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目的寻找医嘱中药物联用致不良反应的理论预测与实际发生情况之间差异的规律。方法利用“e药通”软件分析上海市第一人民医院神经外科一季度住院患者医嘱,得出理论预测数据;查看患者电子病历系统用药前后肌酐、钾离子、凝血酶原时间、血糖等结果的变化趋势,分析药物相互作用对患者病情的实际影响,从而得出差异规律。结果分析2 109次223种药物相互作用,其中肾功能损伤的85条中实际发生48条;影响钾离子的76条中发生14条;改变凝血功能的24条中发生5条;7条血糖影响未知。药物相互作用的临床实际发生率为34.9%,实际发生的病例中以肾功能损害,特别是降压药物与抗菌药物联用致肾功能损害为多见。结论利用软件分析药物相互作用时需与临床实践相结合,对药物不良反应实际发生率较高的药物进行定期总结和加强监护。
OBJECTIVE: To find out the regularity of the difference between the theoretical prediction and the actual occurrence of adverse drug reactions caused by Chinese medicine combined with medical advice. Methods The data of hospitalized patients in the first quarter of neurosurgery in Shanghai First People’s Hospital were analyzed using the “e-drug” software and the theoretical predictive data were obtained. The data of creatinine, potassium, prothrombin time, blood glucose and other factors The trend of the results, the analysis of the actual impact of drug interactions on the patient’s condition, to draw the law of difference. RESULTS: There were 2 109 interactions with 223 drugs, of which 48 were actually found in 85 of the renal damage, 14 of 76 were affected by potassium, 5 of 24 were altered in coagulation, and 7 were glucose unknown. The actual clinical incidence of drug interactions was 34.9%. In the actual cases, renal dysfunction, especially the combination of antihypertensive drugs and antimicrobial drugs, was more common in renal failure. Conclusions The use of software to analyze drug interactions needs to be combined with clinical practice to regularly summarize and strengthen the monitoring of drugs with a high incidence of adverse drug reactions.