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某大型综合医院抗肿瘤药物审方决策系统的构建与应用
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| 篇名： | 某大型综合医院抗肿瘤药物审方决策系统的构建与应用 |
| TITLE： | Construction and application of anti-tumor drug prescription review decision-support system in a large general hospital |
| 摘要： | 目的 介绍抗肿瘤药物智能化审方决策系统的构建，并评价其应用效果。方法整合国家及地方药事管理政策、临床指南/共识和医院信息系统、基因检测等相关数据，遵循“结构化、标准化、动态更新”原则，采用“药品属性+临床情境”双维度建模方法，构建覆盖化疗、靶向治疗、免疫治疗药物等各类抗肿瘤药物的知识库；将所得知识库嵌入医院电子医嘱系统，形成审方决策系统。评价该系统在上海交通大学医学院附属第六人民医院的应用情况及效果。结果构建了含抗肿瘤药物审方规则18318条的知识库，形成了涵盖“事前实时干预-事中互动审方-事后点评分析”闭环流程的审方决策系统。2021－2024年，该系统针对5类典型抗肿瘤药物处方的警示共57879条。其中，铂类药物处方的审核警示累计22577条；注射用顺铂（冻干型）为主要警示品种（13445条），以“合用导致耳毒性”警示持续高发（7682条）；甲氨蝶呤处方的审核警示累计3721条，以“注意事项”类警示为主（76.4%，2843/3721）；多柔比星处方共触发警示17301条，以“用法用量”类警示为主（14315条）；人表皮生长因子受体2（HER2）靶向药物处方的审核警示累计1007条，以“支付限制”警示为主（956条）；程序性死亡受体1/程序性死亡受体配体1抑制剂处方的审核警示逐年增多，累计13273条，以“适应证不适宜”为主（9118条）。4年间，医生响应率依次为21.4%、27.1%、33.5%、51.6%。结论成功构建了一套涵盖“事前实时干预-事中互动审方-事后点评分析”闭环流程的智能化抗肿瘤药物审方决策系统，并实现了全流程应用。该院对抗肿瘤药物的监测重点有向免疫治疗药物转移的趋势；医生对处方审核意见的采纳程度逐年升高。 |
| ABSTRACT： | OBJECTIVE To introduce the development of an intelligent prescription review decision-support system for anti-tumor drugs and assess its clinical application outcomes. METHODS Relevant data sources， including national and local pharmaceutical administration policies， clinical practice guidelines/consensus， hospital information systems data， and genetic testing results， were integrated. Adhering to the principles of structure， standardization and dynamic updating， a knowledge base covering chemotherapeutic， targeted and immunotherapeutic agents was constructed using a dual-dimensional modeling approach that combined “drug attributes” and “clinical contexts”. This knowledge base was then embedded into the hospital’s electronic medical order system to establish the prescription review decision-support system. The application and performance of the system were evaluated at Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. RESULTS A knowledge base containing 18 318 prescription review rules for anti-tumor drugs was constructed， and a closed-loop prescription review system was successfully established， encompassing pre-prescription real-time intervention， in-process interactive review， and post-prescription evaluation and analysis. From 2021 to 2024， the system generated a total of 57 879 alerts for prescriptions of five typical categories of anti-tumor drugs. For platinum-containing prescriptions， 22 577 alerts were generated， with Cisplatin for injection （lyophilized） being the most frequently alerted drug （13 445 alerts）， and “ototoxicity risk due to combined use” alerts remained high （7 682 alerts）. For methotrexate-containing prescriptions， 3 721 alerts were recorded， primarily related to “precaution-related issues” （76.4%， 2 843/3 721）. For doxorubicin-containing prescriptions， 17 301 alerts were triggered， primarily related to “dosage and administration” （14 315 alerts）. For human epidermal growth factor receptor 2-targeted agents-containing prescriptions， 1 007 alerts were issued， mostly related to “reimbursement restrictions” （956 alerts）. For programmed death-1/programmed death-ligand 1 inhibitors-containing prescriptions， the alerts increased year by year， totaling 13 273 alerts， primarily related to “inappropriate indication” （9 118 alerts）. Over the 4 years， the physician response rates to system alerts were 21.4%， 27.1%， 33.5% and 51.6%， respectively. CONCLUSIONS An intelligent decision-support system for anti-tumor drug prescription review， encompassing a closed-loop process of “real-time pre-event intervention， interactive in-event prescription review， post-event evaluation and analysis”， has been successfully constructed and implemented throughout the entire workflow. There is a discernible trend in this hospital， where the focus on monitoring anti-tumor drugs is shifting towards immunotherapy drugs. Additionally， the acceptance rate of physicians regarding prescription review opinions has been steadily increasing year by year. |
| 期刊： | 2026年第37卷第06期 |
| 作者： | 臧靖；干润；杨琦；陈燕；郭澄；张剑萍；李凤前；杨全军 |
| AUTHORS： | ZANG Jing， GAN Run，YANG Qi，CHEN Yan，GUO Cheng，ZHANG Jianping，LI Fengqian，YANG Quanjun |
| 关键字： | 抗肿瘤药物；处方审核；审方决策系统；合理用药；药学服务 |
| KEYWORDS： | anti-tumor drugs； prescription review； prescription review decision-support system； rational drug use； |
| 阅读数： | 2 次 |
| 本月下载数： | 0 次 |
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