CAJ | 학술논문

目的：调查天津医科大学第二医院门诊抗高血压处方的用药情况，分析其与《中国高血压指南2010》（以下简称指南）的差距与不足，以期提高高血压控制率。方法回顾性调查2012年1-12月门诊抗高血压药电子处方154262例。统计患者常用降压药物及联合用药情况，并根据患者年龄、性别、高血压分级、科室、季节等进行分组，统计患者联合用药情况。结果（1）门诊最常用的降压药物为钙离子拮抗剂（52.3%），其后依次为血管紧张素Ⅱ受体拮抗剂（34.0%）、β受体阻滞剂（25.9%）、血管紧张素转换酶抑制剂（12.1%）、固定复方制剂（11.0%）、利尿剂（1.4%）。（2）门诊处方联合用药少于单药治疗（43.9%vs 56.1%），并且应用有指南不常规推荐用药方案（4.6%）。（3）分组分析显示3级高血压联合用药高于2级高血压、1级高血压（44.5%vs 37.7%vs 37.7%，P＜0.01）；心内科联合用药高于其他科室（均P＜0.01)；老年患者较非老年患者更趋向于联合用药（P＜0.01）；夏季处方数少于春、秋、冬季，但夏季患者联合用药率高于春、秋、冬季（均P＜0.01）。结论门诊抗高血压处方联合用药比例偏低，利尿剂使用不足，用药方案与指南要求存在一定差距，需适当增加利尿剂及联合用药比例。
목적：조사천진의과대학제이의원문진항고혈압처방적용약정황，분석기여《중국고혈압지남2010》（이하간칭지남）적차거여불족，이기제고고혈압공제솔。방법회고성조사2012년1-12월문진항고혈압약전자처방154262례。통계환자상용강압약물급연합용약정황，병근거환자년령、성별、고혈압분급、과실、계절등진행분조，통계환자연합용약정황。결과（1）문진최상용적강압약물위개리자길항제（52.3%），기후의차위혈관긴장소Ⅱ수체길항제（34.0%）、β수체조체제（25.9%）、혈관긴장소전환매억제제（12.1%）、고정복방제제（11.0%）、이뇨제（1.4%）。（2）문진처방연합용약소우단약치료（43.9%vs 56.1%），병차응용유지남불상규추천용약방안（4.6%）。（3）분조분석현시3급고혈압연합용약고우2급고혈압、1급고혈압（44.5%vs 37.7%vs 37.7%，P＜0.01）；심내과연합용약고우기타과실（균P＜0.01)；노년환자교비노년환자경추향우연합용약（P＜0.01）；하계처방수소우춘、추、동계，단하계환자연합용약솔고우춘、추、동계（균P＜0.01）。결론문진항고혈압처방연합용약비례편저，이뇨제사용불족，용약방안여지남요구존재일정차거，수괄당증가이뇨제급연합용약비례。
Objective To investigate the pattern of antihypertensive medication prescribing in outpatients from the Second Hospital of Tianjin Medical University, and analyze the shortcoming and deficiency compared with" 2010 Chinese guidelines for the management of hypertension". Methods A total of 154 262 electronic prescribing for outpatients with hy-pertension, from January-December 2012 in a Grade 3A hospital in Tianjin, were enrolled in this retrospective survey. Data of commonly used antihypertensive medication and combination therapy in patients were analyzed. The patient data collected were divided into different groups according to age, gender, high blood pressure level and the onset of the season. Results (1)The list of the drugs commonly used for treating hypertension in outpatients were calcium antagonist (52.3%), angiotensin receptor blockers (34.0%),βblockers (25.9%), angiotensin-converting enzyme inhibitors (12.1%), fixed-dose combination (11.0%) and diuretics (1.4%).(2)The fewer combination therapy was found in outpatients than that of monotherapy (43.9%vs 56.1%). Some prescriptions were not routinely recommended by the Guideline (4.6%).(3)The combination therapy used in patients with stage 3 hypertension was higher than that of patients with stage 1or stage 2 hypertension (44.5%vs 37.7%vs 37.7%, P<0.01). The rate of combination therapy was significantly higher in cardiology department than that of other clini-cal departments (P<0.01). The combination therapy tended to be used in the elderly patients than that of non-elderly pa-tients (P<0.01). The number of prescriptions was lower in summer than that of other seasons,but the rate of combination therapy was higher in summer than that of spring, autumn and winter (P<0.01). Conclusion The prescriptions of combina-tion therapy and diuretic were inadequate in outpatients with hypertension. These findings indicate the difference between clinical prescription and the guideline for the management of hypertension.