應用研究
臨床藥師參與我院部分質(zhì)子泵抑制劑藥物點(diǎn)評分析
蔣 勇 陳 喜*
【摘要】 目的 對我院注射用雷貝拉唑鈉進(jìn)行專(zhuān)項醫囑點(diǎn)評，減少注射用雷貝拉唑鈉的濫用現象，為促進(jìn)臨床合理使用提供依據，進(jìn)一步完善我院重點(diǎn)監控藥物的管理。方法 通過(guò)臨床合理用藥軟件系統（PASS系統）抽取2021年11月使用注射用雷貝拉唑鈉的住院患者病例，依據相關(guān)指南和藥物說(shuō)明書(shū)進(jìn)行點(diǎn)評。
【關(guān)鍵字】 合理用藥,質(zhì)子泵抑制劑,醫囑點(diǎn)評,不合理醫囑
中圖分類(lèi)號：文獻標識碼：文章編號：
[Abstract] Objective To make comments on special medical orders of rabeprazole sodium for injection, reduce its abuse, provide the basis for its rational use, and further improve the management of key monitoring drugs in our hospital. Methods Prescription automatic screening system (PASS) for clinical rational drug use was adopted to select the inpatients who received rabeprazole sodium for injection in November 2021, and comments were made in accordance with related guides and drug instructions. Results Among the 140 cases chosen in the system, there were 39 (27.86%) cases with irrational medical orders. The main reasons of these irrational medical orders were inappropriate indications and improper usage and dosage, which accounted for 74.36% and 35.90% of these irrational medical orders, respectively. Conclusion Through making comments on medical orders, this study found that there was irrational use of rabeprazole sodium for injection in our hospital. Therefore, it is necessary to further strengthen supervision. Clinical pharmacists should perform effective intervention for irrational medical orders. In addition, the criteria for comments should also be timely updated according to evidence-based medicine. Meanwhile, clinical pharmacists should perfect their work methods and transform their primary post-evaluation work pattern gradually into pre-prescription review one, so as to decrease the incidence rate of irrational medical orders.
雷貝拉唑屬于新一代的質(zhì)子泵抑制劑類(lèi)藥物，臨床上主要用來(lái)治療慢性胃炎、胃食管返流、消化性潰瘍等胃酸相關(guān)性疾病。從藥理作用上看，雷貝他唑能抑制胃酸分泌的作用和抗幽門(mén)螺旋桿菌作用都優(yōu)于其他的質(zhì)子泵抑制劑，且起效迅速[1-3]。注射用雷貝拉唑鈉是用于胃或者十二指腸潰瘍出血的不能口服的患者。隨著(zhù)雷貝拉唑被廣泛運用于臨床，其不合理應用的問(wèn)題也日益突出。藥物的不合理使用不僅會(huì )影響藥物療效，而且會(huì )造成該藥物引起的藥物不良反應[4]。自我院開(kāi)展重點(diǎn)監控藥物專(zhuān)項醫囑點(diǎn)評工作以來(lái)，發(fā)現2021年11月注射用雷貝拉唑鈉的使用量較上月相比呈明顯上升趨勢，且國家醫保局規范了注射用雷貝拉唑的限定支付范圍：只有禁食醫囑和吞咽困難的患者使用注射用雷貝拉唑鈉才予以報銷(xiāo)支付，對臨床使用注射用雷貝拉唑鈉加強了監管。為了防止注射用雷貝拉唑鈉的濫用，將我院2021年11月注射用雷貝拉唑鈉的使用情況進(jìn)行專(zhuān)項點(diǎn)評分析，總結其用藥特點(diǎn)，為臨床合理應用提供依據。
1 資料與方法
1.1一般資料 通過(guò)臨床合理用藥系統（PASS系統），臨床藥師采用回顧性分析法，抽取了2021年11月全院使用注射用雷貝拉唑鈉的住院患者病歷一共140份，進(jìn)行專(zhuān)項醫囑點(diǎn)評分析。
1.2方法 根據《臨床用藥須知》、《醫院處方點(diǎn)評管理規范》、《質(zhì)子泵抑制劑臨床應用指導原則（2020年版）》、與注射用雷貝拉唑鈉相關(guān)文獻資[5-6]以及注射用雷貝拉唑鈉的藥物說(shuō)明書(shū)等，制定我院注射用雷貝拉唑鈉的使用評價(jià)標準。主要評價(jià)內容包括雷貝拉唑鈉的適應證、溶媒、用藥劑量、用藥療程、配伍情況等。具體見(jiàn)表1。
