应用研究
临床药师参与我院部分质子泵抑制剂药物点评分析
蒋 勇 陈 喜*
【摘要】 目的 对我院注射用雷贝拉唑钠进行专项医嘱点评，减少注射用雷贝拉唑钠的滥用现象，为促进临床合理使用提供依据，进一步完善我院重点监控药物的管理。方法 通过临床合理用药软件系统（PASS系统）抽取2021年11月使用注射用雷贝拉唑钠的住院患者病例，依据相关指南和药物说明书进行点评。
【关键字】 合理用药,质子泵抑制剂,医嘱点评,不合理医嘱
中图分类号：文献标识码：文章编号：
[Abstract] Objective To make comments on special medical orders of rabeprazole sodium for injection, reduce its abuse, provide the basis for its rational use, and further improve the management of key monitoring drugs in our hospital. Methods Prescription automatic screening system (PASS) for clinical rational drug use was adopted to select the inpatients who received rabeprazole sodium for injection in November 2021, and comments were made in accordance with related guides and drug instructions. Results Among the 140 cases chosen in the system, there were 39 (27.86%) cases with irrational medical orders. The main reasons of these irrational medical orders were inappropriate indications and improper usage and dosage, which accounted for 74.36% and 35.90% of these irrational medical orders, respectively. Conclusion Through making comments on medical orders, this study found that there was irrational use of rabeprazole sodium for injection in our hospital. Therefore, it is necessary to further strengthen supervision. Clinical pharmacists should perform effective intervention for irrational medical orders. In addition, the criteria for comments should also be timely updated according to evidence-based medicine. Meanwhile, clinical pharmacists should perfect their work methods and transform their primary post-evaluation work pattern gradually into pre-prescription review one, so as to decrease the incidence rate of irrational medical orders.
雷贝拉唑属于新一代的质子泵抑制剂类药物，临床上主要用来治疗慢性胃炎、胃食管返流、消化性溃疡等胃酸相关性疾病。从药理作用上看，雷贝他唑能抑制胃酸分泌的作用和抗幽门螺旋杆菌作用都优于其他的质子泵抑制剂，且起效迅速[1-3]。注射用雷贝拉唑钠是用于胃或者十二指肠溃疡出血的不能口服的患者。随着雷贝拉唑被广泛运用于临床，其不合理应用的问题也日益突出。药物的不合理使用不仅会影响药物疗效，而且会造成该药物引起的药物不良反应[4]。自我院开展重点监控药物专项医嘱点评工作以来，发现2021年11月注射用雷贝拉唑钠的使用量较上月相比呈明显上升趋势，且国家医保局规范了注射用雷贝拉唑的限定支付范围：只有禁食医嘱和吞咽困难的患者使用注射用雷贝拉唑钠才予以报销支付，对临床使用注射用雷贝拉唑钠加强了监管。为了防止注射用雷贝拉唑钠的滥用，将我院2021年11月注射用雷贝拉唑钠的使用情况进行专项点评分析，总结其用药特点，为临床合理应用提供依据。
1 资料与方法
1.1一般资料 通过临床合理用药系统（PASS系统），临床药师采用回顾性分析法，抽取了2021年11月全院使用注射用雷贝拉唑钠的住院患者病历一共140份，进行专项医嘱点评分析。
1.2方法 根据《临床用药须知》、《医院处方点评管理规范》、《质子泵抑制剂临床应用指导原则（2020年版）》、与注射用雷贝拉唑钠相关文献资[5-6]以及注射用雷贝拉唑钠的药物说明书等，制定我院注射用雷贝拉唑钠的使用评价标准。主要评价内容包括雷贝拉唑钠的适应证、溶媒、用药剂量、用药疗程、配伍情况等。具体见表1。