肿瘤疼痛患者使用麻醉药品镇痛药处方点评∗

摘要

Objective To investigate current status of narcotic analgesic use in patients with cancer pain in our hospital, in order to promote the rationalization of prescribing narcotic drugs and the rational use of analgesics. Methods A total of 400 narcotic prescriptions ( 100 of outpatients and 300 of inpatients ) in Tongji hospital were randomly selected from March to May in 2014.Basic index and consumption of anesthetic drugs, money consumption distribution on different tumor types, and unreasonable prescription were analyzed. Results The overall prevalence of irrational prescriptions was 11. 00%, with 13.00% from inpatient and 10. 33% from outpatient, respectively. Reasons for irrational prescriptions mainly included vague instructions on dosage and administration, incomplete clinical diagnosis, lack of pharmacist check and inappropriate dosage. In the basic indexes, proportions of reasonable prescription and drugs within the national formulary were higher in the inpatient than in the outpatient service.The average money consumption of outpatient prescription was significantly higher than that of inpatient prescription.Most types of diagnosis were lung cancer in outpatient and inpatient departments, and total cost of lung cancer drugs was the highest.Morphine hydrochloride of outpatient had the highest average consumption, followed by codeine phosphate of the outpatient and the inpatient, and oxycodone hydrochloride controlled-release tablets cost more in inpatient. Conclusion The narcotic analgesic used in our hospital is basically rational. Most doctors prescribe according to the guidelines, but standardized training of prescription for cancer patients with pain medication needs to be strengthened, and supervision of narcotic analgesic medication should be enhanced.%目的：调查肿瘤疼痛患者麻醉药品处方使用现状，以促进麻醉药品处方的合理化和镇痛药的合理使用。方法随机抽取华中科技大学同济医学院附属同济医院2014年3—5月份麻醉药品镇痛药处方共400张(门诊100张和住院部300张)，对麻醉药品镇痛药基本指标，麻醉药品消耗量、不同肿瘤类型消耗金额分布和不合理处方情况等进行分析评价。结果镇痛药不合理处方比例为11.00％，门诊和住院部分别为13.00％和10.33％。不合理处方主要集中为用法用量含糊不清、临床诊断不全、药师未对处方适宜性审核和用法用量不适宜等问题。基本指标中处方合理率、基本药物占比住院部均高于门诊，门诊平均处方金额显著高于住院部。门诊和住院部肺癌诊断类型位居第一，肺癌的药品总费用也最高。门诊盐酸吗啡片的平均消耗量最高，其次为磷酸可待因片；住院部为磷酸可待因片、羟考酮控释片。结论该院麻醉药品镇痛药用药基本合理，使用符合«癌症三阶梯治疗指导原则»，绝大多数医生开具麻醉药品镇痛药处方比较规范，但仍需要加强对肿瘤疼痛患者处方用药的规范化培训，强化对麻醉药品镇痛药处方用药的监管。