基层医疗机构心血管系统疾病治疗用药的安全性问题分析与警戒思考

Safety of medications for cardiovascular diseases in community clinics

目的 挖掘基层医疗机构心血管系统疾病治疗用药的药品不良反应/不良事件(ADR/ADE)发生特点,提出针对性的警戒防范措施。方法 采用频次统计、关联规则等方法,回顾性分析北京市延庆区4家基层医疗机构2004年1月1日至2021年6月30日上报的180例心血管系统疾病治疗用药ADR/ADE。结果 70~79岁报告最多、静脉给药是主要途径;仅7.78%病例记录药物过敏史;瘙痒、皮疹等是上报的主要症状;血脂调节剂、理血剂是上报最多的中药、化药种类,药性温、苦、归肝经、含朱砂等上报最多;天麻素、马来酸桂哌齐特、丹参红花制剂及银杏叶提取物并用前列地尔等上报较多。结论 建议更加关注基层患者年龄、给药途径、药物过敏史、中药药性、含毒性药物、药物(中药、化药)并用对心血管系统治疗用药发生ADR/ADE的影响,多途径、多举措加强药物合理使用。

Objective To explore the characteristics of adverse drug reactions/adverse drug events(ADR/ADE) caused by drugs for cardiovascular diseases in community clinics and to recommend targeted warning and prevention measures.Methods Using frequency statistics and association rules,180 cases of ADR/ADE caused by drugs for cardiovascular diseases reported by four community clinics between January 1,2004 and June 30,2021 were retrospectively analyzed.Results Patients ages 70 to 79 were the most vulnerable,and intravenous administration was the main route reported.Only 7.78% of the cases had a drug allergy history.Pruritus and rash were the main symptoms.Most of the ADR/ADE related to Chinese and western medicines involved blood lipid modulators and blood-removing agents,while those caused by Chinese medicines involved drugs which were bitter in taste,warm in nature,liver-targeting and contained cinnabar.ADR/ADE were more likely when gastrodin,cinnamazide maleate,theophylline,ambroxol,salvia miltiorrhiza safflower preparation and ginkgo biloba extract were used together.Conclusion Community clinicians should be alert to the influence of patients’ age,routes of administration,history of drug allergy,properties of traditional Chinese medicine,toxic drugs,and combination of drugs(traditional Chinese medicine and western medicine) on the incidence of ADR/ADE related to cardiovascular drugs,and strengthen rational use of drugs by whatever means available.