沙库巴曲缬沙坦钠处方点评及用药合理性分析

Prescription review and medication rationality analysis of sacubitril/valsartan sodium

目的:了解某院门诊沙库巴曲缬沙坦钠的使用现状,分类探讨用药合理性,促进其临床合理应用。方法:利用医院HIS系统,抽取2019年11月至2021年11月某院门诊处方数据,筛选其中包含沙库巴曲缬沙坦钠药品的处方,进行点评与合理性分析。结果:共抽取42457张门诊处方,男性占70.9%。心力衰竭是最常见的诊断(57.2%),其次是冠心病(28.4%)和高血压(23.0%),肾脏疾病和糖尿病分别占比7.4%和4.9%。84.3%的患者沙库巴曲缬沙坦钠的处方剂量为100~200 mg bid。不合理处方有759张,处方不合理率为1.8%。不合理处方主要涉及临床诊断不完整(62例,占0.15%)、用法用量不适宜(41例,占0.10%)、联合用药不适宜(656例,占1.5%)、重复用药(316例,占0.74%)。联合用药不适宜的情况主要见于肾内科和诊断为高血压、心力衰竭或肾脏疾病的患者。对其他有潜在相互作用的药物进行分析显示,合用抗高血压药物的比例为58.8%,合用他汀类药物比例为19.5%,合用钾补充剂和非甾体抗炎药的比例相对较小(1.0%和0.07%)。结论:沙库巴曲缬沙坦钠的门诊合理率有待进一步提高。随着其使用不断增加,药师应根据不合理处方的原因进行合理用药宣传,加强与临床医师的沟通,开展药学监护,从而保障患者用药安全。

OBJECTIVE To understand the current use situation of sacubitril/valsartan sodium in the outpatient department of a hospital,classify and explore the medication rationality to promote its rational application in clinic.METHODS The hospital HIS system was used to extract the outpatient prescription data of a hospital from November 2019 to November 2021,the prescriptions containing sacubitril/valsartan sodium were screened,and comments and rationality analysis were performed.RESULTS A total of 42457 outpatient prescriptions were selected,and males accounted for 70.9%.Heart failure was the most common diagnosis(57.2%),followed by coronary heart disease(28.4%)and hypertension(23.0%),kidney disease and diabetes accounted for 7.4% and 4.9%,respectively.84.3% of the patients received 100-200 mg,bid.There were 759 irrational prescriptions with the irrational rate of 1.8%.Irrational prescriptions mainly involved incomplete clinical diagnosis(62 cases,accounting for 0.15%),inappropriate usage and dosage(41 cases,accounting for 0.10%),inappropriate combination of drugs(656 cases,accounting for 1.5%),and repeated medication(316 cases,accounting for 0.74%).The inappropriate combination of drugs was mainly seen in the department of nephrology and in the patients with hypertension,heart failure,or kidney disease.The analysis of other potentially interacting drugs showed that the combination proportion of antihypertensive drugs was 58.8%,that of statins was 19.5%,and the that of potassium supplement and non-steroidal anti-inflammatory drugs was relatively low(1.0% and 0.07%,respectively).CONCLUSION The outpatient reasonableness rate of sacubitril/valsartan sodium needs to be further improved.As its use continuously increases,pharmacists should give publicity to the rational drug use according to the reasons for unreasonable prescriptions,strengthen communication with clinicians,and carry out pharmaceutical care,so as to ensure the drug safety in patients.