某院736例胃肠肝胆外科患者术后预防性使用抗凝药物合理性分析

Rationality of Prophylactic Use of Anticoagulants in 736 Postoperative Patients in the Gastrointestinal and Hepatobiliary Surgery Departments of a Hospital

目的提高胃肠肝胆外科患者术后预防性使用抗凝药物的合理性。方法通过临床药学系统抽取福建省立医院肝胆外科、胃肠外科2021年接受手术治疗的住院患者的病历资料,筛选其中预防性使用抗凝药物的病历资料,分析其用药合理性,并采用Caprini风险评估模型对患者的静脉血栓栓塞症(VTE)风险因素进行分析。结果共纳入736例患者,其中胃肠外科257例(34.92%)、肝胆外科479例(65.08%)。达肝素钠使用频率最高(58.15%),其次为低分子量肝素钙(23.51%)、依诺肝素钠(21.06%)、那屈肝素钙(18.07%),其余药物使用频率均低于2%;用药疗程最短1 d,最长55 d。Caprini模型评估的高危及以上患者710例(96.47%),排名前5的危险因素分别为年龄(92.93%)、恶性肿瘤(58.70%)、严重肺部疾病(26.90%)、肥胖(19.97%)和静脉曲张(5.30%)。26例(3.53%)患者无适应证用药,18例(2.45%)患者用药疗程过长。结论该院胃肠外科、肝胆外科患者术后最常使用的预防性抗凝药物为低分子肝素类药物,用药情况基本合理,导致患者VTE风险增加的主要因素有年龄、恶性肿瘤、严重肺部疾病、肥胖和静脉曲张。

Objective To improve the rationality of prophylactic use of anticoagulants in postoperative patients in the gastrointestinal and hepatobiliary surgery departments.Methods The medical records of all inpatients who underwent surgery in hepatobiliary and gastrointestinal surgery departments in 2021 were collected by the Clinical Pharmacy Information Management System(CPIMS),the data of patients who received prophylactic use of anticoagulants were screened,and the rationality of the patients'medication was analyzed.The Caprini risk assessment model was used to analyze the risk factors of venous thromboembolism(VTE)in patients.Results A total of 736 patients were included,including 257 cases(34.92%)in the gastrointestinal surgery department and 479 cases(65.08%)in the hepatobiliary surgery department.Dalteparin sodium was the most frequently used(58.15%),followed by low-molecular-weight heparin calcium(23.51%),enoxaparin sodium(21.06%),and nadroparin calcium(18.07%),with the rest of the drugs used less than 2%.The medication duration was in the range of 1-55 d.A total of 710 patients(96.47%)were assessed to be high-risk patients by the Caprini model,and the top five risk factors were age(92.93%),malignant tumor(58.70%),severe lung disease(26.90%),obesity(19.97%),and varicose veins(5.30%).A total of 26 patients(3.53%)had no indication for prophylactic medication,while 18 patients(2.45%)had a prolonged course of medication.Conclusion Low-molecular-weight heparin is the most commonly used prophylactic anticoagulants for postoperative patients in the gastrointestinal and hepatobiliary surgery departments of the hospital.The medication situation is generally reasonable,and the main factors that increase the risk of VTE in patients include elder age,malignant tumors,severe lung diseases,obesity,and varicose veins.