中国药物警戒 ›› 2022, Vol. 19 ›› Issue (9): 1023-1026.
DOI: 10.19803/j.1672-8629.2022.09.19

• 安全与合理用药 • 上一篇    下一篇

老年患者胸腔镜术后镇痛使用风险调查及防范

褚燕琦1, 江永贤2, 沈江华1, 邢晓璇1, 张青霞1, 闫素英1,*   

  1. 1首都医科大学宣武医院药学部,北京 100053;
    2电子科技大学医学院附属妇女儿童医院,成都市妇女儿童中心医院药学部,四川 成都 611731
  • 收稿日期:2020-12-04 出版日期:2022-09-15 发布日期:2022-09-16
  • 通讯作者: *闫素英,女,主任药师·硕导,用药安全及老年药学。E-mail：yansuying10@sina.cn
  • 作者简介:褚燕琦, 女, 主任药师, 副教授,临床药学及重症药学。
  • 基金资助:
    国家重点研发计划（2020YFC2008305）; 北京市卫生和计划生育委员会“老年重大疾病关键技术研究”（PXM2018_026283_000002）

Analgesia-related risks after thoracoscopic surgery in elderly patients

CHU Yanqi1, JIANG Yongxian2, SHEN Jianghua1, XING Xiaoxuan1, ZHANG Qingxia1, YAN Suying1,*   

  1. 1Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;
    2Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu Sichuan 611731, China
  • Received:2020-12-04 Online:2022-09-15 Published:2022-09-16

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摘要： 目的 通过调查老年胸腔镜术后镇痛泵管理使用情况,梳理使用风险环节,为医院完善术后镇痛管理及临床药师的镇痛药物重整和用药干预提供参考。方法 回顾性调查2020年1月1日至10月31日某院老年患者胸腔镜（部分）肺叶切除术后使用镇痛泵情况,收集患者基本信息、镇痛评分、术后镇痛不同环节的镇痛方式、镇痛药物使用情况及药品不良反应等,再使用鱼骨图分析风险的原因并提出风险防范措施。结果 共纳入114例病例,其平均年龄为（67.64±5.83）岁。所有病例中使用非甾体类药物的品种数为（2.12±0.64）种,2种非甾体类药物以上联用例数占比85.09%,帕瑞昔布平均使用时间为（5.46±2.76）d,帕瑞昔布和氟比洛芬均存在超剂量使用的现象。患者术后镇痛期间,出现恶心呕吐者共36例（31.58%）,出现眩晕者5例（4.39%）,有瘙痒症状者2例（1.75%）,对症处理后均好转。经过头脑风暴和鱼骨图分析,主要风险原因可能为：缺乏标准的镇痛药物使用交接流程、尚未建立多学科的疼痛管理小组、医嘱和前置审方缺少智能化提醒以及药师尚未开展镇痛药物重整服务。结论 此类患者术后需要经历手术室、监护室以及病区等多个环节,对患者进行术后镇痛时,各个环节缺乏沟通,导致非甾体类药物重复使用率、超剂量使用率高,存在较大的风险隐患。医院可进一步完善各环节交接流程和建立多学科疼痛管理小组和信息化的风险提示系统,促进临床药师开展创新的镇痛药物的药学重整服务。

关键词: 老年患者, 镇痛方案, 风险调查, 风险防范

Abstract: Objective To investigate the management and usage of analgesic pumps after thoracoscopic surgery in the elderly in order to identify the risks and provide reference for postoperative analgesia and interventions by clinical pharmacists. Methods The usage of analgesic pumps after thoracoscopic (partial) lobectomy among elderly patients treated in our hospital between January 1, and October 31, 2020 was retrospectively analyzed. The basic information about these patients, analgesic scores, analgesic methods in different steps of postoperative analgesia, usage of analgesic drugs and adverse reactions were recorded before fishbone diagrams were used to analyze the causes of risks and propose precautions. Results A total of 114 cases were included, whose age averaged (67.64±5.83) years. The types of non-steroidal drugs used in all cases were(2.12±0.64). Cases of combined use of two NSAIDs or more accounted for 85.09% of the total. The average length of parecoxib use was(5.46±2.76) days. There were also cases of overdose of parecoxib and flurbiprofen. During postoperative analgesia, 36 patients (31.58%) developed nausea and vomiting, 5 patients (4.39%) dizziness and 2 (1.75%) pruritus, all of which were mitigated after symptomatic treatment. Brainstorming and fishbone diagram analysis showed that the risks were probably due to the lack of standard handover processes, a multidisciplinary pain management team, intelligent reminders of doctors’ orders and pre-review, and re-organization of analgesic drugs. Conclusion This type of patient needs to stay in different rooms after surgery. During postoperative analgesia, there is a lack of communication between all these links, leading to the high rate of repeated use of non-steroidal drugs and overdose. Hospitals should improve the communication between all the related links and establish a multidisciplinary pain management team and an information-based risk warning system, while clinical pharmacists can innovate the organization of analgesic drugs.

Key words: elderly patients, analgesia, risk investigation, risk prevention

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