骨科患者围术期使用质子泵抑制药预防应激性溃疡的现状分析

Status analysis of using proton pump inhibitors to prevent stress ulcer in perioperative patients in department of orthopaedics

目的分析我院骨科患者围术期使用质子泵抑制药(PPIs)预防应激性溃疡的情况,为医院规范化管理PPIs提供依据。方法用分层抽样的方法收集我院3个骨科病区共100份病例资料,依据相关专家建议和合理利用评价标准,分析其预防用药指征、使用的风险药物、预防应激性溃疡使用的药物种类、用法用量、停药现状和药品费用情况。结果在100例患者中,96例属于有指征使用PPIs,4例属于无指征用药。住院期间使用的风险药物主要包括非甾体抗炎药和糖皮质激素。在100例患者中,91例患者使用奥美拉唑钠,9例使用泮托拉唑,其中96%的患者均是静脉给药,仅4%采用的是口服给药;48%的患者用药时长超过5 d,停药原因方面,57%的患者因出院而停药,住院期间无消化道出血情况发生。PPIs占总药费的比例最低为0.45%,最高为31.39%,平均为(6.48±4.28)%。结论我院骨科围术期预防应激性溃疡在用药指征、药物种类、给药方式、用药疗程等方面存在一些不合理之处,需采取相应的措施进行改进。

Objective To investigate the use of proton pump inhibitors(PPIs) in the prevention of stress ulcers in perioperative patients in department of orthopaedics in order to provide basis for standardized management of PPIs in our hospital.Methods We retrospectively analyzed the data of orthopaedics patients and stratified sampling was used to collect 100 case data of three orthopedic departments in our hospital.According to relevant expert recommendations and evaluation criteria for rational use, we analyzed the indications of prophylactic drugs, the risk drugs used, the types of drugs used to prevent stress ulcer, the usage and dosage, the status of drug withdrawal and drug costs.Results Among the 100 orthopedic patients who used proton pump inhibitors during perioperative period, 96 patients had indications of prophylactic drugs, and 4 patients were non-finger-requisitioned drugs.Risk medications used during hospitalization mainly included non-steroidal anti-inflammatory drugs and glucocorticoids.In terms of drug selection,91 patients were given omeprazole sodium and 9 patients were given pantoprazole, among which only 4% were given orally and 96% were given intravenously.In terms of medication duration,48% of the patients took medication for more than 5 days,and in terms of reasons for drug withdrawal,57% of the patients stopped medication due to discharge.No gastrointestinal bleeding occurred during hospitalization.The proportion of proton pump inhibitors in total drug costs ranged from 0.45% to 31.39%,with an average of(6.48±4.28) %.Conclusion There are some unreasonable points in drug indications,drug varieties,drug administration methods and drug course,and corresponding measures should be taken for improvement.