某儿童专科医院人血白蛋白临床使用分析与处方点评依据梳理

Analysis on Clinical Use of Human Albumin and Summary of Basis for Prescription Evaluation in a Children's Hospital

目的:梳理儿科人群人血白蛋白(HA)用药合理性判定的依据,并初步分析HA在儿科应用的不适宜之处,从而为HA在儿科人群的合理应用与处方点评提供参考。方法:参考国内外关于HA应用的指南文献及说明书,梳理儿科人群HA合理性判定的各项依据。采用回顾性分析方法,抽取某三甲儿童专科医院2019年3月~2020年10月应用HA的患儿病例共计264份,统计患儿的一般资料、血清白蛋白水平、HA用药过程等内容并分析其用药适宜性。结果:264份病例中,48.5%的患儿<1岁。与研究设定的处方点评标准比较,适应症不适宜占52.7%,其中主要包括用药理由为手术后支持治疗、术后渗出等66例(25.0%),用药理由为低蛋白血症者用药前血清白蛋白>30g/L或无数据者48例(18.2%)。根据上述的用药适应症不适宜情况,讨论了围手术期、低蛋白血症的用药依据问题。结论:初步梳理了儿科人群应用HA合理性的判断标准,并将其应用于某儿童专科医院,显示儿科的HA使用者中适应症不适宜的情况较多见。建议各医院制定和定期更新院内HA用药标准,设置开具医嘱的管理流程中必须包含判断合理性的所需数据,并完善处方点评的反馈机制。

Objective:To summarize the basis used to evaluate the rationality of human albumin(HA)use in pediatric population,and preliminarily analyze the inappropriateness of HA use in pediatric population,so as to provide reference for rational use and prescription evaluation of HA in the pediatric population.Methods:The basis used for evaluating the rationality of HA use in pediatric population was summarized by referring to Chinese and foreign guidelines on HA use as well as instructions for use.A total of 264 children treated with HA between March 2019 and October 2020 in a Class A tertiary hospital were selected for retrospective analysis.The following were statistically analyzed:general data,serum albumin level,and course of treatment with HA as well as it's appropriateness.Results:Of the 264 children patients,48.5%were aged<1 year.Measured against the criteria for prescription evaluation as defined in this article,inappropriate indications were identified in 52.7%of the cases,mainly including 66 cases(25.0%)for postoperative supportive care and postoperative exudation,and 48 cases(18.2%)for hypoalbuminemia with pre-dose serum albumin>30 g/L or no data.Based on the inappropriate indications as mentioned above,the rationale of HA use during the perioperative period and hypoproteinemia was discussed.Conclusion:The evaluation criteria for rationality of HA use in pediatric population were preliminarily summarized and applied to a children's hospital,revealing that inappropriate indications were frequently seen in pediatric patients treated with HA.It is recommended that hospitals should develop and periodically update the in-house standards for HA use,establish standard management procedure for medical orders by specifying that data required for rationality evaluation of HA use must be contained,and operate a well-established feedback system for prescription evaluation.