抗高血压药物在某医院的应用及典型药物有效性和安全性的Meta分析

发布时间：2018-01-17 23:31

本文关键词：抗高血压药物在某医院的应用及典型药物有效性和安全性的Meta分析　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的本研究旨在通过了解山西省太原市某三甲医院门诊7类口服抗高血压药物应用情况；以及抗高血压药物钙通道阻滞剂中典型药物左旋氨氯地平和氨氯地平的有效性和安全性进行系统性的评价，为临床用药提供经济、合理、安全、有效的依据。研究方法统计2012年高血压处方，以药品通用名为依据进行分类汇总，采用Microsoft excel软件，对2012年1月至12月抗高血压药物种类、数量、金额总数进行统计并排序，计算各种类所占的比例。计算机检索外文Pubmed数据库，中文数据库中的万方数据库、中国知识资源总库（CNKI）、维普数据库（VIP），对纳入比较抗高血压典型药物氨氯地平与左旋氨氯地平治疗高血压的随机对照试验（RCT），并对研究方法学进行质量评价，应用ReMan4.2软件进行统计分析。研究结果（1）统计该医院7类抗高血压药物销售金额，以CCB、ARB、β-RB销售金额分别位居一、二、三位，利尿剂与a1受体阻滞剂的利用相对较少。（2）统计7类抗高血压药物的DDDs值，钙拮抗剂与其他抗高血压药物应用频度相比更高，提示抗高血压药物中以钙拮抗剂使用频数最大。（3）DDDs排列前10名的抗高血压药物中以钙通道阻滞剂占主导地位，其中有左旋氨氯地平、硝苯地平、氨氯地平分别位于一、三、四位。（4）抗高血压药在《国家基本药物目录》与《山西省增补目录》的应用情况符合非基层医院基本药物使用金额比例以及卫生部的相关要求，并且覆盖品种数各有特色，没有重复品种。（5）在钙通道阻滞剂中，以DDC值比较低的硝苯地平缓释片和左旋氨氯地平，DDC值较高的进口药物氨氯地平的销售量大。CCB类合资药物DDC值比国产药物稍高，以长效及合资的药物DDDs值高。（6）药物的联合使用以两种药物联合应用为主，以CCB与ARB、CCB与β-RB、CCB与ACEI联用最多，，药物的联合应用以CCB为基础，其符合ESH/ESC高血压研究指南提出优势搭配组合的建议，同时也符合文献报道的应用最多的搭配组合。（7）文献检索，共纳入左旋氨氯地平与氨氯地平治疗高血压的随机对照试验（RCT），37项RCT，合计5297例患者。Meta分析结果表明，左旋氨氯地平和氨氯地平均能有效降低血压，总有效率OR＝0.82，95%CI（0.69，0.97），P＝0.02；但是24小时平均舒张压下降值合并效应量WMD＝-0.82，95%CI（-1.50，-0.14），P＝0.02；诊室收缩压下降值SMD＝－5.8，95%CI（－8.81，－1.75），P＝0.03；增加剂量人数合并效应量OR＝0.73，95%CI（0.54，0.99），P＝0.04；不良反应发生率OR＝0.36，95％CI（0.29，0.45），P＜0.00001；均有统计学意义。24小时平均收缩压下降值WMD＝0.24，95%CI（-0.40，0.88），P＝0.47，诊室舒张压下降值两组比较差异无统计学意义，合并效应量SMD＝-1.37，95％CI（－3.15，0.40），P＝0.13。结论（1）该医院应用抗高血压药物以CCB、ARB、β-RB的销售金额及DDDs排列前三。（2）抗高血压药物中基本药物的销售金额超过总销售抗高血压药物金额的25%至30%，该医院使用基本药品的量符合相关规定。（3）在DDDs值排前十的药物中，左旋氨氯地平、氨氯地平分别位于一、四位。 (4)药物的DDC值95%集中在0~6.99元之间，常用的抗高血压药物的价格主要集中在低中价位。 (5)药物联合应用以两种药物联合应用为主，三联、四联用药的处方比较少，联合用药以CCB为基础。 (6)药物联合应用符合ESH／ESC高血压研究指南提出优势搭配组合的建议，同时也符合文献报道的应用最多的搭配组合。 (7)左旋氨氯地平治疗高血压的疗效优于氨氯地平，降低24小时动态舒张压、诊室收缩压的效果更好，不良反应更少；24小时收缩压的下降值在统计学上没有意义，但是在临床效果上左旋氨氯地平优于氨氯地平；在诊室舒张压下降值中2组比较没有统计学意义，临床效果也相当。综合来看，左旋氨氯地平效果较好。
[Abstract]:research objective
This study aims to understand the Shanxi city of Taiyuan province in a hospital outpatient 7 kinds of oral application of anti hypertension drugs; and to evaluate the efficacy and safety of antihypertensive drugs and calcium channel blockers in typical drug amlodipine and amlodipine system, for clinical use to provide economic, reasonable, safe and effective. On the basis of.
research method
The prescriptions of hypertension in 2012 were collected and classified according to the general name of drugs. The Microsoft Excel software was used to make statistics and sort the categories, amount and total amount of antihypertensive drugs from January 2012 to December, and calculate the proportion of all kinds of drugs.
Computer retrieval of foreign Chinese database in Pubmed database, Wanfang database, Chinese knowledge resources database (CNKI), VIP database (VIP), randomized controlled trials of antihypertensive drugs included in the comparison of typical amlodipine and amlodipine in the treatment of hypertension (RCT), and the research methodology to evaluate the quality of the application ReMan4.2 software was used for statistical analysis.
Research results
(1) the sales volume of 7 kinds of antihypertensive drugs in the hospital was counted. The sales amount of CCB, ARB, and beta -RB ranked two, three, respectively, and the utilization of diuretics and A1 receptor blockers was relatively small.
(2) statistics of the DDDs values of the 7 kinds of antihypertensive drugs. Calcium antagonists and other antihypertensive drugs have higher application frequency, suggesting that the frequency of calcium antagonists is the largest among antihypertensive drugs.
(3) calcium channel blockers dominate the top 10 antihypertensive drugs in DDDs. Among them, Levamlodipine, nifedipine and amlodipine are at three, four respectively.
