质子泵抑制剂临床超适应证使用的医疗大数据分析

Medical big data analysis of the clinical off-label use of proton pump inhibitors

目的探讨国内住院患者质子泵抑制剂(PPIs)过度使用的主要原因。方法分析20家综合性医院2015年1月1日至2018年3月31日的患者电子病历信息,统计PPIs的适应证分布,不同品种PPIs的使用分布以及超适应证用药患者的高频疾病、手术、合并用药等。结果 PPIs使用人数最高的适应证为非甾体抗炎药(NSAIDs)相关溃疡的预防,占使用患者的40.9%;34.2%的患者为超适应证用药;超适应证用药患者中,兰索拉唑使用比例最高,占48.1%;使用PPIs患者人数最高的疾病、手术和伴随用药分别是食管、胃和十二指肠疾病、胆囊胆道手术和矿物质补充剂。结论药物性溃疡的预防和超适应证用药是PPIs用量巨大的主要原因;兰索拉唑的应用不够规范;超适应证用药通常发生在肿瘤和消化道疾病的患者,消化道不适、禁食、手术和使用糖皮质激素是其发生的主要原因。

Objective To explore the main causes of the overuse of proton pump inhibitor(PPIs) in domestic hospitalized patients. Methods The electronic medical records of patients in 20 general hospitals from January 1, 2015 to March 31, 2018 were analyzed. The distribution of indications of PPIs, the distribution of different uses of PPIs, the most often diseases of patients using the off-label medications, surgeries and combined medication, etc. were analyzed. Results The number one indication of PPIs was the prevention of NSAIDs-related ulcer, which accounted for 40.9% of the patients and 34.2% of them was off-label users. Among the off-label patients, lansoprazole was the most highly used, which accounted for 48.1%. The most often diseases, surgeries and combined medications of the patients using PPIs were the diseases of esophagus, stomach and duodenum, gallbladder and biliary surgery and mineral supplement. Conclusion The prevention of drug-induced ulcers and the off-label use is the main reasons for the huge amount of PPIs usage. The application of lansoprazole is not standardized;The main causes of the off-label PPIs usage are gastrointestinal discomfort, fasting, surgery and glucocorticoids.