某院骨科手术患者抗凝药物使用合理性分析

Rationality Analysis of Anticoagulant Drug Use Among Patients Undergoing Orthopedic Surgery in a Hospital

目的促进临床合理使用抗凝药物。方法采用回顾性研究方法,利用医院信息系统提取四川省遂宁市中心医院2022年1月至6月骨科手术患者的病历,收集患者的性别、年龄、体质量、手术类型、抗凝药物使用等信息;以药品说明书为基础,参考相关指南和专家共识制订医院抗凝药物合理性用药评价标准,并对患者抗凝药物使用合理性进行评价。结果共收集患者411例,其中393例(609例次)存在不合理用药情况。不合理用药情况发生率排前3的依次为给药时机不适宜(255例次、41.87%),适应证不适宜(114例次、18.72%),用法用量不适宜(113例次、18.56%)。给药时机不适宜主要表现为术后启动抗凝时间过早(245例次),包括使用依诺肝素钠233例次(95.10%),阿哌沙班11例次(4.49%),磺达肝癸钠1例次(0.41%);适应证不适宜主要表现为超药品说明书用药(106例次、92.98%);用法用量不适宜主要表现为预防剂量偏高(56例次、49.56%)和治疗剂量偏低(51例次、45.13%)。结论该院骨科手术患者抗凝药物使用不合理问题较明显,应加强对临床医师及临床药师抗凝相关指南及药品说明书等专业知识的培训,提升临床合理用药意识,保障患者用药安全。

Objective To promote the rational use of anticoagulant drugs in clinical practice.Methods The medical records of patients underwent orthopedic surgery in the Suining Central Hospital from January to June 2022 were extracted retrospectively from the hospital information system,the information on the patients'gender,age,body mass,surgical type and anticoagulant drug use was collected.Based on the drug instructions,the evaluation criteria for the rationality of anticoagulant drug use in hospital were formulated according to the relevant guidelines and expert consensuses to evaluate the rationality of anticoagulant drug use in patients.Results A total of 411 patients were collected,including 393 cases(609 case times)of irrational drug use.The top three types of irrational drug use in terms of incidence were inappropriate medication timing(255 case times,41.87%),inappropriate indications(114 case times,18.72%),inappropriate usage and dosage(113 case times,18.56%).The inappropriate medication timing was mainly induced by early initiation of anticoagulation after surgery(245 case times),including 233 case times of using enoxaparin sodium(95.10%),11 case times of using apixaban(4.49%),one case time of using fondaparinux sodium(0.41%).The inappropriate indication was mainly induced by off-label drug use(106 case times,92.98%).Inappropriate usage and dosage were mainly induced by high preventive doses(56 case times,49.56%)and low treatment dose(51 case times,45.13%).Conclusion The irrational use of anticoagulant drugs among patients undergoing orthopedic surgery in this hospital is serious.It is necessary to strengthen the professional knowledge training for clinical physicians and pharmacists on anticoagulation-related guidelines and drug instructions to improve clinical awareness of rational drug use,and ensure the medication safety of patients.