折内固定术(248例,31.27%)、内固定取出术(167例,21.06%)、髓核摘除术和植骨融合内固定术(88例,11.1%)。793例使用PPIs患者中,522例患者不具备预防用药指征,706例品种和剂型选择不适宜,346例患者给药时机不合理,706例患者给药频次不合理,665例患者预防用药疗程过长。结论:骨科患者围手术期使用PPIs预防应激性溃疡存在严重不合理现象,临床医师、监督管理部门和临床药师应高度重视,避免过度使用造成不必要的资源浪费。

Objective:To investigate the application of proton pump inhibitors(PPIs)in the prevention of stress ulcers in perioperative orthopedic patients in our hospital,and evaluate the suitability of PPIs in the prevention of stress ulcers,and to provide reference for rational use of PPIs in clinic.Methods:The medical records of discharged orthopedic patients were selected from March 2018 to February 2019 through hospital information system.Those records were analyzed statistically in general information of patients,respects of the use of proton pump inhibitors,operation situation and so on.The rationality of the use of proton pump inhibitors was analyzed.Results:Among the 793 patients,the main types of surgery were fracture internal fixation(248 cases,31.27%),internal fixation extraction(167 cases,21.06%),nucleus pulposus excision and internal fixation by bone graft fusion(88 cases,11.1%).Among the 793 patients of receiving PPIs,522 patients had no medication indications,706 patients had unsuitable species selection and dosage forms,346 patients had an error of opportunity for administration,706 patients had unreasonable administration frequency,and 665 patients received long prophylactic medication.Conclusion:Perioperative use of PPIs in orthopedic patients to prevent stress ulcers has serious unreasonable phenomenon.Clinicians,supervisory departments and clinical pharmacists should attach great importance to avoid unnecessary waste of resources caused by excessive use.