我院中重度毛细支气管炎患儿主要治疗药物的使用情况调查及合理性评价
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篇名: 我院中重度毛细支气管炎患儿主要治疗药物的使用情况调查及合理性评价
TITLE:
摘要: 目的:为毛细支气管炎患儿临床合理用药、提高其治疗效果提供参考。方法:调取2014年1月-2016年12月间在我院儿科住院治疗的中重度毛细支气管炎患儿的病历及医嘱资料,就其主要治疗药物使用情况进行回顾性调查,并进行用药合理性评价。结果:共纳入中重度毛细支气管炎患儿423例次,治愈率为92.91%,好转率为6.86%。吸入性糖皮质激素(吸入用布地奈德混悬液)的使用率达98.11%;全身糖皮质激素(静脉给药)的使用率仅为27.90%;支气管扩张剂中抗胆碱能药物和β2受体激动药的使用率分别为74.70%和58.87%;白三烯调节剂(主要是孟鲁司特)的使用率为85.58%;核苷类抗病毒药物(主要是利巴韦林)使用率为15.37%;肌内注射及雾化吸入干扰素的使用率分别为36.64%和17.73%。未用全身糖皮质激素组与应用全身糖皮质激素组患儿治疗效果比较,差异无统计学意义(P>0.05)。有101例次(23.88%)在治疗中重度毛细支气管炎时存在不合理用药情况,其中以属于超常用药类型的无正当理由超说明书用药居多(75例次,占17.73%),其次是属于不适宜用药类型的遴选药品不适宜(11例次,占2.60%),排第3位的是属于不规范用药类型的超剂量用药但未注明原因和再次签名确认(激素冲击疗法)(8例次,占1.89%)。结论:我院中重度毛细支气管炎患儿主要治疗药物的总体使用情况尚可,但部分医嘱仍存在不合理用药情况,表现为无正当理由超说明书用药、遴选药品不适宜、超剂量用药但未注明原因和再次签名确认等。建议制订符合本院实际情况的毛细支气管炎用药规范,加强业务培训和合理用药宣教,强化医师的合理用药意识,并发挥儿科临床药师的专业作用,通过审核医嘱发现不合理用药问题并及时与医师沟通。
ABSTRACT: OBJECTIVE: To provide reference for rational use of drugs and improving the therapeutic effect of bronchiolitis Children. METHODS: Medical records and medical orders of moderate and severe bronchiolitis children were collected from our hospital during Jan. 2014 to Dec. 2016. Retrospective investigation was conducted for the use of main therapeutic drugs. The rationality of drug use was evaluated. RESULTS: A total of 423 children with moderate-to-severe bronchiolitis were included, the cure rate was 92.91% and recovery rate was 6.86%. The utilization rate of inhaled corticosteroid (Budesonide suspension for inhalation) was 98.11%, and that of systemic corticosteroids was 27.90%. The utilization rate of bronchodilator anticholinergic agents and β2-receptor agonists were 74.70% and 58.87%. That of leukotriene modifiers (mainly montelukast) was 85.58%. The utilization rate of nucleoside antiviral drugs (mainly ribavirin) was 15.37%, and those of intramuscular injection and aerosolized inhalation of interferon were 36.64% and 17.73%. There was no statistical significance in therapeutic efficacy between without systemic glucocorticoid group and systemic glucocorticoid group (P>0.05). There was irrational drug use in 101 cases (23.88%) during the treatment of severe bronchiolitis. Among the types of supernormal drug use, most were off-label drug use without justified reasons (75 case time, 17.73%), followed by unsuitable drug selection which was the type of unsuitable drug use (11 case time, 2.60%). The third type of irrational drug use was the type of non-standard drug use as unstated reason and resignatures of drug overdose (hormone shock therapy, 8 case time, 1.89%). CONCLUSIONS: The overall use of major bronchiolitis therapy drugs in our hospital is still acceptable. However, there still is irrational drug use in some medical orders, manifested as off-label drug use without justified reasons, unsuitable drug selection, unstated reason of drug overdose, resignatures, etc. It is suggested to formulate bronchiolitis drug use regulation that meet the actual conditions of the hospital, strengthen business training and rational drug use education, enhance the awareness of pharmacist to rational drug use, play the professional role of pediatric clinical pharmacists, review medical orders to find out the problems of irrational drug use and communicate with physicians in time.
期刊: 2018年第29卷第14期
作者: 贺海珊,邱雪雁,刘阿玲,贺晓露,李玲玲,杨楠
AUTHORS: HE Haishan,QIU Xueyan,LIU Aling,HE Xiaolu,LI Lingling,YANG Nan
关键字: 毛细支气管炎;儿童;治疗药物;使用情况;合理性评价
KEYWORDS: Bronchiolitis; Children; Therapy drug; Use condition; Rationality evaluation
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