Evaluation and application of rational drug use for fat emulsion, amino acids (17) and glucose (11%) injection based on AHP-TOPSIS method
-
摘要:
目的 通过构建脂肪乳氨基酸(17)葡萄糖(11%)注射液的药物利用评价(DUE)标准，为临床合理用药提供参考依据。 方法 采用单纯随机抽样方式抽取2023年1—12月安徽医科大学附属宿州医院应用脂肪乳氨基酸(17)葡萄糖(11%)注射液的255份病历资料，以脂肪乳氨基酸(17)葡萄糖(11%)注射液药品相关循证医学资料、指南、专家共识及药品说明书作为理论依据建立本院DUE标准。采用层次分析(AHP)法计算各项指标的权重系数，并联合逼近理想值排序(TOPSIS)法对应用脂肪乳氨基酸(17)葡萄糖(11%)注射液的患者资料进行回顾性分析，并根据相对接近度(Ci)的分布区间将评价结果分为用药不合理、用药基本合理、用药合理3个层次。 结果 经AHP法联合TOPSIS法对255例应用脂肪乳氨基酸(17)葡萄糖(11%)注射液的患者评价结果显示，脂肪乳氨基酸(17)葡萄糖(11%)注射液处方合理率较低，其中67例(Ci≥0.8，26.27%)用药合理，37例(0.6≤Ci＜0.8，14.51%)用药基本合理，151例(Ci＜0.6，59.22%)用药不合理；用药不合理的主要问题集中体现在用药指征、用药时机、营养评估、用药监测、联合用药和禁忌证。 结论 通过AHP-TOPSIS法建立脂肪乳氨基酸(17)葡萄糖(11%)注射液临床应用的DUE标准，该法以可量化数据形式展现，其评价结果科学合理、直观可信，能客观反映脂肪乳氨基酸(17)葡萄糖(11%)注射液的使用情况。研究发现该药在临床的应用情况尚存在较多不合理现象，需制定有效措施给予干预并加强管理，以便发现问题并改进。 -
关键词:
- 脂肪乳氨基酸(17)葡萄糖(11%) /
- 药物利用评价 /
- 逼近理想值排序法 /
- 合理用药
Abstract:Objective To by constructing the drug utilisation evaluation (DUE) standard of fat emulsion, amino acids (17) and glucose (11%) injection, it provides a reference basis for the rational use of medication in the clinic. Methods A total of 255 medical records of fat emulsion, amino acids (17) and glucose (11%) injection from January to December 2023 in Suzhou Hospital of Anhui Medical University were selected by simple random sampling, and the evidence-based medical data, guidelines, expert consensus and drug instructions related to fat emulsion, amino acids (17) and glucose (11%) injection were used as the theoretical basis to establish DUE criteria for our hospital. The weight coefficients of each index were calculated by the hierarchical analysis (AHP) method, and the data of the patients who applied fat emulsion, amino acids (17) and glucose (11%) injection were retrospectively analysed and evaluated by the method of technique for order preference by similarity to an ideal solution (TOPSIS), and the evaluation results were classified into three levels of irrationality of the medication, basic rationality of the medication, and reasonableness of the medication according to the distribution of the relative proximity (Ci). Results The evaluation results of 255 patients applying fat emulsion, amino acids (17) and glucose (11%) injection by the AHP method combined with the TOPSIS method showed a low rate of rationality in the prescription of fat emulsion, amino acids (17) and glucose (11%) injection, of which 67 cases (Ci≥0.8, 26.27%) were reasonably medicated, 37 cases (0.6 ≤Ci < 0.8, 14.51%) medication was basically reasonable, and 151 cases (Ci < 0.6, 59.22%) were unreasonably medicated; the main