基于属性层次模型的儿童用质子泵抑制剂合理性评价

Rationality evaluation of proton pump inhibitors in children based on a attribute hierarchical model

目的建立儿童用质子泵抑制剂(PPIs)合理性评价标准,分析其不合理用药情况,为儿童临床合理应用PPIs提供参考依据。方法参考PPIs的药品说明书、专家共识和应用指南等制定儿童用PPIs合理性评价细则,并应用属性层次模型(AHM)对亳州市人民医院2021年6月至2022年6月108例住院儿童用PPIs的出院病历进行评价。结果108例病历中,病历评分(MRS)≥90分的优秀病历43例(39.81%),75分≤MRS<90分的良好病历0例(0.00%),60分≤MRS<75分的合格病历17例(15.74%)以及MRS<60分的不合格病历48例(44.44%);不合理类型主要表现为无指征用药37例(34.26%)、给药途径不合理11例(10.19%)、用法用量不合理8例(7.41%)、用药疗程不合理5例(4.63%)及溶媒选择不合理2例(1.85%)等。结论基于AHM法制定的儿童用PPIs合理性评价方法切实可行,结果显示,我院儿童用PPIs不合理用药情况较为明显,医院应加强儿童用PPIs医嘱点评、用药管理,提高临床用药合理性,确保儿童用药安全。

Objective To establish the rational evaluation standard of proton pump inhibitors(PPIs)in children,and to analyze the unreasonable drug use in order to provide a reference for the rational clinical application of PPIs in children.Methods On the basis of drug specification,expert recommendations,guidelines and other relevant documents,the rational dosing evaluation system of PPIs was formulated.According to these rules,the attribute hierarchy model(AHM)was also applied to evaluate the discharge medical records of 108 children with PPIs from June 2021 to June 2022 in Bozhou People′s Hospital.Results Among a total of 108 cases,the medical record score(MRS)was>90(n=43,39.81%),75~90(n=0,0.00%),60~75(n=17,15.74%),and<60(n=48,44.44%);the main unreasonable types included 37 cases of medication without indication(34.26%),11 cases of irrational route of medication(10.19%),8 cases of irrational dose of administration(7.41%),5 cases of irrational medication course(4.63%),and 2 case of irrational soluble selection(1.85%).Conclusion The evaluation method of the reasonableness of PPIs in children based on the AHM method is feasible,and the evaluation results show that there is unreasonable use of PPIs in the hospital.The hospital needs to further standardize the rational use of PPIs and medication management to improve the rationality of clinical drug use and ensure the safety of children′s drug use.