CAJ | 학술논문

目的本调查旨在了解目前非正归来源支气管哮喘(简称哮喘)药物的来源、传播及使用情况,分析其产生、存在的根源等相关因素,提出遏制非正规来源药物的建议.方法全部调查对象来源于2008年5月至2010年4月潍坊哮喘病医院的住院患者.通过调查问卷对患者的基本信息以及非正规渠道药物来源、是否接受过规范化治疗及终止原凶等相关因素进行全面、详细的询问调查;检测患者的皮质醇、骨密度,并对患者提供的非正规治疗药物进行高压液相、质谱-MR检测分析.结果 ①非正规来源治疗的患者状况:使用非正规来源药物的患者1 044例,占同期住院哮喘患者总人数的29.19%,年龄最大的78岁,最小的6岁.以农村居民(56.70%)、低文化程度(小学及以下文化程度38.60%)、无收入及低收入(71.45%)的为高.②非正规来源药物状况:其来源遍布全国各地,以河南最多,占70.01%,其次是河北、山东、北京、山西等.购药渠道有邮购、乡村诊所、集市等.其信息来源主要为患者介绍、乡医推荐、广告宦传.药物性状以胶囊为主;其名称多有功能提示,外包装上有纯中药、祖传秘方等字样.药物文号:有假药准字号、假药制字号、卫健字号……以及什么都没有的科研用药等;药物价格最低每月18元,多数每月100元以下,占78.16%,但也有个别药物1包药价格数千元;从药物成分看几乎所有药物均含有糖皮质激素,相当于强的松10～40 mg/d.③用药后的不良反应包括体质量增加、多毛、皮肤紫纹、痤疮、高血压、糖尿病和骨折等.④皮质醇测定低于正常值的占85.44%;骨密度显示骨量减少的占67.72%.⑤既往接受规范治疗情况:有22.22%的患者曾经接受过规范治疗的患者,其中用过吸入糖皮质激素+长效β2受体激动剂的患者占17.16%.未坚持规范化治疗的原因包括:依次为价格太贵、担心激素不良反应、治疗无效、用起来麻烦,不习惯等.检查患者吸入用药的方法:完全正确的仅占12.07%.关于用药方法的学习途径:医护人员示教占曾经用药总人数的37.5%;其中仅有16.8%的患者由医护人员当场教会使用.结论导致哮喘的非规范来源药物的产生及存在根源的原冈是多方面的,危害也非常大.杜绝非正规来源药物的制造、销售和传播,需要医师、患者和政府多方面的努力. 目的本調查旨在瞭解目前非正歸來源支氣管哮喘(簡稱哮喘)藥物的來源、傳播及使用情況,分析其產生、存在的根源等相關因素,提齣遏製非正規來源藥物的建議.方法全部調查對象來源于2008年5月至2010年4月濰坊哮喘病醫院的住院患者.通過調查問捲對患者的基本信息以及非正規渠道藥物來源、是否接受過規範化治療及終止原兇等相關因素進行全麵、詳細的詢問調查;檢測患者的皮質醇、骨密度,併對患者提供的非正規治療藥物進行高壓液相、質譜-MR檢測分析.結果 ①非正規來源治療的患者狀況:使用非正規來源藥物的患者1 044例,佔同期住院哮喘患者總人數的29.19%,年齡最大的78歲,最小的6歲.以農村居民(56.70%)、低文化程度(小學及以下文化程度38.60%)、無收入及低收入(71.45%)的為高.②非正規來源藥物狀況:其來源遍佈全國各地,以河南最多,佔70.01%,其次是河北、山東、北京、山西等.購藥渠道有郵購、鄉村診所、集市等.其信息來源主要為患者介紹、鄉醫推薦、廣告宦傳.藥物性狀以膠囊為主;其名稱多有功能提示,外包裝上有純中藥、祖傳祕方等字樣.藥物文號:有假藥準字號、假藥製字號、衛健字號……以及什麽都沒有的科研用藥等;藥物價格最低每月18元,多數每月100元以下,佔78.16%,但也有箇彆藥物1包藥價格數韆元;從藥物成分看幾乎所有藥物均含有糖皮質激素,相噹于彊的鬆10～40 mg/d.③用藥後的不良反應包括體質量增加、多毛、皮膚紫紋、痤瘡、高血壓、糖尿病和骨摺等.④皮質醇測定低于正常值的佔85.44%;骨密度顯示骨量減少的佔67.72%.⑤既往接受規範治療情況:有22.22%的患者曾經接受過規範治療的患者,其中用過吸入糖皮質激素+長效β2受體激動劑的患者佔17.16%.未堅持規範化治療的原因包括:依次為價格太貴、擔心激素不良反應、治療無效、用起來痳煩,不習慣等.檢查患者吸入用藥的方法:完全正確的僅佔12.07%.關于用藥方法的學習途徑:醫護人員示教佔曾經用藥總人數的37.5%;其中僅有16.8%的患者由醫護人員噹場教會使用.結論導緻哮喘的非規範來源藥物的產生及存在根源的原岡是多方麵的,危害也非常大.杜絕非正規來源藥物的製造、銷售和傳播,需要醫師、患者和政府多方麵的努力.
