某三甲医院手术科室围术期蛇毒血凝酶的应用合理性调查

Analysis of the use of hemocoagulase during perioperative period in three A hospital

目的调查某三甲医院主要手术科室围术期蛇毒血凝酶的应用合理性。方法选取240例某三甲医院主要手术科室患者,回顾性分析患者围术期应用蛇毒血凝酶的数量、时机和剂量等,结合药物说明和文献分析其合理性。结果12个手术科室240例非创伤手术患者中有10个科室(83.3%)共151例患者(62.9%)应用了蛇毒血凝酶,只有骨一科和产科未应用。3种蛇毒血凝酶中,注射用尖吻蝮蛇血凝酶(商品名:苏灵)的应用患者例数及应用次数均远高于注射用矛头蝮蛇血凝酶(商品名:巴曲亭)和蛇毒血凝酶注射液(商品名:速乐涓)。术前及术后1、2、3、4、5、6、7、8 d应用蛇毒血凝酶的患者占比分别为27.8%、90.7%、61.6%、35.8%、10.6%、4.0%、2.0%、2.0%、0.7%。术后1 U/d 7例,占31.8%;2 U/d 3例,占13.6%;4 U/d 2例,占9.1%;6 U/d 3例,占13.6%;8 U/d 7例,占31.8%。2 U/d 8例,占61.5%;4 U/d 5例,占38.5%。1 U/d 2例,占1.7%;2 U/d 104例,占89.7%;4 U/d 10例,占8.6%。结论该三甲医院主要手术科室在围术期使用蛇毒血凝酶的比例高,血液保护意识强,但在用药时机、剂量等方面循证意识不足,存在一定比例的不合理应用。

Objective To investigate the rationality of the use of the hemocoagulase during perioperative period in a three A hospital.Methods 240 patients from the main surgical departments of a three A hospital were selected to retrospectively analyze the number,timing,and dosage of patients'perioperative applications of hemocoagulase,and analyze their rationality in relation to drug descriptions and literature.Results O f 240 non-trauma surgical patients in 12 surgical departments,hemocoagulase was applied in 10 departments(83.3%)in a total of 151 cases(62.9%),and only the department of orthopedics and obstetrics did not.Among the three types of hemocoagulase,both the number of patients and the number of applications of haemocoagulase agkistrodon for injection(trade name:Suling)were higher than those of hemocoagulase bothrops atrox for injection(trade name:Baquting)and hemocoaqulase injection(trade name:Sulejuan).The proportions of patients who applied hemocoagulase before and 1,2,3,4,5,6,7,and 8 d after surgery were 27.8%,90.7%,61.6%,35.8%,10.6%,4.0%,2.0%,2.0%,and 0.7%.After surgey,7 cases had 1 U/d,accounting for 31.8%;3 cases had 2 U/d,accounting for 13.6%;2 cases had 4 U/d,accounting for 9.1%;3 cases had 6 U/d,accounting for 13.6%;7 cases had 8U/d,accounting for 31.8%.8 cases had 2 U/d,accounting for 61.5%;5 cases had 4 U/d,accounting for 38.5%.2 cases had 1 U/d,accounting for 1.7%;104 cases had 2 U/d,accounting for 89.7%;10 cases had 4 U/d,accounting for 8.6%.Conclusion The major surgical departments in this three A hospital have a high proportion of perioperative use of hemocoagulase and a strong awareness of blood protection,but lack of evidence-based awareness in terms of the timing and dosage of the drug,and there is a certain proportion of unreasonable applications.