基于Delphi法的磺达肝癸钠药物利用评价标准的构建及单中心研究

Construction of Evaluation Criteria for Fondaparinux Sodium Drug Utilization Based on Delphi Method and Single-Center Study

目的 建立磺达肝癸钠的药物利用评价标准(drug use evaluation, DUE),使用Delphi法对我院磺达肝癸钠的应用情况进行分析、评价。方法 以注射用磺达肝癸钠药品说明书为基础,利用万方、知网、维普等相关学术网站查找指南和文献,结合Delphi法建立磺达肝癸钠的DUE,评价我院磺达肝癸钠的用药情况。结果 完全符合磺达肝癸钠DUE标准的有1 852例(73.03%),高于完全符合说明书标准的1 712例(67.51%)(P<0.05)。不符合磺达肝癸钠DUE标准中超说明书用药有512例(20.19%),包括重大骨科手术术后静脉血栓栓塞(venous thromboembolism, VTE)治疗、肿瘤相关VTE防治、复发性流产合并血栓前状态治疗、肺栓塞防治、心房颤动患者围术期抗凝、急性进展性脑梗死治疗和血液透析体外循环的血栓预防;166例(6.55%)为重大骨科手术术后VTE预防中合并肾功能不全未减少剂量,290例患者(11.44%)与增加出血风险药物联合使用,36例(1.42%)患者出现不良反应。结论 我院磺达肝癸钠用药合理情况尚不理想,存在适应证、给药剂量、疗程、药物联合使用等不合理情况。

OBJECTIVE To establish the drug use evaluation(DUE)of fondaparinux sodium.METHODS Based on the drug instructions of fondaparinux sodium for injection,Wanfang,CNKI,VIP and other relevant academic websites were used to search guidelines and literature,and the DUE of fondaparinux sodium was established by Delphi method to evaluate the drug use situation of fondaparinux sodium in our hospital.RESULTS A total of 1852 cases(73.03%)completely met the due standard of fondaparinux sodium,which was higher than the 1712 cases(67.51%)that completely met the specification standard,and the difference was statistically significant(P<0.05).There were 512 cases(20.19%)who did not meet the DUE standard of fondaparinux sodium,including venous thromboembolic disease(VTE)treatment after major orthopedic surgery,prevention and treatment of tumor-related VTE,recurrence abortion combined with prothrombotic state treatment,prevention and treatment of pulmonary embolism,perioperative anticoagulation in patients with atrial fibrillation,acute progressive cerebral infarction treatment,thromboprophylaxis with hemodialysis and extracorporeal circulation.A total of 166 cases(6.55%)were complicated with renal insufficiency in the prevention of VTE after major orthopedic surgery and the dose was not reduced.A total of 290 patients(11.44%)were used in combination with drugs that increase bleeding risk,adverse reactions occurred in 36 cases(1.42%)patients.CONCLUSION The irrational rate of fondaparinux in our hospital is high,and the indications,dosage,course of treatment,and drug interactions are unreasonable.