医院片剂分剂量使用现状调查分析
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摘要
目的:调查广东省人民医院2017年部分科室住院患者片剂分剂量使用情况,尤其针对心血管疾病儿童患者进行深入分析,为保障儿童安全用药提供参考。方法:前期随机抽取1 d部分科室住院患者用药情况,选出用药分剂量需求较大的科室,即心儿科与心外小儿区。后期抽取2017年广东省人民医院第三季度心儿科及心外小儿区住院患者服药情况,分析分剂量涉及人群、药品种类和使用频率、市场供应现状以及分剂量的合理性等。结果:初筛后共调研868例住院患者用药情况,患者年龄涉及4个月～18周岁,病症多为先天性心脏畸形。在调查中,有69. 7%的患者需要使用分剂量片剂药物,有41种片剂需要分剂量,涉及189种规格,1 538次分剂量操作。分剂量片剂均为化学药,主要涉及心血管系统药、利尿药。分剂量使用频率排前三位的的品种分别为螺内酯片、呋塞米片、卡托普利片,占到分剂量总例次的67. 6%。结论:儿童用药市场存在极大的市场缺口,市售规格无法满足医院临床需求,医院口服片剂分剂量现象十分普遍。而医院现有的药品分剂量方式对药物安全使用带来极大隐患,3D打印技术作为新兴制造技术应用于医院药品分剂量将对医药市场产生巨大的影响。
Objective: To investigate and analyze the situation of dividing tablets in some departments of the Guangdong Provincial People's Hospital in 2017,especially for children with cardiovascular disease in order to make sure medication safety for children. Methods: In the period before survey,one day of inpatient medical information in some departments were randomly selected,and the departments with a large divided-dose requirement for medication were screened out,which were the heart pediatrics and the extracardiac pediatric areas. During the third quarter of 2017 in the Guangdong Provincial People's Hospital,inpatient medical information of heart pediatrics and the extracardiac pediatric areas was reviewed,and the population,types,frequency,market availability,and rationality of the divided tablets were analysized. Results: The medication informations of 868 hospitalized patients were investigated. The patients were aged from 4-months to 18-years old,and most of them were congenital heart disease. The surveyfound that69. 7% of patients needed to use divided tablets,and 41 kinds of tablets were required todivide,includeing 189 drug specifications and 1 538 times dosing operations. The divided-dose tabletsare chemical drugs,which mainly involve cardiovascular drugs and diuretics. Spironolactone tablets,furosemide tablets,and captopril tablets were the three most commonly used divided dose tablets,which accounted for 67. 6%of the total use of the divided-dose tablets. Conclusions: There is a huge market gap in the children's drug market,the commercial specifications cannot meet the hospital's clinical need,and the use of divided-dose oral tablets in hospitals is very common. The use of tablets dividing packets can lead to safety problems. The application of 3 D printing technology as an emerging manufacturing technology to the divided-dose tablets will have a greatimpact.
Objective: To investigate and analyze the situation of dividing tablets in some departments of the Guangdong Provincial People's Hospital in 2017,especially for children with cardiovascular disease in order to make sure medication safety for children. Methods: In the period before survey,one day of inpatient medical information in some departments were randomly selected,and the departments with a large divided-dose requirement for medication were screened out,which were the heart pediatrics and the extracardiac pediatric areas. During the third quarter of 2017 in the Guangdong Provincial People's Hospital,inpatient medical information of heart pediatrics and the extracardiac pediatric areas was reviewed,and the population,types,frequency,market availability,and rationality of the divided tablets were analysized. Results: The medication informations of 868 hospitalized patients were investigated. The patients were aged from 4-months to 18-years old,and most of them were congenital heart disease. The surveyfound that69. 7% of patients needed to use divided tablets,and 41 kinds of tablets were required todivide,includeing 189 drug specifications and 1 538 times dosing operations. The divided-dose tabletsare chemical drugs,which mainly involve cardiovascular drugs and diuretics. Spironolactone tablets,furosemide tablets,and captopril tablets were the three most commonly used divided dose tablets,which accounted for 67. 6%of the total use of the divided-dose tablets. Conclusions: There is a huge market gap in the children's drug market,the commercial specifications cannot meet the hospital's clinical need,and the use of divided-dose oral tablets in hospitals is very common. The use of tablets dividing packets can lead to safety problems. The application of 3 D printing technology as an emerging manufacturing technology to the divided-dose tablets will have a greatimpact.
引文
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[2]李瑞霞,武志昂.我国儿童用药风险因素的专家调查研究[J].中国药物警戒,2015,12(5):311-313.
[3]李春霞,黄山田.儿童用药不良反应分析及对策的调查研究[J].临床医药文献电子杂志,2017(80):15826-15838.
[4]汤少梁,朱亚,冯莉钧,等.基于供给侧改革的我国儿童用药安全性与可及性优化路径研究[J].中国医药导报,2017(35):125-129.
[5]季兴,王倩,许静,等.江苏省三级医院儿童药品短缺现状调查及建议[J].中国药房,2017,28(33):4617-4620.
[6]蔡育红,钟慧敏,谭洁英,等.三种片剂药品小儿分剂量用药对有效成分含量及溶出度的影响[J].儿科药学杂志,2014(7):37-39.
[7]林艳.药片分剂量准确性考察及对儿童用药安全的影响[D].浙江:浙江大学,2014.
[8]高鹏,林艳,蔡志波,等.口服药片分剂量现状[C].北京:2013中国药学大会暨中国药师周,2013:2254-2261.
[9]程谋,李其凤.我国儿童药物发展环境与市场分析[J].药学进展,2016,40(9):653-664.