全国192家医疗机构26 011例创伤性颅内损伤患者的药物利用分析
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篇名: 全国192家医疗机构26 011例创伤性颅内损伤患者的药物利用分析
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摘要: 目的:了解创伤性颅内损伤患者的药物应用状况及用药特点,为促进创伤性颅内损伤患者的临床合理用药提供参考。方法:采用金额排序分析和用药频度(DDDs)分析等方法,对全国192家医疗机构2016年6月1日-2017年5月31日期间创伤性颅内损伤住院患者电子病历中的人口统计学信息、诊断信息、药品信息等进行汇总、统计、分析。结果:26 011例创伤性颅内损伤患者中,男性占72.4%,女性占27.5%;31~50岁者占总数的57.0%;交通伤为最主要的致伤因素(占33.8%),而高处坠落伤导致的住院时间最长、费用最多;诊断疾病占比排前3位的分别是未特指的颅内损伤(占55.3%)、脑震荡(占19.6%)、弥散性脑损伤(占13.0%),而局部脑损伤的平均住院时间最长、平均住院费用和药品费用最高。使用金额排前3位是神经系统药物(17 887.5万元)、血液和造血器官药(6 149.6万元)、全身用抗感染药(4 946.1万元)。在神经系统药物中,脑保护药物金额和DDDs均居首位;不同损伤严重程度的患者中,使用脑保护药物组的平均药品费用及住院费用均显著高于未使用组(P<0.05),而两组的平均住院时间差异均无统计学意义(P>0.05)。在血液和造血器官药中,血液代用品和灌注液金额占比最高,其中的静脉注射液、静脉注射液添加剂、血液和相关制品分别占35.51%、19.17%、17.17%。在全身用抗感染药中,金额排序前3位的分别是第三代头孢菌素类药物、碳青霉烯类药物、第二代头孢菌素类药物;DDDs排序前3位的分别是第三代、第二代头孢菌素类药物和氟喹诺酮类药物。结论:创伤性颅内损伤患者所用药物以神经系统药物、血液和造血器官药、全身用抗感染药为主,大多为对症治疗药物,总体使用基本合理,但仍存在脑保护药物滥用等问题。因此,对脑保护药物等的使用还需进一步加强管理和严格控制,从而进一步提高临床合理用药水平。
ABSTRACT: OBJECTIVE: To investigate the situation and characteristics of drug use in patients with traumatic intracranial injury, and to provide reference for rational use of drugs in patients with traumatic intracranial injury. METHODS: By amount sorting analysis and DDDs analysis, electronic medical records of inpatients with traumatic intracranial injury in 192 hospitals during Jun. 1st 2016-May 31st 2017 were summarized and analyzed statistically in respects of demographics, diagnosis, drug information, etc. RESULTS: Among 26 011 patients with traumatic intracranial trauma, the male accounted for 72.4% and the female accounted for 27.5%. The patients aged 31-50 years accounted for 57.0%. The traffic injury was the main injury factor (33.8%), and high falling injury caused longest hospitalization day and highest cost. Top 3 types of traumatic intracranial injury in the list of diagnosed diseases ratio were unspecified intracranial injury (55.3%), concussion (19.6%), diffuse brain injury (13.0%), among which average hospitalization day, average hospitalization cost and drug cost of patients with local cerebral injury were the longest or highest. Top 3 drugs in the list of cost were nervous system drugs (178 875 thousand yuan), blood and hematopoietic agents (61 496 thousand yuan) and anti-infective agents for whole body (49 461 thousand yuan). Among nervous system drugs, the cost and DDDs of brain protective drugs were the highest. Among patients with different injury severity degrees, average drug cost and hospitalization cost of brain protective drugs group were significantly higher than no treatment group (P<0.05), but there was no statistical significance in average hospitalization day between 2 groups (P>0.05). Among blood and hematopoietic organ drugs, the cost of blood substitutes and perfusate accounted for the highest proportion, among which intravenous injection, intravenous injection additives, blood and related preparation accounted for 35.5%, 19.17%, 17.17%, respectively. Among anti-infective agents for whole body, top 3 drugs in the list of cost were third-generation cephalosporins, carbapenem and second-generation cephalosporins. Top 3 drugs in the list of DDDs were third-generation cephalosporins, second-generation cephalosporins and fluoroquinolone. CONCLUSIONS: The drugs for traumatic intracranial injury patients are mainly nervous system drug, blood and hematopoietic agents, anti-infective agents for whole body. Most of drugs are symptomatic treatment drugs, and their use is basically reasonable. There still are problems such as brain protective drugs are used too frequently. So, the use of brain protective drugs should be further strengthened and strictly controlled so as to further improve the level of clinical rational drug use.
期刊: 2018年第29卷第24期
作者: 谭建霞,何志高,舒丽芯,杨樟卫
AUTHORS: TAN Jianxia,HE Zhigao,SHU Lixin,YANG Zhangwei
关键字: 创伤性颅内损伤;药物利用分析;用药金额;用药频度;脑保护药物
KEYWORDS: Traumatic intracranial injury; Drug utilization evaluation; Consumption sum; DDDs; Brain protective drugs
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