problems of unreasonable medication were focused on indications for medication, timing of medication, nutritional assessment, monitoring of medication, combination of medication and contraindications. Conclusion The AHP-TOPSIS method was used to establish the DUE criteria for the clinical application of fat emulsion, amino acids (17) and glucose (11%) injection, which is presented in the form of quantifiable data, and its evaluation results are scientific, reasonable, intuitive and credible, which can objectively reflect the use of fat emulsion, amino acids (17) and glucose (11%) injection. The study found that there are still many unreasonable phenomena in the clinical application of this drug, and it is necessary to formulate effective measures to intervene and strengthen the management, so as to find out the problems and make improvements. -
表 1 脂肪乳氨基酸(17)葡萄糖(11%)注射液的药物利用评价标准
Table 1. Evaluation criteria for fat emulsion, amino acids (17) and glucose (11%) injection utilization
一级指标 二级指标 评价依据 评价结果 评估 营养评估 (1)应用营养制剂之前，需采用营养风险筛查工具(NRS 2002)对患者进行营养风险评估
(2)NRS 2002评分 < 3分的患者不需要给予营养治疗
(3)NRS 2002评分≥3分的患者需要给予营养治疗A：符合(1)或(2)或(3)
B：不符合(1)或(2)或(3)合理用药 用药指征 (1)用于无法经口服和(或)肠内营养的方式来供给目标营养量的患者
(2)用于完全性肠梗阻、短肠综合征、高流量瘘等有严重胃肠功能障碍的患者A：符合(1)或(2)
B：不符合(1)和(2)用药时机 (1)低营养风险(3分≤NRS 2002 < 5分)：经肠内营养治疗7 d后仍无法达到目标营养量的60%时，可补充肠外营养(SPN)
(2)高营养风险(NRS 2002≥5分)：经肠内营养治疗48~72 h仍无法满足患者目标营养量的60%时，可补充SPN
(3)胃肠功能严重障碍且不能使用肠内营养的重度营养不良患者，可直接应用肠外营养A：符合(1)或(2)或(3)
B：不符合(1)或(2)或(3)营养组分配比 (1)糖脂比4∶6~7∶3
(2)热氮比100~200∶1A：符合(1)和(2)
B：不符合(1)或(2)输注途径 (1)选择外周静脉输注途径
(2)选择中心静脉输注途径A：符合(1)或(2)
B：不符合(1)或(2)联合用药 (1)一价阳离子浓度≤150 mmol/L
(2)二价阳离子浓度≤10 mmol/L
(3)丙氨酰谷氨酰胺的氨基酸量占氨基酸总量的浓度≤20%
(4)不加入额外(多种维生素制剂之外)的维生素C
(5)避免加入非营养药物(静脉用胰岛素、西咪替丁等除外)A：符合(1)和(2)和(3)和(4)和(5)
B：不符合(1)或(2)或(3)或(4)或(5)注意事项 禁忌证 (1)对处方中任一成分过敏者
(2)重度高脂血症或严重凝血功能障碍
(3)严重肾功能不全且无法进行腹膜透析与血液透析者
(4)严重肝功能不全
(5)急性休克或高糖血症
(6)血电解质(指本品处方中所含有的)水平出现异常升高
(7)非稳定期疾病状态(严重败血症、高渗性昏迷等)A：不符合(1)和(2)和(3)和(4)和(5)和(6)和(7)
B：符合(1)或(2)或(3)或(4)或(5)或(6)或(7)不良反应发生与处理 监测与处理 (1)用药前应先对有水、血电解质代谢紊乱的患者予以纠正
(2)用药期间应控制血甘油三酯浓度≤3 mmol/L，超过时应及时减量或停药
(3)用药期间应监测血糖、肝功能酶等情况，出现异常应给予减量或停药
(4)长期输注本品应检测血细胞计数与凝血状况，出现异常应给予相应处理等A：符合(1)和(2)和(3)和(4)
B：不符合(1)或(2)或(3)或(4)注：A为合理，B为不合理。NRS 2002为营养风险筛查(nutritional risk screening 2002)，SPN为补充性肠外营养(supplementary parenteral nutrition)。 
下载: 导出CSV
表 2 二级指标的权重系数及Z+、Z-
Table 2. The weight coefficients and Z+, Z- results of secondary indicators
评价指标 权重系数 Z+ Z- 用药监测 0.110 1.102 < 0.001 营养评估 0.150 1.504 < 0.001 联合用药 0.093 0.927 < 0.001 营养组分配比 0.047 0.473 0.473 输注途径 0.036 0.355 0.355 用药指征 0.216 2.158 < 0.001 禁忌证 0.070 0.704 < 0.001 用药时机 0.278 2.776 < 0.001
下载: 导出CSV
表 3 各二级指标的总评分情况
