华西医学

华西医学

2013 年—2017 年我国六市口服抗凝药在呼吸系统疾病中的应用情况分析

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目的 了解 2013 年—2017 年北京、广州、上海、成都、沈阳、郑州 6 个城市 72 所医院口服抗凝药在呼吸系统疾病中的应用现状及发展趋势。 方法 通过各医院信息系统,2013 年 1 月—2017 年 12 月对北京、广州、上海、成都、沈阳、郑州 6 个城市各 12 所医院每季度随机抽取 10 个工作日的门诊处方及住院医嘱的电子信息,汇总后纳入《医院处方分析项目》处方数据库。筛选出使用了口服抗凝药的处方,再通过人工筛选将诊断中有呼吸系统疾病相关诊断的处方提取出来作为研究对象。以用药金额、处方数量、处方日剂量(prescribed daily dose,PDD)、限定日剂量(defined daily dose,DDD)对口服抗凝药物在呼吸系统疾病中应用情况进行统计分析。 结果 2013 年—2017 年,在呼吸系统相关疾病中,华法林钠处方数量依次为 4 769、5 747、7 549、7 261、7 151 张,虽一直排列第一,但自 2015 年后逐年降低,华法林钠用药金额构成比从 2013 年的 32.52% 逐年降低至 2017 年的 5.03%。新型口服抗凝药在 5 年间处方数量构成比及用药金额构成比均逐年升高。华法林钠、达比加群酯、利伐沙班、阿哌沙班 PDD/DDD 分别为 0.41、0.73、0.68、0.33。存在超说明书适应证及禁忌证使用的情况。 结论 我国上述 6 个城市 72 所医院口服抗凝药物 5 年间处方数量构成比仍以华法林为主,临床医生在制定药物治疗方案时充分考虑用药安全、有效、经济性后作出了综合判断。

Objective To realize the application status and development trend of oral anticoagulant drugs used in respiratory diseases in 72 hospitals in 6 cities from the year 2013 to 2017. Methods From January 2013 to December 2017, we randomly selected the electronic information from 10 working days per quarter in 6 cities including Beijing, Guangzhou, Shanghai, Chengdu, Shenyang, and Zhengzhou, with 12 hospitals in each city, and summarized the information into the prescription database of the hospital prescription analysis project. Through the hospital information system, we screened out the information of outpatient prescriptions and inpatient medical records which used oral anticoagulants. The prescriptions with respiratory diseases related-diagnosis were selected as the research objects by manual screening. The application of oral anticoagulant drugs used in respiratory diseases was statistically analyzed by drug amount, prescription amount, prescribed daily dose (PDD), and defined daily dose (DDD). Results From 2013 to 2017, the number of warfarin sodium prescriptions was successively 4 769, 5 747, 7 549, 7 261, and 7 151, which had been always ranked the first in the five years, but decreased year by year since 2015. The proportion of warfarin sodium drug use amount decreased year by year from 32.52% in 2013 to 5.03% in 2017. The proportion of prescription and drug consumption sum of new oral anticoagulants increased year by year in the past five years. The PDD/DDD of warfarin sodium, dabigatran etexilate, rivaroxaban, and apixaban were 0.41, 0.73, 0.68, and 0.33, respectively. There were off lable use of new oral anticoagulants. Conclusions Warfarin still dominates the proportion of oral anticoagulants prescribed in the 72 hospitals in the 6 cities in the five years. The clinicians have made a comprehensive judgment after fully considering the safety, effectiveness, and economy of drug use when formulating drug treatment programs.

关键词: 口服抗凝药; 用药金额; 处方数量; 处方日剂量; 限定日剂量

Key words: Oral anticoagulant; Drug consumption sum; Number of prescription; Prescribed daily dose; Defined daily dose

引用本文: 张静怡, 徐珽, 秦舟, 吴斌, 严郁. 2013 年—2017 年我国六市口服抗凝药在呼吸系统疾病中的应用情况分析. 华西医学, 2019, 34(1): 22-29. doi: 10.7507/1002-0179.201812077 复制

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