ICU应激性溃疡预防药学管理模式的建立和效果评估

Establishment and effect evaluation of pharmaceutical management model for stress ulcer prophylaxis in ICU

目的建立药师主导的重症监护病房(ICU)应激性溃疡预防(SUP)药学管理模式,评估其在ICU实施中的效果。方法以药师为主导建立ICU-SUP药学管理模式,对该管理模式实施前后SUP的合理率、静脉给药转口服的比例、未及时停用SUP的比例、SUP药品费用及不良反应发生率进行比较。结果ICU-SUP药学管理模式实施后与实施前比较,SUP用药的合理率由50.84%升至93.87%(χ^(2)=101.048,P<0.05),其中无适应证用药的比例由15.13%降至5.19%(χ^(2)=11.838,P<0.05),有适应证未用药的比例由7.56%降至2.36%(χ^(2)=6.262,P<0.05),及时静脉给药转口服的比例由73.1%升至98.6%(χ^(2)=57.425,P<0.05),及时停止用药比例由68.9%升至94.8%(χ^(2)=49.107,P<0.05),SUP不适宜造成的药品费用支出由18206元降至2768元,共节约药品费用15438元。胃出血、腹泻及肺炎的发生率在ICU-SUP药学管理模式实施前后差异无统计学意义(χ^(2)=2.283,P>0.05;χ^(2)=0.463,P>0.05;χ^(2)=1.125,P>0.05)。结论在ICU建立药师主导的SUP药学管理模式可行、有效,可促进SUP用药的更加合理化。

Objective To establish a pharmacist-led pharmaceutical management model for stress ulcer prophylaxis(SUP)in intensive care unit(ICU)and evaluate its effect in ICU.Methods The pharmaceutical management model of SUP in ICU was established by the pharmacists as the leading role.The reasonable rate of SUP in ICU,ratio of intravenous to oral,prorate of timely SUP discontinuation,drug cost for prevention of stress ulcer,as well as incidence of adverse reactions before and after the implementation of the management model were compared.Results After the implementation of SUP pharmaceu⁃tical management model,the rational rate of SUP medication increased from 50.84%to 93.87%(χ^(2)=101.048,P<0.05),the rate of medication without indications decreased from 15.13%to 5.19%(χ^(2)=11.838,P<0.05),the proportion of medication without indications decreased from 7.56%to 2.36%(χ^(2)=6.262,P<0.05),the proportion of timely intravenous administration to oral administration increased from 73.1%to 98.6%(χ^(2)=57.425,P<0.05),the proportion of timely discontinuation in⁃creased from 68.9%to 94.8%(χ^(2)=49.107,P<0.05),the drug cost expenditure caused by inappropriate SUP decreased from 18206 yuan to 2768 yuan,with saving a total of 15438 yuan.There was no significant difference in the incidence of gastric bleeding,diarrhea and pneumonia before and after the implementation of SUP pharmaceutical management model(χ^(2)=2.283,P>0.05;χ^(2)=0.463,P>0.05;χ^(2)=1.125,P>0.05).Conclusion The pharmaceutical management model of stress ulcer led by pharmacists is feasible and effective,which can promote the rationalization of prevention and treatment of stress ulcer.