23例芦山地震住院妇产儿科伤病员用药合理性分析
摘要
目的分析四川大学华西第二医院收治的芦山地震妇、产、儿科住院伤病员药物使用情况,为妇女儿童伤病员的药物使用及评价方法提供参考依据。方法回顾性调查震后1月内四川大学华西第二医院收治的芦山地震妇、产、儿科住院伤病员药物使用情况,提取住院天数、用药医嘱单、基本药物使用种类与费用、抗菌药物使用种类与费用等信息。出院诊断按国际疾病分类标准(ICD-10)标化后分类。用药合理性指标包括:限定成人日剂量(DDD)、总限定日剂量数(DDDs)、药物利用指数(DUI)、儿童限定日剂量(cDDD)、儿童药物利用指数(cDUI)、基本药物使用比例、抗菌药物使用比例、用药与诊断不符、重复用药、联合用药不当、用法用量不当及药物频繁更换。伤病员用药医嘱由处方点评工作小组成员评价和讨论,如有分歧报处方点评专家组审核。结果震后1月内,共收治住院妇女儿童伤病员23例。其中儿科伤病员13例,多为支气管肺炎;妇产科伤病员10例,多为剖宫产分娩;基本药物使用比例儿科、妇产科分别为13/13和9/10;抗菌药物使用比例分别为10/13和8/10。不合理用药多为抗生素用法用量不当。结论芦山地震23例住院妇女儿童伤病员的医疗救治药物使用基本合理,亟需制定高风险人群的用药合理性评价方法。cDDD和cDUI为儿童药物利用评价的一种积极探索,尚待更多实践检验和完善。
Objective To analyze drug use for 23 sick and wounded hospitalized in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital,during one month ater Lushan earthquake,so as to provide references for the drug use for the sick and wounded women and children.Methods Medication information was retrospectively investigated in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake.We extracted data including hospitalization duration,medication prescriptions,types and costs of essential medicines,types and costs of antibiotic medicines using the HIS system.Discharge diagnosis was standardized and classiied according to ICD-10.Indicators of rational drug use included deined daily dose(DDD),deined daily dose statistic(DDDs),drug utilization index(DUI),children deined daily dose(cDDD),children drug utilization index(cDUI),proportion of essential medicines,proportion of antibiotic medicines,mismatch of medicine and diagnosis,repeated drug use,improper combination of drug,incorrect usage and dosage,and frequently drug change.Medication information was evaluated and discussed by the prescription working group.Discrepency was resolved by consulting with the panel.Results A total of 23 sick and wounded women and children were assessed during one month ater Lushan Earthquake.here were 13 sick and wounded children in the department of pediatrics(mainly manifested as bronchial pneumonia) and 10 sick and wounded women in the department of gynaecology and obstetrics(mainly involved in cesarean delivery).Proportions of essential medicines were 13/13 in the department of pediatrics and 9/10 in the department of gynaecology and obstetrics.Proportions of antibiotic medicines were 10/13 in the department of pediatrics and 8/10 in the department of gynaecology and obstetrics.Irrational drug use was mainly caused by improper use of antibiotics.Conclusion he drug use for 23 hospitalized sick and wounded is rational in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital during one month ater Lushan earthquake.Evaluation methods of rational drug use in high-risk population are urgently needed.Using cDDD and cDUI is an active exploration for the evaluation of pediatric drug use,which needs more practice to test and improve.
Objective To analyze drug use for 23 sick and wounded hospitalized in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital,during one month ater Lushan earthquake,so as to provide references for the drug use for the sick and wounded women and children.Methods Medication information was retrospectively investigated in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital during one month after Lushan earthquake.We extracted data including hospitalization duration,medication prescriptions,types and costs of essential medicines,types and costs of antibiotic medicines using the HIS system.Discharge diagnosis was standardized and classiied according to ICD-10.Indicators of rational drug use included deined daily dose(DDD),deined daily dose statistic(DDDs),drug utilization index(DUI),children deined daily dose(cDDD),children drug utilization index(cDUI),proportion of essential medicines,proportion of antibiotic medicines,mismatch of medicine and diagnosis,repeated drug use,improper combination of drug,incorrect usage and dosage,and frequently drug change.Medication information was evaluated and discussed by the prescription working group.Discrepency was resolved by consulting with the panel.Results A total of 23 sick and wounded women and children were assessed during one month ater Lushan Earthquake.here were 13 sick and wounded children in the department of pediatrics(mainly manifested as bronchial pneumonia) and 10 sick and wounded women in the department of gynaecology and obstetrics(mainly involved in cesarean delivery).Proportions of essential medicines were 13/13 in the department of pediatrics and 9/10 in the department of gynaecology and obstetrics.Proportions of antibiotic medicines were 10/13 in the department of pediatrics and 8/10 in the department of gynaecology and obstetrics.Irrational drug use was mainly caused by improper use of antibiotics.Conclusion he drug use for 23 hospitalized sick and wounded is rational in the departments of gynaecology,obstetrics and paediatrics in the West China Second University Hospital during one month ater Lushan earthquake.Evaluation methods of rational drug use in high-risk population are urgently needed.Using cDDD and cDUI is an active exploration for the evaluation of pediatric drug use,which needs more practice to test and improve.
