某院心血管病住院患者的人群特征及用药合理性分析
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摘要
目的分析心血管病住院患者的人群特征及其药物治疗方案特点。方法通过回顾性方法,调查2015年3月-2016年12月的心血管疾病患者住院医嘱。每月随机抽取含心血管疾病的病历约20份,采集住院患者性别、年龄、心血管疾病名称、合并疾病名称、医嘱条数、不合理医嘱和不优化医嘱等。结果共入选病例467例,审核的医嘱条数8 706条中不优化医嘱228条,不优化率2.6%;不合理医嘱262条,不合理率为3.0%。不合理医嘱与患者合并的疾病数、患者的医嘱条数之间呈正相关;心血管疾病中以高血压最为多见,占所有心血管疾病28.23%;心血管疾病合并疾病排名靠前的是椎基底动脉供血不足,占所有合并疾病14.17%,其次是慢性阻塞性肺疾病急性加重,占13.23%。结论心血管临床药师在查房过程中应重点关注心血管疾病老年患者的并发症,并掌握心血管疾病及常见并发症的治疗方案。
AIM To analyze the population characteristics of hospitalized patients with cardiovascular diseases and the characteristics of drug treatment programs. METHODS Through retrospective study, the inpatient medical advice of our hospital from March 2015 to December 2016 was investigated. About 20 medical records of cardiovascular disease were monthly randomly selected. The age, gender, name of cardiovascular disease, name of concomitant disease name, the doctor's advice articale number and unreasonable ones,the doctor's advice which was not optimizing,etc of hospitalized patients were collected. RESULTS At last,467 cases were selected,228 of the 8 706 articales of medical advice were not optimizing,accounting for 2.6% and 262 were not qualified,the default rate was 3.0%. The number of unreasonable medical orders were positively correlated with the number of patients' combined diseases and the number of patients' medical orders.Hypertension was the leading composition of cardiovascular diseases,accounting for 28.23% of all.Top of the list cardiovascular disease was insufficient vertebral basilar artery blood supply, accounting for 14.17% of all concomitant diseases,and followed by acute exacerbation of chronic obstructive pulmonary disease, accounting for 13.23%. CONCLUSION Clinical pharmacists of cardiovascular diseases should focus on the common complications of cardiovascular diseases in elderly patients with more diseases and master the treatment of cardiovascular diseases and common complications.
AIM To analyze the population characteristics of hospitalized patients with cardiovascular diseases and the characteristics of drug treatment programs. METHODS Through retrospective study, the inpatient medical advice of our hospital from March 2015 to December 2016 was investigated. About 20 medical records of cardiovascular disease were monthly randomly selected. The age, gender, name of cardiovascular disease, name of concomitant disease name, the doctor's advice articale number and unreasonable ones,the doctor's advice which was not optimizing,etc of hospitalized patients were collected. RESULTS At last,467 cases were selected,228 of the 8 706 articales of medical advice were not optimizing,accounting for 2.6% and 262 were not qualified,the default rate was 3.0%. The number of unreasonable medical orders were positively correlated with the number of patients' combined diseases and the number of patients' medical orders.Hypertension was the leading composition of cardiovascular diseases,accounting for 28.23% of all.Top of the list cardiovascular disease was insufficient vertebral basilar artery blood supply, accounting for 14.17% of all concomitant diseases,and followed by acute exacerbation of chronic obstructive pulmonary disease, accounting for 13.23%. CONCLUSION Clinical pharmacists of cardiovascular diseases should focus on the common complications of cardiovascular diseases in elderly patients with more diseases and master the treatment of cardiovascular diseases and common complications.
引文
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[11] 姜朝晖.<急性冠状动脉综合征患者强化他汀治疗专家共识>——强化他汀治疗推荐解读[J].中国医院用药评价与分析,2014,14(7): 580.
[12] 张明发,沈雅琴.甘草酸及其苷元甘草次酸的盐皮质激素样作用研究进展[J].现代药物与临床,2011,26(6):448.
[13] 刘然.甘草及甘草酸制剂引起的假性醛固酮增多症及防治[J].药物不良反应杂志,2009,11(6):416.
[14] 杨艳敏,方全,王斌,等.硝酸酯类药物静脉应用建议[J].中华内科杂志,2014,53(1):74.
[2] CHERYL R L,STEPHAN V E. Acute exacerbation of chronic obstructive pulmonary disease: cardiovascular links[J].Biomed Res Int,2014,2014:528789.
[3] MANEECHOTESUWAN K,WONGKAJORNSILP A,ADCOCK I M,et al. Simvastatin suppresses airway IL-17 and upregulates IL-10 in patients with stable COPD[J].Chest,2015,148:1164.
[4] 赵考昌,陈国忠.他汀类药物对慢性阻塞性肺疾病患者治疗作用的Meta分析[J].海南医学,2015,26(2):272.
[5] 李彦,胡永芳,周宏灏.基因检测在氯吡格雷抗血小板治疗中的意义[J].中国临床药理学杂志,2012,28(9):694.
[6] 钟诗龙,韩雅玲,陈纪言,等.氯吡格雷抗血小板治疗个体化用药基因型检测指南解读[J].中国实用内科杂志,2015,35(1):38.
[7] GIUSTI B,GORI A M, MARCUCCI R,et al. Determinants to optimize response to clopidogrel in acute coronary syndrome[J]. Pharmgenomics Pers Med, 2010,3:33.
[8] Van VARK L C,BERTRAND M, AKKERHUIS K M, et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158998 patients[J].Eur Heart J,2012,33(16):2088.
[9] 苏定冯,陈丰原.心血管药理学[M].北京:人民卫生出版社,2011.
[10] 过云峰,郭素峡,杨颖,等.不同他汀类药物标准剂量对稳定性斑块的影响[J].岭南心血管病杂志,2012,18(6):576.
[11] 姜朝晖.<急性冠状动脉综合征患者强化他汀治疗专家共识>——强化他汀治疗推荐解读[J].中国医院用药评价与分析,2014,14(7): 580.
[12] 张明发,沈雅琴.甘草酸及其苷元甘草次酸的盐皮质激素样作用研究进展[J].现代药物与临床,2011,26(6):448.
[13] 刘然.甘草及甘草酸制剂引起的假性醛固酮增多症及防治[J].药物不良反应杂志,2009,11(6):416.
[14] 杨艳敏,方全,王斌,等.硝酸酯类药物静脉应用建议[J].中华内科杂志,2014,53(1):74.