CAJ | 학술논문

目的评价首都医科大学宣武医院老年脑梗死住院患者治疗用药的合理性。方法收集2011年1月1日至12月31日我院60岁及以上老年脑梗死住院患者的病历资料，描述性分析患者一般情况，计算每种药物的药物利用指数（DUI）、限定日剂量的费用（DDC）、人日均费用。检索国内外公开发表的与脑梗死有关的诊疗指南，并将我院老年脑梗死患者用药情况与中国指南对比，分析其合理性。结果共收集到老年脑梗死住院患者430例，其中男272例，女158例；年龄为60~92岁，平均（71±7）岁。平均患病种数为5.4种，住院期间共用药物243种，平均用药种数为17种。共检索到美国、日本、中国、南非、新西兰、英国、欧洲、巴西发表的8个与脑梗死相关的诊疗指南。这些指南中涉及的药物有溶栓药、抗血小板药、抗凝药、降纤药、扩容药、扩血管药和神经保护药共7类。中国指南推荐的治疗药物有3类，分别是溶栓药、抗血小板药和降纤药，其中有2类4种在我院使用，分别是阿替普酶、尤瑞克林、阿司匹林、氯吡格雷，其 DUI 值分别为1.0、1.2、1.2、1.2。我院老年脑梗死患者用药涉及神经保护药13种，所需费用1782343.6元，占药费总和4599576.7元的38.75%，是指南推荐用药费用103779.7元的17倍。结论我院老年脑梗死住院患者治疗用药与指南推荐用药一致性高，但是非指南推荐的神经保护药使用数量过多、费用过高，需进一步规范。
목적평개수도의과대학선무의원노년뇌경사주원환자치료용약적합이성。방법수집2011년1월1일지12월31일아원60세급이상노년뇌경사주원환자적병력자료，묘술성분석환자일반정황，계산매충약물적약물이용지수（DUI）、한정일제량적비용（DDC）、인일균비용。검색국내외공개발표적여뇌경사유관적진료지남，병장아원노년뇌경사환자용약정황여중국지남대비，분석기합이성。결과공수집도노년뇌경사주원환자430례，기중남272례，녀158례；년령위60~92세，평균（71±7）세。평균환병충수위5.4충，주원기간공용약물243충，평균용약충수위17충。공검색도미국、일본、중국、남비、신서란、영국、구주、파서발표적8개여뇌경사상관적진료지남。저사지남중섭급적약물유용전약、항혈소판약、항응약、강섬약、확용약、확혈관약화신경보호약공7류。중국지남추천적치료약물유3류，분별시용전약、항혈소판약화강섬약，기중유2류4충재아원사용，분별시아체보매、우서극림、아사필림、록필격뢰，기 DUI 치분별위1.0、1.2、1.2、1.2。아원노년뇌경사환자용약섭급신경보호약13충，소수비용1782343.6원，점약비총화4599576.7원적38.75%，시지남추천용약비용103779.7원적17배。결론아원노년뇌경사주원환자치료용약여지남추천용약일치성고，단시비지남추천적신경보호약사용수량과다、비용과고，수진일보규범。
Objective To evaluate rationality of drug application in aged inpatients with brain infarction in Xuanwu Hospital of Capital Medical University. Methods Medication records of ≥60 years old inpatients with brain infarction from january 1st,2011 to December 31st in our hospital were collected. The patients' general information was descriptively analyzed and drug utilization index(DUI),defined daily cost(DDC),and an average daily cost of each patient were calculated. Published guidelines in our country and abroad were searched and the therapeutic drugs used in aged inpatients with brain infarction in our hospital were compared with recommended drugs in Chinese guideline,and the rationality of drug use in our hospital was evaluated. Results Data of a total of 430 patients were collected. Of them,272 patients were male and 158 were female. The age of the patients was from 60 to 92 years and an average age was (71 ± 7)years. The average number of diseases in each patient was 5. 4. A total of 243 kinds of drugs were used during hospitalization and an average number of kinds of drugs in each patient was 17. A total of 8 guidelines related to brain infarction published in USA,japan,China,South Africa,New Zealand,United Kindom,Europe,and Brazil were searched. There were 7 kinds of drugs in the above mentioned guidelines, including thrombolytic drugs,antiplatelet drugs,anticoagulation drugs,antifibrinolytic drugs,volume extending drugs,drugs for vasodilation,and neuroprotective drugs. The Chinese guideline recommended 3 kinds of drugs,including thrombolytic,antiplatelet,and antifibrinolytic drugs. Of them,4 drugs in 2 kinds were used in our hospital,including alteplase( rt-PA),urinary kallidinogenase,aspirin,and clopidogrel and their DUI were 1. 0,1. 2,1. 2,and 1. 2,respectively. Thirteen kinds of neuroprotective drugs were used in aged inpatients with brain infarction in our hospital,whose cost accounted for 38. 75%(1 782 343. 6 / 4 599 576. 7)of total medication cost,which was 17 times(1 782 343. 6 / 103 779. 7)the cost of recommended drugs in the Chinese guidelines. Conclusions Drugs used in aged inpatients with brain infarction in our hospital are in accordance with recommended drugs in Chinese guidelines. However, neuroprotective drugs which are not recommended in Chinese guidelines are used excessively,which cost too much and should be standardized further.