某三级甲等医院住院患者雾化吸入用药分析

Analysis of Atomization Inhalation Medication for Inpatients in A GradeⅢLevel A Hospital

目的:了解某三级甲等医院(以下简称“该院”)住院患者雾化吸入用药使用情况,为临床合理用药提供参考。方法:利用医院信息系统,抽取2019年1—6月该院住院患者给药途径为雾化吸入的长期医嘱12075条,收集科室、患者基本信息、药品名称、用法、用量和临床诊断等信息,对限定日剂量、处方日剂量和药物利用指数(drug utilization index,DUI)等进行统计分析。结果:12075条雾化吸入用药医嘱涉及住院患者3209例,年龄1 d至98岁,≥60岁患者医嘱数居多,共5744条(占47.57%);涉及31个临床科室,主要为脊柱外科、呼吸科和耳鼻喉科;疾病诊断以呼吸系统疾病为主;涉及药品21个品规,使用例次数排序居前3位的为吸入用布地奈德混悬液、吸入用乙酰半胱氨酸溶液和盐酸氨溴索注射液;雾化制剂的医嘱数为5443条,涉及6个品规,仅吸入用乙酰半胱氨酸溶液的DUI>1,提示该药处方日剂量超过药品说明书规定的最大日剂量;非雾化制剂用于雾化途径属于超说明书用药,医嘱数为6632条;涉及2077组联合用药,二联用药主要为吸入用布地奈德混悬液+吸入用乙酰半胱氨酸溶液、吸入用布地奈德混悬液+吸入用硫酸沙丁胺醇溶液或硫酸特布他林雾化液、吸入用布地奈德混悬液+吸入用异丙托溴铵溶以及吸入用布地奈德混悬液+盐酸氨溴索注射液或注射用盐酸氨溴索等,三联用药主要为吸入用布地奈德混悬液+吸入用硫酸沙丁胺醇溶液或硫酸特布他林雾化液+吸入用异丙托溴铵溶,还存在四联用药情况;单次给药量范围为2~110 ml,平均给药量(9.52±5.76)ml。结论:雾化吸入治疗临床应用广泛,但雾化制剂品种选择较少,临床使用存在单次给药剂量不准确、联合用药不合理及非雾化制剂滥用等情况,需加强监管,促进雾化用药的合理应用。

OBJECTIVE:To investigate the application of atomization inhalation medication for inpatients in a GradeⅢLevel A hospital(hereinafter referred to as“the hospital”),so as to provide reference for clinical rational drug use.METHODS:The hospital information system was used to extract 12075 long-term medical orders with inpatients given drugs by atomization inhalation from Jan.to Jun.2019.Departments,basic information of patients,drug name,usage,dosage and clinical diagnosis were collected,defined daily dose system(DDDs),prescription daily dose,drug utilization index(DUI)were statistically analyzed.RESULTS:A total of 12075 atomization inhalation medication orders were collected,including 3209 inpatients,aged 1 d to 98 years old.The number of orders of patients over 60 years old was mostly(5744 pieces,47.57%).There were 31 clinical departments,mainly spinal surgery,respiratory and otolaryngology.Disease diagnosis mainly based on respiratory diseases.A total of 21 kinds of drugs were enrolled,and the top 3 are budesonide suspension for inhalation,acetylcysteine solution for inhalation and ambroxol hydrochloride injection.The number of medical orders for atomized preparation was 5443 pieces,including 6 specifications,and only the DUI of acetylcysteine for inhalation was more than 1,which indicating that the daily dose of the prescription was more than the maximum daily dose specified in the drug instructions.Non-atomization preparation used for atomization was off-label drug use,and the number of medical orders was 6632 pieces.There were 2077 groups of drug combination.Double drug combination were mainly inhalation of budesonide suspension+acetylcysteine solution for inhalation,inhalation of budesonide suspension+inhalation of albuterol sulphate solution or terbutaline sulphate atomization,inhalation of budesonide suspension+inhalation of isopropanotropium bromide solution and inhalation of budesonide suspension+ambroxol hydrochloride injection or injection of ambroxol hydrochloride.Triple drug combination were mainly inhalation of budesonide suspension+inhalation of albuterol sulphate solution or terbutaline sulphate aerosol+inhalation of isopentropium bromide solution,and there were quadruple drug combination.The single dose range was 2-110 ml,and the average dose was(9.52±5.76)ml.CONCLUSIONS:Atomization inhalation treatment is widely used in clinical practice,but there are few kinds of atomization preparations to choose.And there are some situations such as inaccurate single doses,irrational drug combination,and abuse of non-atomization preparations.It is necessary to strengthen supervision and promote the rational use of atomization inhalation medication.