【作者】 杜秋明；

【导师】 王存选；

【作者基本信息】 天津医科大学 ， 中西医结合临床， 2011， 硕士

【摘要】 目的：通过调查天津市三个级别甲等医院抗高血压药物的使用情况,了解各级医院抗高血压药物的用药特点,分析用药是否合理、是否符合指南要求,为今后抗高血压药物的合理应用和主管部门的监督管理提供科学依据。方法：回顾性调查天津市三家甲等医院的抗高血压药物应用情况及发展动向。这三家医院包括天津市某三级甲等综合医院(以下简称三甲医院)、天津市红桥区某二级甲等医院(以下简称二甲医院)及天津市河西区某社区医院(以下简称社区医院)。分别调查2009年7-12月份的高血压门诊处方,同时调查三甲医院和二甲医院高血压住院患者的处方情况。统计每位患者的年龄、性别,使用抗高血压药物名称(商品名及化学名)、药物剂量、药物费用、联合用药情况及总的处方量。采用WHO推荐的金额排序法和频度分析法,利用Microsoft Excel2003软件对三家医院抗高血压药物的销售金额、用药频度、日均费用及联合用药情况进行分析,总结并探讨抗高血压药物的用药特点和用药趋势。结果：三家医院抗高血压药使用情况,男性稍多于女性,患者的年龄以50-80岁最多。三甲医院门诊常用抗高血压药用药频度排序前五位的依次是：钙通道阻滞剂(CCB)、血管紧张素Ⅱ受体拮抗剂(ARB)、血管紧张素Ⅰ转化酶抑制剂(ACEI)、β受体阻滞剂(β-RB)、和复方制剂；二甲医院门诊常用抗高血压药用药频度排序前五位的依次是：CCB、ACEI、中药制剂、ARB和p-RB；社区医院门诊常用抗高血压药用药频度排序前五位的依次是：CCB、中药制剂、ARB、ACEI、和β-RB。三甲医院门诊常用抗高血压药总金额排序前五位的依次是：CCB、ARB、β-RB、ACEI和复方制剂；二甲医院门诊常用抗高血压药总金额排序前五位的依次是：CCB、ACEI、中药制剂、ARB和β-RB；社区医院门诊常用抗高血压药总金额排序前五位的依次是：CCB、ARB、中药制剂、ACEI和β-RB。药物利用指数(DUI)基本接近于1。住院患者抗高血压药物使用情况,男性稍少于女性,患者的年龄以60-90岁最多。三甲医院住院患者常用抗高血压药物用药频度排序前五位的依次是：CCB、利尿剂、ACEI、ARB和中药制剂；二甲医院住院患者常用抗高血压药物用药频度排序前五位的依次是：CCB、利尿剂、ACEI、ARB和β-RB。三甲医院住院患者常用抗高血压药物总金额排序前五位的依次是：利尿剂、CCB、α-受体阻滞剂(α-RB)、ACEI和ARB；二甲医院住院患者常用抗高血压药物总金额排序前五位的依次是：CCB、利尿剂、ACEI、ARB和中药制剂。药物利用指数(DUI)基本接近于1。结论：天津市三家不同级别甲级医院应用抗高血压药物基本合理,其中以CCB、ACEI、ARB、β-RB及利尿剂等几类药物为主。抗高血压药物用药频度在前十几位的药物与广大患者需求及新指南相一致。长效制剂、复方制剂及小剂量联合应用更有利于高血压病的治疗。这三家医院在选择抗高血压药物治疗时基本遵循了科学、安全、有效、适用、经济的原则。抗高血压药品种较多,临床应用广泛,广大临床医生应注意减少不合理用药现象的发生。总之,长效、高效、不良反应少及价格便宜的抗高血压药物将受到就诊患者的欢迎。更多还原

【Abstract】 Objective:Through investigating the application of antihypertensive drugs in three Class-vary and Grade-A Hospitals in Tianjin, comparing Hypertension Guideline, analyzing the use of antihypertensive drugs in order to provide the scientific basis for the rational use and management of antihypertensive drugs.Methods:The retrospective investigation in respect of the tendency of using antihypertensive drugs in three Class-vary and Grade-A Hospitals in Tianjin were statistically analyzed from July to December in 2009.The three hospitals include the Class-3 Hospital, Class-2 Hospital and a Community Health Center in Hexi district of Tianjin. The drug utilization including the dates, the patient sex, age, drug name,consumption sum, and the combination drug use of antihypertensive drugs. The money for consume, the defined daily doses (DDDs) and defined daily dose cost (DDDc) were investigated with Microsoft Excel 2003. The utilization characteristics and development trend of antihypertensive drugs were discussed.Results:Of the outpatient prescriptions reviewed, three hospitals involved use of antihypertensive drugs, of whom, male represented more than female and antihypertensive drugs were mostly used in patients aged between 50 to 80 years. The classes of antihypertensive drugs in the Class-3 ranked by the defined daily doses (DDDs) were Calcium channel blockers (CCB)、angiogenesisⅡreceptor antagonist (ARB)、angiogenesis converting enzyme inhibitors(ACEI)、β-receptor blockers (B-RB) and compound preparation; Class-2 Hospital:CCB、ACEI、traditional Chinese medicine、ARB、andβ-RB; Community Health Center Hospital:CCB、traditional Chinese medicine、ARB、ACEI and B-RB. The classes of antihypertensive drugs in the Class-3 ranked by the money for consume were CCB、ARB、β-RB、ACEI and compound preparation; Class-2 Hospital:CCB、ACEI、traditional Chinese medicine、ARB andβ-RB; Community Health Center Hospital:CCB、ARB、traditional Chinese medicine、ACEI andβ-RB. Drug utiliztion index (DUI) about is one.Of the inpatient prescriptions reviewed, three hospitals involved use of antihypertensive drugs, of whom, female represented more than male and antihypertensive drugs were mostly used in patients aged between 60 to 90 years. The classes of antihypertensive drugs in the Class-3 ranked by DDDs were CCB、diuretics、ACEI、ARB and traditional Chinese medicine; Class-2 Hospital:CCB、diuretics、ACEI、ARB andβ-RB. The classes of antihypertensive drugs in the Class-3 ranked by the money for consume were diuretics、CCB、α-RB、ACEI and ARB; Class-2 Hospital:CCB、diuretics、ACEI、ARB and traditional Chinese medicine. Drug utiliztion index (DUI) about is one.Conclusions:The utilization of antihypertensive drugs were basically reasonable in three Class-vary and Grade-A Hospitals in Tianjin. Keeping good control of blood pressure meanwhile protecting target organs. CCB、ACEI、ARB、β-RB and diuretics dominate in the antihypertensive market in Tianjin. The top more ten of DDDs was in accordance with antihypertensive drugs indicates. Prolonged action preparation、compound preparation and the combination drug use of antihypertensive drugs are helpful for treating hypertensive disease. The doctors of the three hospitals followed scientific, safe and effective, applicable and economical principles in respect of the selection of antihypertensive medications. In line with the domestic and abroad general medication situation, the antihypertensive drugs are characterized by complicated categorization, wide variety, and widespread clinical application. It’s necessary to train the physicians to strengthen their sense of responsibilities and reasonable prescriptions, to reduce irrational administration, and to make the service truly patient-oriented. For some time to come, antihypertensive drugs of long-lasting efficiency, less adverse reactions and low cost would be welcome in our hospital, in line with the development trend of antihypertensive drugs.更多还原