1073例热毒宁注射液临床用药帕累托图及鱼骨图分析

Analysis of 1073 Cases of Clinical Use of Reduning Injection by Pareto Chart and Fishbone Diagram

目的通过对我院热毒宁注射液的用药合理性及药品不良反应情况进行分析,为儿童合理应用热毒宁注射液提供参考。方法抽取我院2017年12月至2018年11月儿童应用热毒宁注射液的1 073例病例,应用帕累托图对用药不合理因素进行分析,应用鱼骨图对药品不良反应(ADR)根因进行分析。结果儿童使用热毒宁注射液的1 073例病例中有532例(49.58%)存在不合理用药的情况。其中超适应证(56.58%)和超疗程用药(24.25%)为其主要因素,次要因素为未辨证用药(12.22%)。1 073份病例中,发生ADR的共22例,发生率为2.05%;ADR的发生与超适应证、超疗程用药、静脉用药浓度和滴速、患者自身等因素有关;其中,超适应证用药引起的ADR占59.09%,超疗程用药引起的ADR占31.82%。结论该院热毒宁注射液临床用药存在一定不合理性,医院可依据不合理用药的主要因素、次要因素以及药品不良反应风险因素加强中药注射剂合理用药的信息化,实时监测及干预,进行重点监控,促进中药注射剂的合理使用水平,提高儿童用药的安全性。

Objective To analyze the rationality of clinical use of Reduning injection and consequent adverse drug reactions in our hospital in order to provide reference for the rational use of Reduning injection in children.Methods Data on all the cases of children who received Reduning injection in our hospital between December 2017 and November 2018 was retrieved,and a total of 1073 cases were selected.Adverse drug reactions were analyzed using Pareto charts and fishbone diagrams.Results Improper medication was found in 532(49.58%)of the 1073 cases who used Reduning injection.of which off-labeled use(56.58%)and overcourse of treatment(24.25%)were the leading factors.The secondary factor was undifferentiated medication(12.22%).ADR occurred in 22 of the 1073 cases,accounting for 2.05%and related to off-labeled use,beyondthe-course medication,intravenous drug concentration and drip rate,and patients themselves.59.09%of the adverse reactions were caused by off-labeled use and 31.82%by beyond-the-course treatment.Conclusion There is something irrational about the way Reduning injection is used in our hospital.The hospital can strengthen the real-time monitoring and intervention of the use of TCM injections with the risk factors in mind.