胸外科术后患者自控镇痛用药合理性调研

Post-thoracic Surgery Patient-controlled Intravenous Analgesia Use Rationality Investigation

目的:调查丽水市中心医院(以下简称“我院”)胸外科行开胸术后患者静脉自控镇痛(PCIA)的应用情况,促进患者PCIA的合理应用。方法:回顾性调查胸外科2016年7月~2017年12月符合纳入标准的病例资料,制定PCIA用药评价标准,根据给药疗程、给药剂量、禁忌证、用药监测、联合用药情况、给药途径等进行合理用药评估,并根据患者实际用药情况分组比较各组不良反应(ADR)、疼痛评分(NRS),对联合其他镇痛药、止吐药等进行合理用药评估。结果:合理用药评价结果:给药疗程合理率40.0%,给药剂量合理率57.0%,禁忌证合理率92.0%,用药监测合理率98.0%,联合用药合理率98.0%,给药途径合理率100.0%。100例患者的疼痛缓解率为98.0%,不良反应发生率为8.0%,联合其他镇痛药或止吐药比例分别为34.0%,14.0%。不同组别PCIA的镇痛效果和不良反应发生率基本相当,A组联合其他镇痛药比例明显高于B组(P<0.001)。结论:我院PCIA使用存在一定的不合理现象,应加强药师干预,进一步提高临床用药的合理性。

Objective:To investigate the application of patient-controlled intravenous analgesia(PCIA)in patients undergoing thoracotomy in Lishui Municipal Central Hospital(hereinafter referred to as our hospital),so as to promote the rational application of PCIA in patients.Methods:Retrospectively investigated cases of thoracic surgery department that met the inclusion criteria from July 2016 to December 2017;established PCIA evaluation standards,and conducted rational drug use evaluation according to the course of treatment,dosage,contraindication,drug use monitoring,combined drug use,administration route;meanwhile,divided the patients into groups according to their actual medication situation,and compared the adverse drug reactions(ADR),numeric rating scales(NRS)and combined with other analgesics and antiemetics of each group,so as to conduct rational drug use evaluation.Results:Evaluation results of rational drug use:the rational rate of course of teartment,dosage were respectively 40.0%and 57.0%;then,the rational rate of contraindication was 92.0%,the rational rate of drug monitoring was 98.0%,the rational rate of combined drug use was 98.0%,and the rational rate of administration route was 100.0%.The pain relief rate of these 100 patients was 98.0%,and the incidence of adverse reactions was 8.0%,plus the incidences of combined with other analgesics and antiemetics were 34.0%and 14.0%,respectively.In addition,the analgesic effect and the incidence of adverse reactions of PCIA were basically the same in different groups,and the proportion of group A combined with other analgesics was significantly higher than that in group B(P<0.001).Conclusion:There are some unreasonable phenomena in the administration of PCIA in our hospital,and pharmacists’intervention should be strengthened to further improve the rationality,safety and effectivenessof clinical medication.