慢性阻塞性肺疾病急性加重期糖皮质激素利用评估程序的建立与实践

摘要

Objective:To investigate the use rationality of glucorticosteroids and set up the drug use evaluation procedures ( DUE) for glucorticosteroids used in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods:From September 2014 to December 2014, 66 patients with AECOPD from department of respiratory medicine in our hospital were selected, and the medical history including the use of glucorticosteroids was analyzed. According to Glucocorticoid Clinical Use Guidelines, COPD related guide-lines and references, the DUE for glucorticosteroids was established, and the drug use reasons, therapeutic process and therapeutic out-come were comprehensively evaluated. Results:Six kinds of glucocorticoids were used in the 66 patients. Totally 6 cases showed ad-verse drug reactions( ADR) , and 39 cases were with unreasonable utilization, and among them, 35 ones without oral contraindications were treated by intravenous injection, 2 ones were treated only with budesonide inhalation, and 2 ones were treated by intravenous in-jection for above 14 days. Conclusion:The DUE can evaluate the application of glucocorticoids more comprehensively, which is helpful to the specification of clinical drug use and provide safe, effective and economic drug use mode for clinics.%目的:探讨评价糖皮质激素类药物的用药合理性,建立适用于慢性阻塞性肺疾病急性加重期(AECOPD)患者的糖皮质激素药物利用评估(DUE)程序.方法:分析我院呼吸内科2014年9~12月66例AECOPD患者使用糖皮质激素类药物的病例资料,根据《糖皮质激素临床应用指导原则》、COPD相关指南及其参考文献,建立AECOPD的糖皮质激素DUE程序,对用药原因、用药过程、治疗结果3个评估项目进行综合性分析.结果:66例患者中,主要涉及6种糖皮质激素,其中6例出现药品不良反应(ADR),39例使用不合理,其中较为突出的问题是有35例患者无口服禁忌但选择静脉给药,2例患者单独使用布地奈德雾化给药,2例患者静脉使用疗程过长,超过14 d.结论:应用DUE方法可更全面评价AECOPD患者糖皮质激素用药情况,规范临床用药,为临床提供安全、有效、经济的药物使用模式.