医院骨科围术期预防性使用质子泵抑制剂的合理性评价

Rationality evaluation of the perioperative preventive use of proton pump inhibitors in orthopedic department of a hospital

目的 分析医院骨科围术期使用质子泵抑制剂(PPIs)预防应激性溃疡(SU)的使用情况及合理性评价,为临床合理使用PPIs提供参考。方法 调取东南大学附属中大医院2020年1月份骨科出院手术病例,统计基本信息、手术情况、PPIs的使用、SU应激源及风险因素,综合分析用药合理性。结果 376例手术病人中有289例预防性使用PPIs,多选用注射剂(261例,90.31%),用药时机主要为术后用药(233例,80.62%),用药疗程中位数为3.0 d。不合理使用问题普遍存在,其中44例(15.23%)无适应证用药、26例(9.00%)用药频次错误、139例(48.10%)用药疗程过长、242例(83.74%)剂型选择不适宜。结论骨科围术期PPIs预防性使用不合理的现象较为严重,医院应加强对围术期预防性使用PPIs的管理。

Objective To analyze the rationality of proton pump inhibitors(PPIs) in the prevention of stress ulcer(SU) in perioperative orthopedic patients of a hospital,so as to provide reference for the rational use of PPIs in clinic.Methods The medical records of surgical orthopedic patients who were discharged from a hospital during January 2020 were selected to analyze statistically in respects of general information of patients,operation information,use of PPIs,the stressors and risk factors for stress ulcer.The rationality of the use of PPIs was analyzed comprehensively.Results Among 376 surgical patients,PPIs were used in 289 cases,of whom most cases used intravenous infusion of PPIs(261 cases,90.31%).The timing of medication was mainly postoperative(233 cases,80.62%).The median duration of treatment course was 3.0 d.Irrational use of PPIs was common,including 44(15.23%) cases of off-label drug use,26(9.00%) cases of incorrect dosage frequency,139(48.10%) cases of prolonged use of medication,and 242(83.74%) cases of unreasonable choice of dosage forms.Conclusion There is serious irrational use of PPIs among perioperative orthopedic patients to prevent stress ulcer.It is necessary to strengthen the management of perioperative preventive use of PPIs in hospitals.