临床医师对慢病患者围手术期用药的认知现状调查

Investigation on Current Drug Use of Clinicians to Patients with Chronic Disease during Peri-operation

目的调查分析武汉市某三级医院手术科室临床医师对慢病患者围手术期用药的认知现状,为促进慢病患者围手术期用药管理提供参考。方法根据慢病患者围手术期用药的特点设计调查表格。从理论认知和实践知识两方面,对该院相关手术科室共56名临床医师进行问卷调查。结果副主任医师认为药品说明书、参考文献与指南,以及自身的工作经验同等重要;而80%的主治医师认为药品说明书、参考文献与指南最值得信赖;住院医师中参考药品说明书用药的比例最高(86.67%),同时也相信上级医师的建议(73.33%),但对参考文献及指南的应用相对较低(66.67%)。89.13%的医师认为药品不良反应是主要风险来源;仅60.87%的临床医师关注药物相互作用;且对药物的药效学、药动学特点关注也较低(67.39%)。绝大部分临床医师(95.65%)认为药物的消除半衰期是术前停药时间的决定因素。36.96%的医师对生物利用度、19.56%的医师对最大血药浓度和峰浓度的理解不明确,错误认为这些因素同样会影响药物的代谢时间。结论临床医师对慢病患者围手术期用药认识尚有较多不足,需要加强培训,规范用药,规避临床药物治疗风险。

Objective To investigate and analyze the current cognitive status of clinicians for drug uses to patients with chronic disease during the peri-operation in the operation department of a third-class hospital in Wuhan,and to provide a reference for the effective management.Methods An anonymous questionnaire was designed according to the characteristics of drug use during peri-operation period.From two aspects of theoretical cognition and practical knowledge,the questionnaire survey was carried out among 56 clinicians in the relevant operation departments of the hospital.Results According to associate chief physicians,drug Instructions,references,medical guide,and their work experience were the equally important.And 80%of the attending physicians think that the drug instructions,references and guidelines were most reliable.Among the resident physicians,86.67%of them referred to the drug instructions,and 73.33%were willing to believe the recommendations of their superiors,but the application of references and guidelines was relatively low(66.67%).89.13%of clinicians thought the major risk was from adverse drug reactions.But in fact,only 60.87%of them would pay attention to drug interaction,followed by pharmacokinetics and pharmacodynamics of drugs(67.39%).Most of clinicians(95.65%)also thought the half-life of drugs decided when to stop using them.Some of clinicians do not understood the meaning of bioavailability(36.96%)and the peak concentration(19.56%).Conclusion It is clear that there still are many deficiencies in clinicians'understanding of perioperative medication for patients with chronic diseases.Then tt is necessary to strengthen the training,standardize medication and avoid the risk of clinical medication.