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252例心力衰竭住院患者沙库巴曲缬沙坦的用药分析
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| 篇名： | 252例心力衰竭住院患者沙库巴曲缬沙坦的用药分析 |
| TITLE： | Analysis of the Use of Sacubitril-valsartan in 252 Inpatients with Heart Failure |
| 摘要： | 目的：分析心力衰竭住院患者沙库巴曲缬沙坦的用药情况。方法：收集我院2019年10月－2020年3月使用沙库巴曲缬沙坦的住院心力衰竭患者的资料，包括其基本信息，如性别、年龄、住院科室、住院时间等；汇总其沙库巴曲缬沙坦使用情况（包括适应证、禁忌证、用法用量、用药疗程）、与血管紧张素转化酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）类药物的转换、药物不良反应等信息。结果：共收集到252例患者的资料，其中男性172例（68.25％）、女性80例（31.75％）；平均年龄为（67.02±14.23）岁，有85例（33.73％）的年龄≥75岁；平均住院时间为（12.03±8.19）d，用药前平均左室射血分数（LVEF）为（38.69±10.45）％，平均血钾水平为（4.16±0.65）mmol/L，平均肾小球滤过率估计值（eGFR）为（69.14±32.01）mL/（min·1.73m2）。分布科室以心内科（59.14％）为主，其次为肾内科（8.73％）、呼吸科（7.14％）、心外科（5.95％）、老年科（5.56％）、急诊内科（3.57％）和神经内科（3.17％）。所有患者均有用药适应证，但有25例（9.92％）存在用药禁忌证，其中6例（2.38％）为血钾＞5.4mmol/L、19例（7.54％）为eGFR＜15mL/（min·1.73m2）。用法用量以50mg，bid为主（45.24％）；39例（15.47％）给药频次为qd，为不合理给药；平均疗程为（7.80±5.86）d。有7例患者（2.78％）与ACEI转换，其中3例患者（42.86％）的转换间隔时间未达36h；20例患者（7.93％）与ARB转换，均无明显转换不适宜情况。14例患者（5.56％）出现低血压，其中2例经停药、12例经减少用药剂量后，血压均恢复至正常范围内；所有患者均未出现高血钾、血管神经性水肿、肾功能损害、不自主肌肉颤动和心律失常等不良反应。结论：我院心力衰竭住院患者使用沙库巴曲缬沙坦均有用药适应证，且安全性良好，仅有少数患者出现血压不耐受情况；但存在给药剂量偏小、给药频次不适宜、禁忌证用药、药物转换时机不适宜等情况。临床药师可开展合理用药知识宣讲，加强对患者的药学监护，及时发现不合理用药情况并监测不良反应，同时积极干预，以确保患者用药的合理性及安全性。 |
| ABSTRACT： | OBJECTIVE：To analyze the situation of inpatients with heart failure taking sacubitril-valsartan. METHODS ：The data of heart failture inpatients using sacubitril-valsartan in our hospital were collected during Oct. 2019 to Mar. 2020，including basic information of patients such as gender ，age，inpatient department ，length of stay ；the application of sacubitril-valsartan ， including indications ，contraindications，usage and dosage ，course of medication ；conversion with angiotensin converting enzyme inhibitor（ACEI）/angiotensin Ⅱ receptor antagonist （ARB）and adverse drug reactions ，were summarized. RESULTS ：A total of 252 cases were collected ，including 172 males（68.25％）and 80 females（31.75％）. The average age of the patients was （67.02± 14.23）years old ，and 85 cases were 75 years or older （33.73％）. Average hospitalization time was （12.03±8.19）d，the average left ventricular ejection fraction （LVEF）before medication was （38.69±10.45）％，the average blood potassium was （4.16±0.65） mmol/L，and the average estimated value of glomerular filtration （eGFR）was（69.14±32.01）mL/（min·1.73 m2）. The main distri- bution departments were cardiology department （59.14％），followed by nephrology department （8.73％），respiration department （7.14％），cardiac surgery department （5.95％），geriatrics department （5.56％），emergency medicine department （3.57％）and neurology department （3.17％）. All patients had indications ，but 25 cases（9.92％）had contraindications ，6 cases（2.38％）had blood potassium ＞5.4 mmol/L，19 cases（7.54％）had eGFR ＜15 mL/（min·1.73 m2）. The usage and dosage was 50 mg/bid （45.24％）；39 cases（15.47％）were given medicine once a day ，which was unreasonable. Average treatment course was （7.80± 5.86）d. 7 patients（2.78％）converted to ACEI ，and 3 patients（42.86％）had a conversion interval less than 36 h；20 patients （7.93％） were converted to ARB ，and there was no obvious inappropriate conversion. Hypotension occurred in 14 patients （5.56％）. Blood pressure returned to the normal range in 2 patients after drug withdrawal and 12 patients after dose reduction. No patient had adverse reactions such as involuntary muscle tremor and arrhythmia. CONCLUSIONS ： All the inpatients wit h heart failure in our hospital have indications and good safety. Only a few patients have blood pressure intolerance. However ，there were problems such as low dosage ，inappropriate frequency of administration ，drug use against contraindications，and inappropriate timing of drug conversion. Clinical pharmacists can carry out the knowledge propaganda of rational drug use ，strengthen the pharmaceutical care of patients ，timely detect the situation of irrational drug use and monitor adverse drug reactions ，and actively intervene to ensure the rationality and safety of patients ’medication. |
| 期刊： | 2020年第31卷第22期 |
| 作者： | 孙莹，顾永丽，孙增先 |
| AUTHORS： | SUN Ying，GU Yongli ，SUN Zengxian |
| 关键字： | 血管紧张素受体-脑啡肽酶抑制剂；沙库巴曲缬沙坦；心力衰竭；住院患者；合理用药；安全性 |
| KEYWORDS： | Angiotensin receptor-enkephalinase inhibitor ；Sacubitril-valsartan；Heart failure ；Inpatient；Rational drug use ； |
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