Table 3. Total score of each second-level indicator
评价指标 不合理
[例(%)]合理
[例(%)]总评分
(分)用药监测 35(13.73) 220(86.27) 2 200 营养评估 76(29.80) 179(70.20) 1 790 联合用药 12(4.71) 243(95.29) 2 430 营养组分配比 0 255(100.00) 2 550 输注途径 0 255(100.00) 2 550 用药指征 147(57.65) 108(42.35) 1 080 禁忌证 19(7.45) 236(92.55) 2 360 用药时机 151(59.22) 104(40.78) 1 040
下载: 导出CSV
表 4 脂肪乳氨基酸(17)葡萄糖(11%) 注射液用药合理性评价情况
Table 4. Evaluation of rationality of fat emulsion, amino acids (17) and glucose (11%) injection use
Ci值 分类 例数(%) 评价结果 Ci < 0.6 < 0.5 147(57.65) 用药不合理 0.5~ < 0.6 4(1.57) 用药不合理 0.6≤Ci < 0.8 0.6~ < 0.7 9(3.53) 用药基本合理 0.7~ < 0.8 28(10.98) 用药基本合理 Ci≥0.8 0.8~ < 0.9 10(3.92) 用药合理 1 57(22.35) 用药合理
下载: 导出CSV
-
[1] 王秀花, 何泽然, 李志蕻, 等. 脂肪乳氨基酸(17)葡萄糖(11%)注射液临床应用点评与规范、合理使用[J]. 昆明医科大学学报, 2023, 44(3): 138-142.WANG X H, HE Z R, LI Z H, et al. Clinical Application Evaluation and Standard, Reasonable Use of Fat Emulsion, Amino Acids(17) and Glucose(11%) Injection[J]. Journal of Kunming Medical University, 2023, 44(3): 138-142. [2] 安徽省卫生健康委.关于印发三级医院评审标准(2022年版)安徽省实施细则(试行)的通知(皖卫发[2023]3号)[EB/OL].(2023-07-18)[2024-05-28]. https://wjw.ah.gov.cn/public/7001/56838361.html . Health Commission of Anhui Province. Notice on Issuing the Implementation Rules of Anhui Province (Trial) for the Evaluation Standards of Third level Hospitals (2022 Edition) (Anhui Health Commission[2023] No. 3)[EB/OL].(2023-07-18).https://wjw.ah.gov.cn/public/7001/56838361.html .[3] 王金利, 石慧. DUR联合DUE模式对恶性肿瘤化疗患者保肝药物应用效果的影响[J]. 贵州医科大学学报, 2022, 47(11): 1349-1353.WANG J L, SHI H. Effect of DUR combined with DUE on the application of hepatoprotective drugs in patients with malignant tumors undergoing chemotherapy[J]. Journal of Guizhou Medical University, 2022, 47(11): 1349-1353. [4] LI L, TONG J P, WANG H, et al. Maturity degree assessment of hospital ward system using integrated fuzzy AHP-TOPSIS model[J]. Medicine(Baltimore), 2023, 102(44): e35752. DOI: 10.1097/MD.0000000000035752. [5] KHAN I, PINTELON L, MARTIN H. The application of multicriteria decision analysis methods in health care: a literature review[J]. Med Decis Making, 2022, 42(2): 262-274. doi: 10.1177/0272989X211019040 [6] 中华医学会肠外肠内营养学分会. 中国成人患者肠外肠内营养临床应用指南(2023版)[J]. 中华医学杂志, 2023, 103(13): 946-974. doi: 10.3760/cma.j.cn112137-20221116-02407Chinese Society of Parenteral and Enteral Nutrition. Guideline for clinical application of parenteral and enteral nutrition in adults patients in China (2023 edition)[J]. National Medical Journal of China, 2023, 103(13): 946-974. doi: 10.3760/cma.j.cn112137-20221116-02407 [7] 中华医学会肠外肠内营养学分会. 肠外营养多腔袋临床应用专家共识(2022)[J]. 