引文
1 中华人民共和国国家卫生和计划生育委员会.关于印发《医院处方点评管理规范(试行)》的通知.Available from:http://www.moh.gov.cn/yzygj/s3590/201003/ac4d04a85da5478793761224abc10fd3.shtml.
2 中华人民共和国国家卫生和计划生育委员会.中华人民共和国卫生部令(第53号)-处方管理办法.Available from:http://www.moh.gov.cn/fzs/s3576/200804/1f2a754594e8419e9e164fedcae05f1c.shtml.
3 张崖冰,胡善联.限定日剂量在药物经济学研究中的应用.卫生经济研究,2001,4:15-17.
4 World Health Organization.ATC/DDD Index 2008.Available from:http://www.whocc.no/atcddd/indexdatabase/.
5 陈新谦,金有豫,汤光,主编.新编药物学.第17版.北京:人民卫生出版社,2011.
6 韩璐,曾力楠,张伶俐,等.329例汶川地震妇女儿童伤病员药物利用分析.中国循证医学杂志,2009,9(3):265-272.
7 董景武.疾病和有关健康问题的国际统计分类:ICD-10.第十次修订本.北京:人民卫生出版社,2010.
8 毛萌,贺廷富.充分发挥国家级妇女儿童专科医院在汶川地震医疗救援中的作用.中国循证医学杂志,2008,8(8):588-590.
9 中华人民共和国国家卫生和计划生育委员会.关于建立国家基本药物制度的实施意见.Available from:http://www.moh.gov.cn/tigs/s9660/200908/98b25d019fdb4700b3409daf43f8bd81.shtml.
10 中华人民共和国国家卫生和计划生育委员会.卫生部办公厅关于抗菌药物临床应用管理有关问题的通知.Available from:http://www.moh.gov.cn/mohbgt/s9508/200903/39723.shtml.
11 高健,张钰欣,王桂芝,等.两种β-内酰胺类抗生素联用的合理性分析.临床和实验医学杂志,2013,12(6):465-466.
12 陈淑瑜,吴晓莉.抗菌药物联合用药现状调查与研究.齐齐哈尔医学院学报,2008,29(21):2609-2611.
13 曾佑群,吴扬.小儿呼吸道感染抗生素的使用及耐药性分析.儿科药学杂志,2002,8(2):33-35.
14 张伶俐,李幼平,曾力楠,等.用儿童药物利用指数评价儿科用药剂量合理性的思考与探索.中国循证医学杂志,2012,12(2):125-128.
15 范洪伟,吕玮,吴东,等译.桑德福抗微生物治疗指南.(新译)第41版.北京:中国协和医科大学出版社,2011:187.
2 中华人民共和国国家卫生和计划生育委员会.中华人民共和国卫生部令(第53号)-处方管理办法.Available from:http://www.moh.gov.cn/fzs/s3576/200804/1f2a754594e8419e9e164fedcae05f1c.shtml.
3 张崖冰,胡善联.限定日剂量在药物经济学研究中的应用.卫生经济研究,2001,4:15-17.
4 World Health Organization.ATC/DDD Index 2008.Available from:http://www.whocc.no/atcddd/indexdatabase/.
5 陈新谦,金有豫,汤光,主编.新编药物学.第17版.北京:人民卫生出版社,2011.
6 韩璐,曾力楠,张伶俐,等.329例汶川地震妇女儿童伤病员药物利用分析.中国循证医学杂志,2009,9(3):265-272.
7 董景武.疾病和有关健康问题的国际统计分类:ICD-10.第十次修订本.北京:人民卫生出版社,2010.
8 毛萌,贺廷富.充分发挥国家级妇女儿童专科医院在汶川地震医疗救援中的作用.中国循证医学杂志,2008,8(8):588-590.
9 中华人民共和国国家卫生和计划生育委员会.关于建立国家基本药物制度的实施意见.Available from:http://www.moh.gov.cn/tigs/s9660/200908/98b25d019fdb4700b3409daf43f8bd81.shtml.
10 中华人民共和国国家卫生和计划生育委员会.卫生部办公厅关于抗菌药物临床应用管理有关问题的通知.Available from:http://www.moh.gov.cn/mohbgt/s9508/200903/39723.shtml.
11 高健,张钰欣,王桂芝,等.两种β-内酰胺类抗生素联用的合理性分析.临床和实验医学杂志,2013,12(6):465-466.
12 陈淑瑜,吴晓莉.抗菌药物联合用药现状调查与研究.齐齐哈尔医学院学报,2008,29(21):2609-2611.
13 曾佑群,吴扬.小儿呼吸道感染抗生素的使用及耐药性分析.儿科药学杂志,2002,8(2):33-35.
14 张伶俐,李幼平,曾力楠,等.用儿童药物利用指数评价儿科用药剂量合理性的思考与探索.中国循证医学杂志,2012,12(2):125-128.
15 范洪伟,吕玮,吴东,等译.桑德福抗微生物治疗指南.(新译)第41版.北京:中国协和医科大学出版社,2011:187.
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