摘要
目的评估围手术期非重症患者应激性溃疡出血(SUB)预防用药干预效果。方法基于前期首都医科大学附属北京友谊医院建立的围手术期非重症患者SUB预防用药合理性评价指标体系,2020年6月起该院通过重点科室查房、临床药师床旁患者教育、质子泵抑制剂(PPI)专项点评、处方点评反馈及绩效奖惩等方式对泌尿科、耳鼻喉科和普外科围手术期患者SUB预防用药进行干预。调取该院2021年1—4月和2019年1—4月每月最后1周出院的手术患者资料,分别纳入为观察组和对照组,比较SUB预防用药情况及药品费用等信息。结果共纳入1019例患者,观察组556例,对照组463例。观察组和对照组SUB预防用药率分别为19.42%和32.83%;无指征用药率分别为14.92%和18.66%;预防用抑酸药品总费用分别为34760.21元和79182.91元,中位费用分别为238.40(0.90~1728.05)元和274.17(6.05~6912.20)元,差异均有统计学意义(P<0.05)。干预后,各科室预防用抑酸药物的减少,均未造成患者住院天数及SUB患者人数增加,其中,普外科住院天数及SUB患者人数降低最显著,观察组和对照组住院天数分别为(10.76±7.82)d和(13.90±8.31)d,SUB患者人数分别为2例和19例,差异均有统计学意义(P<0.05)。结论通过建立围手术期非重症患者SUB预防用药合理性评价指标体系,对临床用药进行合理药学干预,能在保障临床治疗安全、有效的情况下,降低抑酸药物预防用药率,减少医疗费用。
Objective To evaluate the effect of medication intervention on stress ulcer bleeding(SUB)prevention in non-critically ill patients during the perioperative period.Methods Based on a previously established evaluation index system for the rationality of SUB preventive medication in non-critically ill patients during the perioperative period,Beijing Friendship Hospital Affiliated to Capital Medical University implemented interventions such as key department rounds,bedside patient education of clinical pharmacists,targeted evaluation of proton pump inhibitors(PPI),prescription feedback as well as performance reward and punishment system for patients in the urology,otorhinolaryngology,and general surgery departments since June 2020.We extracted data from surgical patients discharged in the last week of each month from January to April 2021 and the same period in 2019,with the former being the observation group and the latter being the control group.The SUB preventive medication use and medication costs were compared between the two groups.Results A total of 1019 cases were included,with 556 cases in the observation group and 463 cases in the control group.The rates of SUB prophylactic medication in the observation group and the control group were 19.42%and 32.83%,respectively.The rates of medication without clear indications were 14.92%and 18.66%,respectively.The total cost of acid-suppressing drugs for prevention were 34760.21 yuan and 79182.91 yuan,the median cost 238.40(0.90 to 1728.05)yuan and 274.17(6.05 to 6912.20)yuan,respectively,and the difference were statistically significant(P<0.05).After the intervention,the reduction of acid-suppressing drugs in each department did not cause an increase of hospitalization days and SUB patients.Among them,the hospitalization days of general surgery and the number of SUB patients decreased most significantly.The average hospital stays of the observation group and the control group were(10.76±7.82)d and(13.90±8.31)d,respectively.The number of SUB patients was 2 cases and 19 cases,respectively,and the differences were statistically significant(P<0.05).Conclusion By establishing an evaluation index system for the rationality of SUB prophylaxis in non-critically ill patients during the perioperative period,and by making rational pharmaceutical interventions,the use of acid-suppressing drug prophylaxis can be reduced,ensuring clinical safety and effectiveness,while also reducing medical costs.
作者
郑英明
李丹丹
陈威
李哲
李泽
温爱萍
ZHENG Ying-ming;LI Dan-dan;CHEN Wei;LI Zhe;LI Ze;WEN Ai-ping(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069,China)
出处
《临床药物治疗杂志》
2023年第11期60-64,共5页
Clinical Medication Journal
基金
北京市医院管理局消化内科学科协同发展中心消化专项重点项目(XXZ06)。
关键词
应激性溃疡出血
围手术期
非重症
药学干预
stress ulcer bleeding
perioperative period
non-critically ill
pharmaceutical intervention
