基于属性层次分析模型和加权TOPSIS法的低分子肝素注射液药物利用评价标准建立与应用

Establishment and Application of Criteria for Drug Utilization Evaluation of Low-Molecular-Weight Heparin Injection Based on Attribute Hierarchy Model and Weighted TOPSIS Method

目的进一步提高低分子肝素(LMWH)注射液的临床合理用药水平。方法以药品说明书(含达肝素、那屈肝素钙、依诺肝素钠)为基础,参考相关指南和文献,通过德尔菲法建立LMWH注射液的药物利用评价(DUE)标准。提取2023年1月至7月某三级医院使用LMWH注射液的住院患者病历(300份,使用前述3种LMWH各100份),采用逼近理想解排序(TOPSIS)法评价该药的使用合理性。结果病历中评价指标与最优方案的相对接近程度,≥80%(合理)的占16.00%,70%~<80%(基本合理)的占44.00%,60%~<70%(基本合理)的占39.00%,<60%(不合理)的占1.00%。其中,达肝素、那屈肝素钙、依诺肝素钠的平均Ci分别为(79.19±0.12)%、(72.62±0.10)%、(76.22±0.10)%,组间比较,差异有统计学意义(F=9.016,P<0.001);用药不合理病历数分别为1份、2份、0份,不合理问题主要为适应证不适宜,给药时机与给药剂量不适宜,实验室检查未完善及不良反应未进行监测和上报。结论该研究中建立的标准与方法可用于评价LMWH临床使用的合理性。

Objective To promote the clinical rational use of low-molecular-weight heparin(LMWH)injection.Methods Based on the drug instructions(involving daheparin,nadroparin calcium,enoxaparin sodium),relevant guidelines and literature,a drug utilization evaluation(DUE)criteria for LMWH injection was established by the Delphi method.A total of 300 medical records(100 for each of the above three LMWHs)of inpatients using LMWH injection in a tertiary hospital from January to July 2023 were extracted,and the rationality of drug use was evaluated by the technique for order preference by similarity to ideal solution(TOPSIS)method.Results The medical records with the similarity coefficient of evaluation indicator to ideal solution(Ci)≥80%(rational)accounted for 16.00%,70%≤Ci<80%(basically rational)accounted for 44.00%,60%≤Ci<70%(basically rational)accounted for 39.00%,Ci<60%(irrational)accounted for 1.00%.The mean Ci of daheparin,nadroparin calcium and enoxaparin sodium were(79.19±0.12)%,(72.62±0.10)%,(76.22±0.10)%respectively,with a significant difference between the groups(F=9.016,P<0.001);there were one,two,zero medical records with irrational medication respectively;the irrational problems mainly were inappropriate indications,inappropriate timing and dosage of administration,incomplete laboratory examination and lack of monitoring and reporting of adverse reactions.Conclusion The criteria and methods established in this study can be used to evaluate the rationality of clinical use of LMWHs.