天津市第一中心医院蛇毒血凝酶的临床应用合理性分析

Clinical application and rationality evaluation of hemocoagulase in Tianjin First Central Hospital

目的 调查并分析天津市第一中心医院蛇毒血凝酶的临床真实应用情况及规律,为指导临床安全、合理用药提供参考。方法 回顾性分析2022年1~8月天津市第一中心医院使用蛇毒血凝酶的住院患者病历信息,统计患者性别、年龄、临床诊断、用药情况、疗程>5 d、是否监测纤维蛋白原(FIB)水平及药物不良反应(ADRs)等相关信息,依据药品说明书及相关共识,评价用药合理性。结果 22个临床科室共1 170例患者使用了蛇毒血凝酶,使用量前3位的科室为神经外科、肝胆外科及耳鼻喉科;622例患者(占53.16%)为预防性用药,548例(占46.84%)为治疗性用药;给药途径以iv为主;共有578例次不合理用药,存在的主要问题为未监测FIB、疗程过长以及给药途径不合理等;总ADRs发生率为1.54%,发生FIB降低的ADRs共有18例,无过敏反应的ADRs。结论 天津市第一中心医院临床使用蛇毒血凝酶的比例高,但仍存在较多不合理用药情况,临床应严格按照药品说明书或共识使用并监测凝血指标,避免疗程过长,以减少ADR,并增加用药安全性。

Objective To explore the clinical application and rational evaluation of hemocoagulase in Tianjin First Central Hospital to provide references for rational drug use.Methods Medical records of hospitalized patients using hemocoagulase in Tianjin First Central Hospital from January to August 2022 were retrospectively analyzed,and relevant information such as gender,age,clinical diagnosis,medication status,duration of treatment>5 d,whether fibrinogen(FIB)level was monitored,and adverse drug reactions(ADRs)were collected.Evaluate the rationality of drug use.Results A total of 1170 patients in 22 clinical departments were treated with hemagglutinin,and the top 3 departments were neurosurgery,hepatobiliary surgery,and otolaryngology.622 Patients(53.16%)used prophylactic drugs,and 548 patients(46.84%)used therapeutic drugs.The main route of administration was intravenous injection.There were 578 cases of irrational drug use,and the main problems were not monitoring FIB,too long course of treatment,and unreasonable route of drug administration.The total incidence of ADRs was 1.54%,and there were 18 cases of ADRs with reduced FIB,and no ADRs with allergic reaction.Conclusion The proportion of clinical use of hemagglutinin is high,but there are still many irrational drug use cases.Clinical use should be strictly in accordance with drug instructions or consensus,and coagulation indexes should be monitored to avoid too long course of treatment,so as to reduce ADR and increase drug safety.