抗高血压不合理用药处方分析

Analysis of the irrational antihypertension drug prescriptions

目的对广东地区抗高血压药物治疗处方的不合理情况进行现况调查,为药师处方审核提供参考,以促进临床合理用药。方法对广东省153家医院2018年8-10月1304张门诊抗高血压药物治疗不合理处方进行审核,分析不合理用药情况。结果1304张不合理处方中女性[54.22%(707/1304)]、老年[55.14%(719/1304)]、高血压未分级[67.79%(884/1304)]、有特殊合并疾病[66.41%(866/1304)]患者处方比例较高。1304张处方共开具降压药2657种,出现频率最高的降压药为钙通道阻滞剂[31.37%(409/1304)],其次为β受体阻滞剂[18.56%(242/1304)]和血管紧张素受体拮抗剂[17.33%(226/1304)]。联合用药处方中二联用药最常见[38.73%(505/1304)]。不合理用药类别前3位依次为用法及用量不适宜[28.45%(371/1304)]、未遵照个体化给药原则[24.54%(320/1304)]、联合用药不适宜[18.40%(240/1304)]。不合理用药均随患者年龄、高血压严重程度、合并疾病数量增加而增加。结论处方医师和审方药师应重视各种降压药的不合理使用情况,尤其是用法及用量不适宜、联合用药不适宜和重复给药等,抗高血压药物的临床使用应注意遵循个体化用药原则,把握用药适应证。

Objective To investigate the situation of the irrational prescriptions of antihypertensive drugs in Guangdong,and provide a reference on prescription checking for pharmacists,so as to promote the rational use of drugs in clinic.Methods A total of 1304 irrational out-patient prescriptions with hypertension in 153 hospitals of Guangdong from August to October in 2018 were checked,and the irrational drug use conditions were analyzed.Results Among the 1304 irrational prescriptions of hypertension,female[54.22%(707/1304)],the elderly[55.14%(719/1304)],ungraded hypertension[67.79%(884/1304)]and patients with specific comorbidities[66.41%(866/1304)]were more common.A total of 2657 antihypertensive drugs were prescribed in 1304 prescription.The most frequent prescribed drugs were calcium channel blockers(CCB)[31.37%(409/1304)],followed by beta-blockers[18.56%(242/1304)]and angiotensin receptor antagonists(ARB)[17.33%(226/1304)].Among the combined use of drugs,two drugs were the most common[38.73%(505/1304)].The top three categories of irrational drug use were inappropriate usage and dosage[28.45%(371/1304)],failure to comply with the principle of individualized administration[24.54%(320/1304)],unsuitable combination medication[18.40%(240/1304)].The irrational use of drugs in each category increased with patients′age,the severity of hypertension and the number of comorbidities.Conclusion Prescribers and pharmacists should pay attention to the irrational use of antihypertensive drugs,especially inappropriate usage and dosage,unsuitable combination medication and repeated administration.The clinical use of antihypertensive drugs should follow the principle of individualized medication and grasp the indications of medicine.