목적 본조사지재료해목전비정귀래원지기관효천(간칭효천)약물적래원、전파급사용정황,분석기산생、존재적근원등상관인소,제출알제비정규래원약물적건의.방법 전부조사대상래원우2008년5월지2010년4월유방효천병의원적주원환자.통과조사문권대환자적기본신식이급비정규거도약물래원、시부접수과규범화치료급종지원흉등상관인소진행전면、상세적순문조사;검측환자적피질순、골밀도,병대환자제공적비정규치료약물진행고압액상、질보-MR검측분석.결과 ①비정규래원치료적환자상황:사용비정규래원약물적환자1 044례,점동기주원효천환자총인수적29.19%,년령최대적78세,최소적6세.이농촌거민(56.70%)、저문화정도(소학급이하문화정도38.60%)、무수입급저수입(71.45%)적위고.②비정규래원약물상황:기래원편포전국각지,이하남최다,점70.01%,기차시하북、산동、북경、산서등.구약거도유유구、향촌진소、집시등.기신식래원주요위환자개소、향의추천、엄고환전.약물성상이효낭위주;기명칭다유공능제시,외포장상유순중약、조전비방등자양.약물문호:유가약준자호、가약제자호、위건자호……이급십요도몰유적과연용약등;약물개격최저매월18원,다수매월100원이하,점78.16%,단야유개별약물1포약개격수천원;종약물성분간궤호소유약물균함유당피질격소,상당우강적송10～40 mg/d.③용약후적불량반응포괄체질량증가、다모、피부자문、좌창、고혈압、당뇨병화골절등.④피질순측정저우정상치적점85.44%;골밀도현시골량감소적점67.72%.⑤기왕접수규범치료정황:유22.22%적환자증경접수과규범치료적환자,기중용과흡입당피질격소+장효β2수체격동제적환자점17.16%.미견지규범화치료적원인포괄:의차위개격태귀、담심격소불량반응、치료무효、용기래마번,불습관등.검사환자흡입용약적방법:완전정학적부점12.07%.관우용약방법적학습도경:의호인원시교점증경용약총인수적37.5%;기중부유16.8%적환자유의호인원당장교회사용.결론 도치효천적비규범래원약물적산생급존재근원적원강시다방면적,위해야비상대.두절비정규래원약물적제조、소수화전파,수요의사、환자화정부다방면적노력.
Objective To investigate the sources, transmission and use of non-conformal bronchial asthma (asthma) drugs, analyze the related factors of the causes and existences, and put forward some suggestions to restrain the use of these drugs. Methods Patients treated in Weifang Asthma Hospital from May 2008 to April 2010 were investigated about their sources of non-formal drugs, history of accepting standard treatment, termination reasons and so on by the questionnaire interview. The xamination items on these patients included plasmatic cortisol (COR), bone mineral density (BMD) , and composition of the drugs by high pressure liquid chromatograph (HPLC) and MR spectroscopy (MRS). Results ①The situations of patients treated with non-formal drugs: 1 044 patients have accepted nonformal asthma drugs, making up 29. 19% of total inpatients in the orresponding period, while the oldest patients were 78 years old and the youngest were 6 years old. Most of these patients were rural residents (56.70%), low education level (primary educational and lower were 38.60%), no income and lowincome (accounting for 71. 45%). ②Status of non-formal drugs:the non-formal drug came from different regions of China, but predominantly from Henan province (accounting for 70.01%), and then Hebei province, Shandong province, Beijing, and Shanxi province etc. Drugs were bought by mail or in country clinics and country markeplaces, and the news were got from other patients, some country doctors or the advertising. Most of the drug were made into capsule, and the name were related to the function which were marked "Pure Chinese Medicine" or "Home Remedy " and so on. Reference Numbe：some of the drugs had fake qualifies for health-tax credit and non marked. These drugs were different in price, with the lowest medicine fee 18 yuan every month, and most of them were less than 100 yuan every month (accounting for 78.1%), but some individual drugs were expensive and attained thousands yuan per package. Most of these drugs contained Glucocorticoids, that is to say, one should eat 10 to 40 mg prednisone one day. ③ The adverse reaction of these drugs involved fat, hirsutism, purple lines,hypertension, diabetes, fractures and so on. ④The results of COR and BMD were lower than the nomal,which were 85. 44% and 67.72% , respectively. ⑤History of accepting standard treatment:22. 22% of all the subject had tried standard treatment, 17.16% of which had used ICS+LABA. The reasons of patients abandoned standard treatment were in sequence of the high drug price, fearing for side effects of hormone,ineffective treatment, and non-convenient etc. The correct methods of inhalation: 12.07% of the patients can use the drug correctly. How to get the correct methods of inhalation: 37.5% of the patients learned the correct method from doctors or nurses-only 16.8% of them learned how to use the drug from doctors or nurses when they were buying it. Conclusions There are various reasons for the causes and existences of the non-formal drugs which do harm to the public. It is necenssary for doctors,patients, and the government to make efforts to prevent the manufacture, sale and transmission of nonformal drugs.