妊娠期用药咨询妇女妊娠结局随访及用药分析

Follow-up of pregnancy outcome and medication analysis of pregnancy counseling patients

目的 分析妊娠期用药咨询药师门诊的妊娠期妇女资料,探讨影响妊娠结局的因素,为妊娠期合理安全用药提供参考依据。方法 回顾性分析399例妊娠期妇女的基本信息,包括妊娠期妇女的年龄、用药时孕周、咨询分类、妊娠结局、用药情况。结果 399例妊娠期妇女的平均年龄为(28.93±3.80)岁。其中,有338例妊娠期妇女使用过药物,以孕0~4周、孕5~10周用药占比最多,分别为68.64%、11.83%。未知妊娠情况下使用过药物最多, 312例,占78.20%;妊娠过程中突发疾病需药物治疗61例,占15.29%,这类患者尚未用药;患慢性疾病需长期用药26例,占6.52%。在260例随访到的妊娠期妇女中,不同用药风险分级的妊娠期妇女活产率比较,差异具有统计学意义(P<0.05)。用药风险分级由A级到X级,活产率逐渐降低。不同用药时孕周妊娠期妇女的妊娠结局比较,差异无统计学意义(P>0.05)。338例使用过药物的妊娠期妇女共使用了1045种药物,其中前5类咨询药物分别为中药(包括中成药和中药饮片)、抗感染药、抗过敏药、解热镇痛药、避孕药,代表药物分布为蒲地蓝、头孢呋辛、氯雷他定、布洛芬、左炔诺孕酮。44例妊娠期妇女用药风险分级为X级药物有6种,其中避孕药左炔诺孕酮占比最高,为75.00%。患慢性疾病需长期用药有26例,占比6.52%,其中包括甲状腺功能亢进症9例,抑郁症4例,红斑狼疮2例,高血压2例,癫痫2例,慢性乙型肝炎2例,肾病综合征、糖尿病、肺结核、肝功能异常、未分化结缔组织病各1例。结论 妊娠期妇女使用的药物种类较多,药物的安全性、用药时的孕周、临床药师的用药分析均可能会影响妊娠期妇女的妊娠决策。

Objective To analyze the data of pregnant women in the outpatient department of pharmacists for medication consultation during pregnancy,and to explore the factors affecting pregnancy outcome,so as to provide reference for rational and safe drug use during pregnancy.Methods The basic information of 399 pregnant women was retrospectively analyzed,including their age,gestational week at the time of medication,consultation classification,pregnancy outcome and medication situation.Results The mean age of 399 pregnant women was(28.93±3.80)years.Among them,338 cases of pregnant women had used drugs,with the highest incidence occurring between 0-4 weeks and 5-10 weeks of gestation,accounting for 68.64%and 11.83%,respectively.The use of drugs in unknown pregnancy was the most,312 cases(78.20%);there were 61 cases(15.29%)of sudden diseases requiring drug treatment during pregnancy,and these patients had not taken drugs.26 patients with chronic diseases needed long-term medication,accounting for 6.52%.Among 260 pregnant women followed up,the live birth rate of pregnant women with different drug risk grades was statistically significant(P<0.05).The live birth rate decreased gradually from grade A to X.There was no statistically significant difference in the outcome of pregnant women with different gestational weeks(P>0.05).338 pregnant women who had used drugs used a total of 1045 kinds of drugs,among which the top five types of consulting drugs were Chinese medicine(including Chinese patent drug and Chinese herbal slices),anti-infective drugs,anti-allergic drugs,antipyretic and analgesic drugs,contraceptives,and the representative drug were Pudilan,cefuroxime,loratadine,ibuprofen,levonorgestrel.There were 6 drugs with a medication risk rating of X in 44 pregnant women,among which the contraceptive drug levonorgestrel accounted for the highest proportion as 75.00%.There were 26 cases of chronic diseases requiring long-term medication,accounting for 6.52%,including 9 cases of hyperthyroidism,4 cases of depression,2 cases of lupus erythematosus,2 cases of hypertension,2 cases of epilepsy,2 cases of chronic hepatitis B,1 case of nephrotic syndrome,1 case of diabetes mellitus,1 case of tuberculosis, 1 case of liver dysfunction, and 1 case of undifferentiated connective tissue disease. Conclusion There are many kinds of drugs used by pregnant women, the safety of drugs, the gestational age of drug use, and the analysis of drug use by clinical pharmacists may affect the pregnancy decision of patients.