2019 年第 8 期 第 14 卷

镇痛药物地佐辛的临床应用调查分析与合理用药评价

Analysis of clinical application of dezocine for rational medication

作者：唐辉吴楠张薇王哲刁瑞刚侯宁

英文作者：

单位：250021济南，山东大学附属省立医院药学部（唐辉、张薇、侯宁）；210009南京医科大学附属肿瘤医院江苏省肿瘤医院药学部江苏省肿瘤防治研究所（吴楠）；250000济南，解放军第九六○医院药学部（王哲）；264100烟台毓璜顶医院药学部（刁瑞刚）

英文单位：

关键词：合理用药；地佐辛；用药评价；疼痛评估

英文关键词：

• 摘要：

• 【摘要】目的    对镇痛药地佐辛注射液的临床应用情况进行调查分析并进行合理用药评价，为安全规范使用该类药物提出对策。方法    应用医院管理信息系统回顾性分析山东大学附属省立医院2017年1月1日至12月31日住院应用地佐辛患者的临床资料和用药基本情况，临床资料包括性别、年龄、住院时间、住院科室、是否手术和术式，用药基本情况包括地佐辛的用药频次、给药途径和超剂量给药情况以及用药时间。选择地佐辛用量排名前10名的科室，每个科室随机选择200例患者，对纳入的2 000例患者地佐辛用药适应证、用药前疼痛评估和肝、肾功能不全情况进行合理用药评价。结果    2017年1月1日至12月31日住院应用地佐辛患者共27 091例，男16 173例、女10 918,平均年龄（47±14）岁，年龄分布主要集中在40~69岁(66.40%)。非手术患者用药3 124例；采用口服、外用、皮下注射等非说明书规定的其他途径给药147例（0.54%）；超剂量给药20例（0.07%），其中，肌内注射单剂量超过20 mg者4例、静脉给药单剂量超过10 mg者16例；用药时间>7 d者4 118例（15.20%），其中1例患者用药时间最长，达49 d。地佐辛用量前10名科室抽取的2 000例患者中1 008例（50.40%）患者未进行疼痛评估，肝功能不全422例（21.10%）和肾功能不全177例（8.85%）患者均未进行剂量减量调整。结论    山东大学附属省立医院在镇痛药物地佐辛应用中存在非手术患者用药、非说明书规定的其他途径给药、超剂量超时间给药、用药前未进行疼痛评估以及肝、肾功能不全者未进行减量调整等不合理用药现象。针对不合理用药应及时采取科学用药管理策略，规范医师处方，积极推进患者疼痛评估；发挥药师作用，严格审方流程，加强与临床沟通协作，评估用药方案，提高合理用药水平，避免药源性疾病发生。

• 【Abstract】Objective    To investigate the clinical application of dezocine injection for rational drug use. Methods    Clinical records of inpatients who were treated with dezocine in Shandong Provincial Hospital Affiliated to Shandong University from January 1st, 2017 to December 31st were analyzed retrospectively by the hospital management information system. General data including sex, age, hospitalization time, department and surgical procedures, and frequency, route, dosage and duration of dezocine were recorded. Two thousand patients were selected from the top 10 departments using dezocine, with 200 patients in each department; the indications, pre-medication pain assessment and doses of dezocine in patients with hepatic and renal insufficiency were analyzed. Results    A total of 27 091 inpatients were treated with dezocine injection between January 1st, 2017 and December 31st, including 16 173 males and 10 918 females. The mean age was (47±14)years. Majority(66.40%) of patients distributed in the age group of 40-69 years. There were 3 124 cases of non-surgical patients; 147 patients(0.54%) were treated by oral, external, subcutaneous injection and other off-label routes. In 20 patients(0.07%) with overdose medication, single dose of intramuscular injection was more than 20 mg in 4 cases, and intravenous single dose was more than 10 mg in 16 cases. A total of 4 118 patients(15.20%) were continuously treated by dezocine for more than 7 days; 1 patient was treated for 49 days. One thousand and eight（50.40%） in 2 000 patients from the top 10 departments in total dosage rank of dezocine had no pain assessment before medication. Patients with liver dysfunction(422 cases, 21.10%) or renal insufficiency(177 cases, 8.85%) did not receive dose reduction adjustment. Conclusions    Irrational use of dezocine included medication for non-surgical patients, off-label routes, overdose and overtime administration, no pain assessment before medication and no adjustment for liver and renal insufficiency patients in Shandong Provincial Hospital Affiliated to Shandong University. It is necessary to adopt scientific medication management strategies, standardize prescriptions and promote pre-medication pain assessment. Pharmacists need to strictly check and approve the prescriptions of dezocine, work with clinicians to improve rational drug use.