重症肌无力患者对慎用药物知晓及应用情况的调查分析

Survey and analysis of the awareness and application status of drugs used with caution in myasthenia gravis patients

目的了解重症肌无力(MG)患者对MG慎用药物的知晓及应用情况。方法经首都医科大学宣武医院药学专家和神经内科专家共同讨论,制定出MG慎用药物目录(含抗感染类、心血管类、镇静催眠类、他汀类、抗癫痫类、精神类、镇痛类、麻醉类、解痉类和其他10类50余种药物)。选取2021年1月至2022年2月于首都医科大学宣武医院神经内科就诊的MG患者进行慎用药物知识问卷调查。问卷内容包括患者的一般人口学资料、MG病程与分型、并存疾病、用药情况、对MG慎用药物的知晓和应用情况以及相关用药知识获取途径等。调查问卷于患者结束就诊后现场发放,自愿参加,当场作答和回收。根据是否知晓慎用药物将患者分为知晓组和不知晓组,比较2组患者的临床特征,应用多因素logistic回归分析方法分析慎用药物知晓程度的影响因素,计算比值比(OR)及其95%置信区间(CI)。结果共发放问卷290份,回收290份。290例患者中男性165例,女性125例;MG病程为3周~360个月;临床分型为眼肌型者179例,非眼肌型111例;174例(60.0%)并存至少1种慢性疾病(高血压病、高脂血症、糖尿病、冠状动脉粥样硬化性心脏病、免疫系统疾病、焦虑/抑郁症等);接受MG药物治疗者248例(85.5%);在有知识获得途径的患者中,通过医护人员宣教、医院宣传栏/展板、网络和书籍获得用药知识者分别为191例(92.7%)、26例(12.6%)、22例(10.7%)和7例(3.4%)。64.8%(188/290)的患者对慎用药物一无所知。110例患者在确诊MG后应用过慎用药物,7例(6.4%)用药后出现MG病情加重或发生不良反应,其中4例为应用滴眼剂(喹诺酮类和大环内酯类各2例)。未接受MG药物治疗和确诊MG时未获知用药注意事项是慎用药物知晓程度低的独立影响因素(OR=6.811,95%CI:2.252~20.593,P=0.001;OR=5.615,95%CI:3.223~9.785,P<0.001)。结论MG患者对慎用药物的知晓程度较低,神经科医护人员应采取更有效的措施对MG患者进行慎用药物知识宣教。

Objective To understand the awareness and application status of drugs used with caution in myasthenia gravis(MG)patients.Methods The list of drugs that should be used with caution in MG patients was formulated through discussion among pharmaceutical experts and neurology experts in Xuanwu Hospital,Capital Medical University,including 10 categories and more than 50 drugs like anti-infective drugs,cardiovascular drugs,sedative-hypnotics,statins,antiepileptics,antipsychotics,analgesics,anaesthetics,spasmolytics,and others.The questionnaire survey on knowledge of drugs used with caution was conducted in outpatients with MG in the Department of Neurology between January 2021 and February 2022 in Xuanwu Hospital,Capital Medical University.The contents of the questionnaire included the general demographic data of patients,the disease course and type of MG,comorbidities,drug utilization,awareness and application of drugs used with caution in MG patients,and accesses to relevant drug use knowledge.The questionnaire was distributed on-site after the patient ended the visit,and the patients were asked to participate voluntarily and answer and return the questionnaire on the spot.The participants were divided into the with and without relevant knowledge groups according to whether they were aware of drugs used with caution in MG patients,and the clinical characteristics of the patients in the 2 groups were compared.Multivariate logistic regression analysis was used to analyze the influencing factors of awareness of drugs used with caution,and the odds ratio(OR)and 95%confidence interval(CI)were calculated.Results A total of 290 questionnaires were distributed and all of them were recovered.Among the 290 patients,165 were male and 125 were female,and the disease course of MG ranged from 3 weeks to 360 months.The clinical subtypes were ocular MG in 179 patients and non-ocular MG in 111 patients.One or more chronic disease coexisted in 174 patients(60.0%),including hypertension,hyperlipidemia,diabetes mellitus,coronary atherosclerotic heart disease,immune system disease,anxiety/depression,etc.There were 248 patients(85.5%)who had received medications for MG.In the MG patients having access way to knowledge about drugs used with caution,there were 191(92.7%),26(12.6%),22(10.7%),and 7(3.4%)patients through the propagation by healthcare staff,bulletin boards/display boards in the hospital,networks,and books,respectively.There were 64.8%(188/290)of the patients knowing nothing about the drugs used with caution.After the diagnosis of MG,110 patients had used the drugs that should be used with caution,and 7(6.4%)had aggravated MG or adverse reactions later,of which 4 applied eye drops(quinolones and macrolides in 2 patients respectively).The independent influencing factors of low awareness of drugs used with caution were not receiving drugs for MG and not obtaining precautions in medication at the time of diagnosis(OR=6.811,95%CI:2.252-20.593,P=0.001;OR=5.615,95%CI:3.223-9.785,P<0.001).Conclusion Patients with MG have low awareness of the drugs used with caution,and neurology staffs should take more effective measures to the patient education about drugs used with caution.