质子泵抑制剂临床合理应用的探讨

发布时间：2018-03-15 12:43

本文选题：质子泵抑制剂　切入点：不良反应　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.分析总结质子泵抑制剂的不合理使用情况及不良反应;2.制定质子泵抑制剂评价标准;3.调查该院质子泵抑制剂的使用情况,依据质子泵抑制剂评价标准,分析评价质子泵抑制剂临床应用的合理性;4.制定该院质子泵抑制剂推荐使用建议,促进临床质子泵抑制剂的合理应用。方法:1.通过查阅中国知网、万方数据库、维普数据库、pubmed、web of science等数据库,以质子泵抑制剂、质子泵抑制剂的不良反应、质子泵抑制剂的合理应用等检索词进行检索,根据查阅的文献分析总结质子泵抑制剂的不合理使用现象,使用过程中发生的不良反应;2.通过查阅相关文献、药品说明书等相关资料,制定质子泵抑制剂的评价标准;3.采用回顾性调查研究的方法,随机抽取该院2015年1月-2016年3月内使用质子泵抑制剂的若干患者,分析评价质子泵抑制剂应用的合理性;4.依据该院质子泵抑制剂的使用情况,制定质子泵抑制剂的内院推荐使用建议。结果:1.经分析总结,质子泵抑制剂存在超剂量、超疗程、给药频次不合理、无用药指征用药等不合理应用的现象,且在使用过程中,常见不良反应与长期使用潜在的不良反应的发生均较多。2.调查研究中,随机抽取的2805例患者中静脉给药1241(44.20%),口服给药1564(55.80%)。2805例中治疗用药232例(8.27%)均有十二指肠溃疡,上消化道出血,胃溃疡等明确用药指征;预防性用药2179例(77.68%),其中1092例(50.11%)为推荐用药指征,1087例(49.89%)为无用药指征;394例(14.05%)无明确用药目的亦及无用药指征。质子泵抑制剂使用剂量、疗程、频次不合理率较低,超疗程使用主要为注射制剂。抽取的患者中有适应症用药的248例(8.84%),非适应症用药的2557例(91.16%),影响质子泵抑制剂应用趋势的因素有8个。结论:抽取的患者中静脉给药与口服给药几乎各占一半;质子泵抑制剂预防应激性溃疡的使用率高于治疗用药,且预防应激性溃疡方面无用药指征率高;无适应症使用现象较为严重,非适应症与适应症用药率的比例约为10.0:1.0。质子泵抑制剂不合理应用将增加不良反应的发生率与患者的医疗费用,临床医师与临床药师应重视质子泵抑制剂的常见与长期使用潜在的不良反应,依据质子泵抑制剂推荐使用建议,合理使用,减少因不合理使用而发生的不良反应。
[Abstract]:Objective: To summarize the 1. analysis of unreasonable use of proton pump inhibitors and adverse reactions; 2. developed proton pump inhibitor evaluation criteria; 3. to investigate the use of proton pump inhibitors, evaluation of proton pump inhibitors, analysis of the rationality of evaluation of clinical application of proton pump inhibitors; the 4. Hospital of proton pump inhibitor recommended suggestions to promote clinical rational use of proton pump inhibitors. Methods: 1. according to China CNKI, Wanfang database, VIP database, PubMed web, of science database, with a proton pump inhibitor, the adverse reaction of proton pump inhibitors, proton pump inhibitors, reasonable application of the retrieval words, according to the literature analysis is not reasonable the use of summary of proton pump inhibitors, the adverse reaction in the process of using; 2. through access to relevant literature, relevant information of drug instructions, making quality PPIs evaluation criteria; 3. by using the method of retrospective study, some patients using proton pump inhibitors were randomly selected in the hospital from January 2015 -2016 years in March, analysis of the rationality of the use of proton pump inhibitors in evaluation of the situation of the hospital; the use of proton pump inhibitors on the basis of 4., making the proton pump inhibitor of the inner court recommended the use of advice. Results: 1. after analyzing, there is a super dose of proton pump inhibitors, super treatment, frequency of administration is not reasonable, useless indication of drug medication unreasonable application, and in the use process, the occurrence of common adverse reactions and long-term use of potential adverse reactions were more.2. in the investigation and study, a random sample of 2805 patients in the intravenous administration of 1241 (44.20%), oral administration of 1564.2805 cases (55.80%) in the treatment of 232 cases (8.27%) had duodenal ulcer, upper gastrointestinal bleeding, gastric ulcer and other clear indications of medication; Preventive medication in 2179 cases (77.68%), of which 1092 cases (50.11%) as the recommended medication indications, 1087 cases (49.89%) for drug useless indication; 394 cases (14.05%) without a clear purpose of medication and drug indications also useless. Proton pump inhibitor dosage, course of treatment, the frequency of unreasonable rate is low, super use for injection. The main course of extraction in patients with 248 cases of disease to medication (8.84%), 2557 patients with non adaptive medication (91.16%), there are 8 factors influencing the use of proton pump inhibitors trend. Conclusion: extraction in patients with intravenous and oral administration of almost half of the proton; the use of pump inhibitors in prevention of stress ulcer was higher than that of treatment and prevention of stress ulcer with no indications of medication rate; no indications for the use of the phenomenon is more serious, non indications and indications of medication rate ratio is about 10.0:1.0. of proton pump inhibitors unreasonable application will increase the adverse reaction Clinicians and clinical pharmacists should pay attention to the potential adverse reactions of the common and long-term use of proton pump inhibitors. According to the recommended use of proton pump inhibitors, we should make rational use of them and reduce the adverse reactions due to unreasonable use.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R975

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