(4) the application of antihypertensive drugs in the national essential drug list and the Shanxi supplementary catalogue is in line with the proportion of essential drugs used in non basic hospitals and the relevant requirements of the Ministry of health, and the number of varieties covered with different characteristics is not repeated.
(5) in calcium channel blockers, the DDC value of Extended Release Nifedipine Tablets and Levamlodipine were relatively low, the sales of amlodipine with high DDC value and the DDC value of.CCB class joint drugs were slightly higher than those of domestic drugs, and the DDDs value of long-acting and joint venture drugs was high.
(6) the combined use of drugs in the two drug combination, with CCB and ARB, CCB and beta -RB, CCB and ACEI together with the highest combined use of drugs based on CCB, which conforms to the ESH/ESC hypertension research guide presents advantages of collocation suggestions, but also meet the application reported combination up the collocation.
(7) literature retrieval, randomized controlled trials of amlodipine and amlodipine in the treatment of hypertension were included (RCT), 37 RCT, a total of 5297 cases of patients with the results of.Meta analysis showed that amlodipine and amlodipine can effectively reduce blood pressure, the total efficiency of OR = 0.82,95%CI (0.69,0.97, P) = 0.02; but 24 hours average diastolic blood pressure decreased the value of the combined effect of the amount of WMD = -0.82,95%CI (-1.50, -0.14), P = 0.02; consulting room systolic blood pressure decreased value of SMD = 5.8,95%CI (- 8.81, - 1.75), P = 0.03; increase the number of doses of the combined effect of the amount of OR (0.54,0.99) = 0.73,95%CI, P = 0.04 the incidence of adverse reaction; OR = 0.36,95%CI (0.29,0.45), P < 0.00001; there was statistically significant.24 hour average systolic blood pressure decreased value of WMD = 0.24,95%CI (-0.40,0.88), P = 0.47, the consulting room decreased diastolic blood pressure values of the two groups were not statistically significant, the combined effect of the amount of SMD (= -1.37,95%CI 3.15,0.40), P = 0.13.
conclusion
(1) the hospital used antihypertensive drugs for the sales of CCB, ARB, beta -RB and the top three of the DDDs arrangement.
(2) the sales amount of essential drugs in antihypertensive drugs is over 25% to 30% of the total sales of antihypertensive drugs. The amount of essential medicines in the hospital is in conformity with the relevant provisions.
(3) among the ten drugs before the DDDs value, levoamlodipine and amlodipine were one, four, respectively.
(4) the DDC value 95% of the drug is concentrated between the 0~6.99 yuan, and the price of the commonly used antihypertensive drugs is mainly concentrated in the low middle price.
(5) the combination of drugs is mainly used in combination with two kinds of drugs, and the prescription of the combination of the four drugs is relatively small, and the combination of the drugs is based on the CCB.
(6) the combination of ESH / ESC hypertension research guidelines, which conforms to the most applied combination of the literature.
(7) amlodipine in the treatment of hypertension efficacy than amlodipine, reduce 24 hour ambulatory diastolic blood pressure, systolic blood pressure of the consulting room is better, less adverse reaction decreased; 24 hour systolic blood pressure values were not statistically significant, but the levo amlodipine is better than amlodipine in the clinical effect in the consulting room; diastolic blood pressure decreased values in the 2 groups was not statistically significant, the clinical effect is quite good. Overall, s-amlodipine effect.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R954

【参考文献】