某综合医院住院患者质子泵抑制剂临床应用分析

Analysis of clinical application of proton pump inhibitors in inpatients of a general hospital

目的分析本院质子泵抑制剂(PPIs)临床应用情况,为该类药物合理使用提供参考。方法回顾性分析955例应用PPIs治疗的患者的临床资料,观察临床使用剂型与科室分布,分析使用PPIs治疗、预防疾病及注射剂型PPIs用药疗程的合理情况。结果本月出院病例3388例,其中955例使用PPIs治疗,PPIs药物使用率为28.2%。本研究使用注射剂与口服剂2种剂型。681例应用注射剂型PPIs的患者分布于30个科室,应用注射用泮托拉唑钠患者主要分布于骨外一科、关节外科、心内一科、脊柱外科、经介入科、综合治疗二科等,应用注射用雷贝拉唑钠患者主要分布于消化内一科、胃肠外科、消化内二科等,应用注射用艾普拉唑钠患者主要分布于甲乳外科、胸心外科、重症医学一科等。274例应用口服剂型PPIs的患者分布于19个科室,应用雷贝拉唑钠肠溶片患者主要分布于心内一科、心内二科等,应用艾司奥美拉唑镁肠溶片患者主要分布于消化内一科、消化内二科等,应用奥美拉唑肠溶胶囊患者主要分布于消化内二科及其他科室等。112例患者使用PPIs治疗上消化道出血、消化性溃疡、胃食管反流病、幽门螺杆菌感染根除,治疗用药占比11.7%,其中38例治疗以上疾病时与说明书适应证不符,使用不合理率达33.9%。另外843例患者使用PPIs用于预防应激性黏膜病变(437例)、非甾体类抗炎药相关性溃疡(124例)、其他症状(282例),预防用药占比88.3%,其中556例与药品说明书适应证不符,使用不合理率为66.0%。本院注射剂型PPIs疗程时间偏长,与说明书规定不符。说明书规定:注射用泮托拉唑钠连续应用为7~10 d,超疗程29例,不合理率为10.7%;注射用雷贝拉唑连续应用为≤5 d,超疗程103例,不合理率为38.4%;注射用艾普拉唑连续应用为3 d,超疗程96例,不合理率为67.6%。结论PPIs广泛用于多个科室,注射剂型使用率高于口服剂型,但存在不合理现象,在治疗、预防病症时均出现品种选择与说明书不符、用药疗程过长现象。针对以上不合理现象。临床应严格掌握不同品种PPIs的适应证及疗程,避免药物选择不当及超剂量用药。

Objective To analyze the clinical application of proton pump inhibitors(PPIs),so as to provide reference for the rational use of these drugs.Methods The clinical data of 955 patients treated with PPIs was retrospectively analyzed.The clinical dosage forms and the distribution of departments were observed,and the rationality of the use of PPIs for treatment,disease prevention,and the treatment course of injected PPIs was analyzed.Results Of the 3388 discharged cases this month,955 cases were treated with PPIs,and the rate of PPIs drug use was 28.2%.The study used both injectable and oral dosage forms.The 681 patients who applied injectable PPIs were distributed in 30 departments,and the patients who applied injectable pantoprazole sodium were mainly distributed in the first department of orthopedics,joint surgery,the first department of cardiology,the second department of spine surgery,the department of interventional therapy,and the second department of comprehensive treatment;patients applying injectable sodium rabeprazole were mainly distributed in the first department of gastroenterology,department of gastroenterology,second department of gastroenterology;patients applying injectable sodium eprazole were mainly distributed in the department of thyroid and breast surgery,department of thoracic surgery,first department of intensive care medicine.274 patients who applied oral PPIs were distributed in 19 departments,and patients who applied rabeprazole sodium enteric-coated tablets were mainly distributed in first department of cardiology and second department of cardiology;patients applying esomeprazole magnesium enteric soluble tablets were mainly distributed in the first department of gastroenterology and second department of gastroenterology;patients applying omeprazole enteric-coated capsule were mainly distributed in the second department of gastroenterology and other departments.PPIs were given to 112 patients for the treatment of upper gastrointestinal bleeding,peptic ulcer,gastroesophageal reflux disease,and Helicobacter pylori infection eradication,with a treatment use rate of 11.7%,of which 38 cases were treated for the above diseases with indications not in accordance with the instructions,with an unreasonable use rate of 33.9%.Another 843 patients were given PPIs for the prevention of stress-induced mucosal lesions(437 cases),nonsteroidal anti-inflammatory drugs-related ulcers(124 cases),and other symptoms(282 cases),accounting for 88.3%of prophylactic use,of which 556 cases did not accordance with the indications of the drug instructions,with an unreasonable use rate of 66.0%.The duration of the course of our injectable PPIs was long,which was not in accordance with the instructions.The instructions stipulate that the continuous application of pantoprazole sodium for injection was 7-10 d,with 29 cases exceeding the course of treatment,and the unreasonable rate was 10.7%;the continuous application of rabeprazole for injection was≤5 d,with 103 cases exceeding the course of treatment,and the unreasonable rate was 38.4%;the continuous application of ilaprazole for injection was 3 d,with 96 cases exceeding the course of treatment,and the unreasonable rate was 67.6%.Conclusion PPIs are widely used in many departments,and the utilization rate of injectable dosage forms is higher than that of oral dosage forms,but there are unreasonable phenomena,such as the selection of varieties is inconsistent with the instructions,and the treatment course is too long.In view of the above unreasonable phenomena,the clinical practice should strictly grasp the indications and treatment courses of different types of PPIs to avoid improper drug selection and over dose medication.