维持性腹膜透析患者用药情况及影响因素的单中心回顾性分析

Single-Center Retrospective Analysis of Drug Use and Influencing Factors in Maintenance Peritoneal Dialysis Patients

目的:了解该院维持性腹膜透析患者的用药情况,为腹膜透析患者用药结构优化提供参考。方法:采用回顾性分析方法,调取2016—2020年该院维持性腹膜透析1年以上患者的临床资料,对其用药情况进行分析。结果:共纳入327例维持性腹膜透析患者,人均医疗总费用、人均药品总费用呈降低趋势,但药占比呈升高趋势。使用金额排序居前3位的药物种类(不含腹膜透析液)分别为血液和造血系统用药、心血管系统用药和中成药。血液和造血系统用药使用金额占比增长较大,其中抗贫血药和磷结合剂用量增加是血液和造血系统用药使用金额增长的最主要原因;心血管系统用药使用金额占比稳定,其中人均年使用金额排序居前5位的药品种类为钙通道阻滞剂、复方抗高血压药、血管紧张素转换酶抑制剂、β受体阻断剂和血管紧张素Ⅱ受体阻断剂;而中成药使用金额占比降低明显,其中人均年使用金额排序居前3位的药品为尿毒清颗粒、百令胶囊和肾衰宁片。并发症诊断条数、初次透析年龄、透析持续时间是维持性腹膜透析患者药品费用增长的影响因素。结论:长期腹膜透析患者并发症多,联合用药情况复杂;用药结构需进一步优化,以改善治疗效果,有利于减少药品不良反应、降低患者药费负担。

OBJECTIVE:To investigate the medication status of maintenance peritoneal dialysis patients in the hospital,so as to provide reference for the optimization of medication structure for peritoneal dialysis patients.METHODS:Clinical data of patients with maintenance peritoneal dialysis for more than 1 year in the hospital from 2016 to 2020 were collected and analyzed by retrospective analysis.RESULTS:A total of 327 maintenance peritoneal dialysis patients were included.The total per capita medical expenses and the per capita total medicine spending showed a downward trend,yet the proportion of medicines showed an upward trend.The top 3 medicine types(excluding peritoneal dialysis fluid)according to spending were blood and hematopoietic system medicines,cardiovascular medicines and Chinese patent medicines.The expenses of blood and hematopoietic system medicines increased significantly,among which the increase in the usage of anti-anemia drugs and phosphorus binders was the main reason for the increase in the expenses of blood and hematopoietic medicines.The proportion of cardiovascular medicines was stable,the top 5 medicines ranked by per capita annual expenses were calcium channel blockers,compound antihypertensive drugs,angiotensin-converting enzyme inhibitors,β-receptor blockers and angiotensin-Ⅱreceptor blockers.The proportion of Chinese patent medicines decreased significantly,the top 3 medicines ranked by per capita annual expenses were Niaoduqing granules and Bailing capsules and Shenshuaining tablets.The number of complication diagnoses,age of the first dialysis and the duration of dialysis were the influencing factors of the increase in medicine expenses.CONCLUSIONS:Long-term peritoneal dialysis patients have many complications and complex drug combinations.The medicine composition needs to be further optimized to improve the therapeutic effect,which could help to reduce adverse drug reactions and the burden of medicine expenses in patients.