1374例中重度毛细支气管炎患儿主要用药调查及合理性分析
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摘要
目的促进中重度毛细管支气管炎患儿的临床合理用药。方法选取医院2016年8月至2018年9月收治的中重度毛细支气管炎患儿1 374例,就其主要用药情况进行统计,并分析用药合理性。结果糖皮质激素类药、支气管扩张剂、抗病毒药物、抗菌药物及白三烯调节剂、祛痰药、解痉药等均为本院治疗中重度毛细支气管炎的临床用药,其中使用率排名前八的药品依次为布地奈德混悬液(吸入给药,98. 76%)、祛痰药(68. 70%)、白三烯调节剂(22. 13%)、沙丁胺醇(57. 21%)、甲泼尼龙/地塞米松(静脉注射,22. 42%)、干扰素(吸入给药,21. 62%)、解痉药(14. 48%)、干扰素(肌肉注射,14. 05%);超说明书用药405例(29. 48%),其中超常用药317例(23. 07%),不适宜用药62例(4. 51%),不规范用药26例(1. 89%)。结论该院中重度毛细支气管炎患儿主要用药情况基本合理,但仍存在超说明书用药情况,主要表现为不规范用药、不适宜用药及超常用药。临床医师应与临床药师及时有效沟通,严格参照相关指南及医学证据,强化临床用药安全意识,制订严格的儿科中重度毛细支气管炎用药规范,确保用药安全。
Objective To promote clinical rational drug use in children with moderate to severe bronchiolitis. Methods Totally 1 374 children with moderate to severe bronchiolitis admitted to our hospital from August 2016 to September 2018 were selected and the main drugs used for these children were investigated to analyze the rationality of medication. Results Glucocorticoids,bronchodilators,antivirals,antibiotics and leukotriene regulators,expectorants and antispasmodics were all clinical drugs for the treatment of moderate to severe bronchiolitis in our hospital. The top 8 drugs used in the clinic were Budesonide Suspension for Inhalation( inhalation,98. 76%),expectorants( 68. 70%) and leukotriene regulators( 22. 13%),salbutamol( 57. 21%),methylprednisolone/dexamethasone( intravenous injection,22. 42%),interferon( inhalation,21. 62%),antispasmodics( 14. 48%) and interferon( intramuscular injection,14. 05%). Totally 405 cases( 29. 48%) were off-label drug use,of which 317 cases( 23. 07%) were extraordinary drug use,62 cases( 4. 51%) were unsuitable drug use,and 26 cases( 1. 89%) were irregular drug use. Conclusion The drugs mainly used in children with moderate to severe bronchiolitis in our hospital are basically reasonable,but the phenomenon of off-label drug use is still exist,the main manifestations are irregular drug use,unsuitable drug use and extraordinary drug use. Clinicians should communicate with clinical pharmacists in time and effective manner,strictly refer to relevant guidelines and medical evidence,strengthen the awareness of clinical medication safety,formulate strict medication standards for moderate to severe bronchiolitis in pediatrics to ensure the medication safety.
Objective To promote clinical rational drug use in children with moderate to severe bronchiolitis. Methods Totally 1 374 children with moderate to severe bronchiolitis admitted to our hospital from August 2016 to September 2018 were selected and the main drugs used for these children were investigated to analyze the rationality of medication. Results Glucocorticoids,bronchodilators,antivirals,antibiotics and leukotriene regulators,expectorants and antispasmodics were all clinical drugs for the treatment of moderate to severe bronchiolitis in our hospital. The top 8 drugs used in the clinic were Budesonide Suspension for Inhalation( inhalation,98. 76%),expectorants( 68. 70%) and leukotriene regulators( 22. 13%),salbutamol( 57. 21%),methylprednisolone/dexamethasone( intravenous injection,22. 42%),interferon( inhalation,21. 62%),antispasmodics( 14. 48%) and interferon( intramuscular injection,14. 05%). Totally 405 cases( 29. 48%) were off-label drug use,of which 317 cases( 23. 07%) were extraordinary drug use,62 cases( 4. 51%) were unsuitable drug use,and 26 cases( 1. 89%) were irregular drug use. Conclusion The drugs mainly used in children with moderate to severe bronchiolitis in our hospital are basically reasonable,but the phenomenon of off-label drug use is still exist,the main manifestations are irregular drug use,unsuitable drug use and extraordinary drug use. Clinicians should communicate with clinical pharmacists in time and effective manner,strictly refer to relevant guidelines and medical evidence,strengthen the awareness of clinical medication safety,formulate strict medication standards for moderate to severe bronchiolitis in pediatrics to ensure the medication safety.
引文
[1]林渊液,卢君,林冬丽,等.小儿毛细支气管炎抗感染治疗的探讨[J].临床和实验医学杂志,2011,10(1):33-35.
[2]李贵庆.中西医结合治疗小儿毛细支气管炎的研究进展[J].内蒙古中医药,2016,35(16):98-99.
[3]余秋艳.多索茶碱联合重组人干扰素α1b治疗婴幼儿中重度毛细支气管炎的临床观察[J].中西医结合心血管病杂志:电子版,2017,5(31):183-184.
[4]孙晓敬.毛细支气管炎治疗中糖皮质激素的运用分析[J].中国继续医学教育,2017,9(21):165-167.
[5]廖景文.支气管扩张剂氧驱动雾化吸入辅助治疗小婴儿毛细支气管炎疗效比较[J].临床医学,2014,34(8):39-40.
[6]安娜,丁翔宇,张古英,等.儿童医院毛细支气管炎住院患儿用药分析[J].中国药业,2018,27(19):86-89.
