應用研究
臨床藥師參與我院部分質子泵抑制劑藥物點評分析
蔣 勇 陳 喜*
【摘要】 目的 對我院注射用雷貝拉唑鈉進行專項醫囑點評，減少注射用雷貝拉唑鈉的濫用現象，為促進臨床合理使用提供依據，進一步完善我院重點監控藥物的管理。方法 通過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，依據相關指南和藥物說明書進行點評。
【關鍵字】 合理用藥,質子泵抑制劑,醫囑點評,不合理醫囑
中圖分類號：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子泵抑制劑類藥物，臨床上主要用來治療慢性胃炎、胃食管返流、消化性潰瘍等胃酸相關性疾病。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螺旋桿菌作用都優于其他的質子泵抑制劑，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。隨著雷貝拉唑被廣泛運用于臨床，其不合理應用的問題也日益突出。藥物的不合理使用不僅會影響藥物療效，而且會造成該藥物引起的藥物不良反應[4]。自我院開展重點監控藥物專項醫囑點評工作以來，發現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行專項點評分析，總結其用藥特點，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，進行專項醫囑點評分析。
1.2方法 根據《臨床用藥須知》、《醫院處方點評管理規范》、《質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文獻資[5-6]以及注射用雷貝拉唑鈉的藥物說明書等，制定我院注射用雷貝拉唑鈉的使用評價標準。主要評價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。具體見表1。