109家医院人工血浆代用品5年临床应用情况分析

Analysis of 5-year clinical application of plasma substitutes in 109 hospitals

目的 分析国内人工血浆代用品的临床使用现状,为临床合理用药提供参考。方法 采用分层抽样与整体抽样相结合的二阶抽样方式,对医院处方分析合作项目中全国8个城市的109家医院2015—2019年门诊、急诊和住院患者使用人工血浆代用品的情况进行统计分析。结果 共抽取血浆代用品处方/医嘱数据668 083条,含4大类10个通用名52个药品,涉及患者609 911人次。羟乙基淀粉的临床处方量占比最高(54.81%),其次为琥珀酰明胶(21.11%),两者在5年间用量稳定增长;右旋糖酐和聚明胶肽的用量较少且处方量逐年减少。重症监护病房与非重症监护病房相比,羟乙基淀粉处方占比明显偏低(38.31%比56.21%,P<0.01),而琥珀酰明胶处方占比明显偏高(41.85%比19.37%,P<0.01)。结论 羟乙基淀粉仍是国内使用最多的血浆代用品,但在重症领域使用趋势已发生明显变化,琥珀酰明胶成为用量最大的品种。

Objective To analyze current situation of clinical use of plasma substitutes and provide reference for the clinical rational drug use. Methods Two-stage sampling method combining stratified sampling with overall sampling was used to statistically analyze the use of artificial plasma substitutes by outpatients,emergency patients and inpatients in 109 hospitals in8 cities nationwide in the Hospital Prescription Analysis Cooperation Project from 2015 to 2019. Results A total of 668 083prescriptions for plasma substitutes were collected,including 52 medications with 10 generic names in 4 categories,involving609 911 patients. The prescriptions of hydroxyethyl starch accounted for the highest proportion(54. 81%),followed by succinylated gelatin(21. 11%),and both increased steadily in 5 years. Dextran and polygeline were used less and the number of prescriptions was decreasing year by year. Compared with non-ICU,the proportion of hydroxyethyl starch prescriptions with ICU was significantly lower(38. 31% vs 56. 21%,P<0. 001)and the proportion of succinylated gelatin prescriptions with ICU was significantly higher(41. 85% vs 19. 37%,P<0. 001). Conclusion Hydroxyethyl starch is still the most widely used plasma substitute in China,but the trend of use in ICU has changed significantly,and succinylated gelatin has become the most popular one.