[7]中华医学会儿科学分会呼吸学组.毛细支气管炎诊断、治疗与预防专家共识(2014年版)[J].中华儿科杂志,2015,53(3):168-171.
[8] RALSTON SL,LIEBERTHAL AS,MEISSNER HC,et al. Clinical practice guideline:the diagnosis,management,and prevention of bronchiolitis[J]. Pediatrics,2014,134(5):e1474-e1502.
[9]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识(2018年修订版)[J].临床儿科杂志,2018,36(2):95-107.
[10]洪建国,陈强,陈志敏,等.儿童常见呼吸道疾病雾化吸入治疗专家共识[J].中国实用儿科杂志,2012,27(4):265-269.
[11]王卫平.儿科学[M].第8版.北京:人民卫生出版社,2013:269.
[12]贺海珊,邱雪雁,刘阿玲,等.我院中重度毛细支气管炎患儿主要治疗药物的使用情况调查及合理性评价[J].中国药房,2018,29(14):1988-1991.
[13]冯柱兴,李欣其,李桥蓉.痰热清注射液结合西医常规疗法治疗小儿毛细支气管炎临床研究[J].国际中医中药杂志,2016, 38(6):515.
[14] ZEIGER RS,MAUGER D,BACHARIER LB,et al. Daily or intermittentbudesonide in Preschool children with recurrent wheezing[J]. N Engl J Med,2011,365(21):1990-2001.
[15]林立,李昌崇.“儿童社区获得性肺炎管理指南(2013修订)”解读[J].中华妇幼临床医学杂志:电子版,2014,10(6):728-732.
[16] NORRIS CL,O'NEAL PV,ADAMS ED,et al. Nasal Airway Clearance for Bronchiolitis[J]. MCN Am J Matern Child Nurs,2018,43(6):318-323.
[17]龚益,陈小东.白三烯调节剂在哮喘治疗中的应用[J].上海医药,2014,35(5):8-12.
[18]柳筱筱,张常科,张媛媛,等.干扰素雾化吸入在急性毛细支气管炎患者中的临床应用研究[J].甘肃科技,2018,34(18):130-131.
[19]马雪萍.布地奈德联合重组人干扰素α-2b雾化吸入治疗小儿毛细支气管炎的临床疗效分析[J].中国实用医药,2017,12(24):123-124.
[20]张乐.重组人干扰素α1b治疗急性毛细支气管炎患儿疗效分析[J].中国卫生标准管理,2018,9(18):78-80.
[2]李贵庆.中西医结合治疗小儿毛细支气管炎的研究进展[J].内蒙古中医药,2016,35(16):98-99.
[3]余秋艳.多索茶碱联合重组人干扰素α1b治疗婴幼儿中重度毛细支气管炎的临床观察[J].中西医结合心血管病杂志:电子版,2017,5(31):183-184.
[4]孙晓敬.毛细支气管炎治疗中糖皮质激素的运用分析[J].中国继续医学教育,2017,9(21):165-167.
[5]廖景文.支气管扩张剂氧驱动雾化吸入辅助治疗小婴儿毛细支气管炎疗效比较[J].临床医学,2014,34(8):39-40.
[6]安娜,丁翔宇,张古英,等.儿童医院毛细支气管炎住院患儿用药分析[J].中国药业,2018,27(19):86-89.
[7]中华医学会儿科学分会呼吸学组.毛细支气管炎诊断、治疗与预防专家共识(2014年版)[J].中华儿科杂志,2015,53(3):168-171.
[8] RALSTON SL,LIEBERTHAL AS,MEISSNER HC,et al. Clinical practice guideline:the diagnosis,management,and prevention of bronchiolitis[J]. Pediatrics,2014,134(5):e1474-e1502.
[9]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识(2018年修订版)[J].临床儿科杂志,2018,36(2):95-107.
[10]洪建国,陈强,陈志敏,等.儿童常见呼吸道疾病雾化吸入治疗专家共识[J].中国实用儿科杂志,2012,27(4):265-269.
[11]王卫平.儿科学[M].第8版.北京:人民卫生出版社,2013:269.
[12]贺海珊,邱雪雁,刘阿玲,等.我院中重度毛细支气管炎患儿主要治疗药物的使用情况调查及合理性评价[J].中国药房,2018,29(14):1988-1991.
[13]冯柱兴,李欣其,李桥蓉.痰热清注射液结合西医常规疗法治疗小儿毛细支气管炎临床研究[J].国际中医中药杂志,2016, 38(6):515.
[14] ZEIGER RS,MAUGER D,BACHARIER LB,et al. Daily or intermittentbudesonide in Preschool children with recurrent wheezing[J]. N Engl J Med,2011,365(21):1990-2001.
[15]林立,李昌崇.“儿童社区获得性肺炎管理指南(2013修订)”解读[J].中华妇幼临床医学杂志:电子版,2014,10(6):728-732.
[16] NORRIS CL,O'NEAL PV,ADAMS ED,et al. Nasal Airway Clearance for Bronchiolitis[J]. MCN Am J Matern Child Nurs,2018,43(6):318-323.
[17]龚益,陈小东.白三烯调节剂在哮喘治疗中的应用[J].上海医药,2014,35(5):8-12.
[18]柳筱筱,张常科,张媛媛,等.干扰素雾化吸入在急性毛细支气管炎患者中的临床应用研究[J].甘肃科技,2018,34(18):130-131.
[19]马雪萍.布地奈德联合重组人干扰素α-2b雾化吸入治疗小儿毛细支气管炎的临床疗效分析[J].中国实用医药,2017,12(24):123-124.
[20]张乐.重组人干扰素α1b治疗急性毛细支气管炎患儿疗效分析[J].中国卫生标准管理,2018,9(18):78-80.