药物利用评价和药物利用评估法评价ST段抬高心肌梗死临床路径患者的用药情况

doi:10.19803/j.1672-8629.2022.06.20

摘要/Abstract

摘要： 目的评价实施临床路径(clinical pathway, CP)的急性ST段抬高心肌梗死（ST elevated myocardial infarction, STEMI）患者的用药情况及合理性。方法收集和整理安徽省淮南市朝阳医院2018年1月1日至2019年12月31日实施 CP的STEMI患者相关资料，采用药物利用评价(drug use review, DUR)和药物利用评估法(drug use evaluation, DUE)，对STEMI临床路径患者的药物利用指数、评价指标和诊断、治疗药物监测及临床诊疗效果进行综合分析。结果 76例患者所用主要治疗药物共38种，其中5种药物利用指数（drug utilization index, DUI）>1，20种药物DUI<1，13种药物DUI=1。用药强度居前列的药物为阿司匹林肠溶片、硫酸氢氯吡格雷片、阿托伐他汀钙片、替格瑞洛片、泮托拉唑肠溶片、单硝酸异山梨酯片和盐酸曲美他嗪片。76例患者入院后均首次接受了心肌损伤标志、肝功能、肾功能、血常规及血脂水平等指标的监测；治疗期间再次接受心肌损伤标志、肝功能、肾功能、血常规和血脂水平的监测及异常再监测的比例分别为100.00%、40.78%、22.36%、9.21%和3.94%。药品不良反应（adverse drug reaction, ADR)共发生9例次。经过治疗后，76例（100.00%）患者临床症状明显好转。结论联合应用DUR和DUE可全面评估实施CP的STEMI患者的用药情况，及时发现不合理用药情况，促进临床药物合理使用。

关键词: 急性ST段抬高心肌梗死, 临床路径, 药物利用评价, 药物利用评估, 药物利用指数, 药品不良反应

Abstract: Objective To evaluate the drug use and its rationality among patients with acute ST segment elevation myocardial infarction treated with clinical pathways (CP). Methods The clinical data on STEMI patients who had implemented CP in our hospital between January 1, 2018 and December 31, 2019 was collected. The drug utilization index (DUI), evaluation index, diagnosis, effect of therapeutic drug monitoring and that of clinical diagnosis and treatment were analyzed using methods for drug use review and drug use evaluation. Results There were thirty-eight main types of drugs used by seventy-six patients. The DUI for five of these types was above 1, less than 1 for twenty types, and was 1 for thirteen types. Aspirin enteric coated tablets, clopidogrel bisulfate tablets, atorvastatin calcium tablets, ticagrelor tablets, pantoprazole enteric coated tablets, isosorbide mononitrate tablets and trimetazidine hydrochloride tablets were high in drug use intensity. All 76 patients were monitored for the first time after admission for myocardial injury, liver function, renal function, blood routine examination and blood lipid level; During the treatment, 100.00%, 40.78%, 22.36%, 9.21% and 3.94% of them received the monitoring of myocardial injury markers, liver function, renal function, blood routine and blood lipid levels and abnormal re monitoring respectively. There were nine cases of adverse drug reaction ADR. After treatment, the clinical symptoms of the seventy-six cases (100.00%) improved significantly. Conclusion The combination of DUR and DUE can comprehensively evaluate the drug use of STEMI patients treated with CP. Irrational drug use should be detected in time and rational use of clinical drugs promoted.

Key words: ST elevated myocardial infarction, clinical pathway, drug utilization review, drug utilization evaluation, drug utilization index, adverse drug reaction

中图分类号:

R994.11

俞吉, 冉烁. 药物利用评价和药物利用评估法评价ST段抬高心肌梗死临床路径患者的用药情况[J]. 中国药物警戒, 2022, 19(6): 674-679.

YU Ji, RAN Shuo. Evaluation of drug use during applications of clinical pathways in patients with STEMI based on DUR and DUE[J]. Chinese Journal of Pharmacovigilance, 2022, 19(6): 674-679.

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