中华外科杂志, 2022, 60(4): 321-328. doi: 10.3760/cma.j.cn112139-20211228-00624Chinese Society of Parenteral and Enteral Nutrition. Expert consensus on clinical application of multi-chamber bag for parenteral nutrition (2022)[J]. Chinese Journal of Surgery, 2022, 60(4): 321-328. doi: 10.3760/cma.j.cn112139-20211228-00624 [8] 广东省药学会. 肠外肠内营养临床药学实践共识(2022年版)[J]. 今日药学, 2023, 33(6): 414-421.Guangdong Pharmaceutical Association. Consensus on clinical pharmacy practice of parenteral and enteral nutritionlz(2022)[J]. Pharmacy Today, 2023, 33(6): 414-421. [9] 戴曼, 秦守权, 杜宇, 等. 脂肪乳氨基酸(17)葡萄糖(11%)注射液临床应用及相关用药评价[J]. 药学与临床研究, 2023, 31(3): 254-257.DAI M, QIN S Q, DU Y, et al. Clinical Application and Related Drug Evaluation of Fat Emulsion, Amino Acids(17) and Glucose(11%) Injections[J]. Pharmaceutical and Clinical Research, 2023, 31(3): 254-257. [10] 刘少志, 梅峥嵘, 袁中文, 等. 基于AHP-TOPSIS法和数据挖掘综合评价新型抑酸药伏诺拉生临床应用的合理性[J]. 实用医学杂志, 2022, 38(12): 1541-1547.LIU S Z, MEI Z R, YUAN Z W, et al. Comprehensive evaluation of a new type of acid-suppressing drug vonoprazan based on AHP-TOPSIS method and data mining rationale for clinical use[J]. The Journal of Practical Medicine, 2022, 38(12): 1541-1547. [11] 吴慧, 翁惠芬, 刘宝, 等. 基层卫生信息化水平评估指标体系的应用研究[J]. 中华全科医学, 2023, 21(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.003143WU H, WENG H F, LIU B, et al. Study on the application of indicator system for evaluating the informatization level of grassroots healthcare[J]. Chinese Journal of General Practice, 2023, 21(9): 1449-1452. doi: 10.16766/j.cnki.issn.1674-4152.003143 [12] 许健, 孔令提. 基于加权TOPSIS法的药学干预对阿帕替尼处方合理率的影响[J]. 中华全科医学, 2022, 20(9): 1598-1602. doi: 10.16766/j.cnki.issn.1674-4152.002658XU J, KONG L T. Pharmaceutical intervention based on weighted TOPSIS method on the rationality rate of apatinib prescription[J]. Chinese Journal of General Practice, 2022, 20(9): 1598-1602. doi: 10.16766/j.cnki.issn.1674-4152.002658 [13] WANG K, WANG Z, DENG J, et al. Study on the evaluation of emergency management capacity of resilient communities by the AHP-TOPSIS method[J]. Int J Environ Res Public Health, 2022, 19(23): 16201. DOI: 10.3390/ijerph192316201. [14] HEZER S, GELMEZ E, ÖZCEYLAN E. Comparative analysis of TOPSIS, VIKOR and COPRAS methods for the COVID-19 regional safety assessment[J]. J Infect Public Health, 2021, 14(6): 775-786. doi: 10.1016/j.jiph.2021.03.003 [15] GUILLEN-MENA V, QUESADA-MOLINA F, ASTUDILLO-CORDERO S, et al. Lessons learned from a study based on the AHP method for the assessment of sustainability in neighborhoods[J]. MethodsX, 2023, 11: 102440. DOI: 10.1016/j.mex.2023.102440. [16] CHOI Y K, KIM H J, AHN J, et al. Impact of early nutrition and feeding route on clinical outcomes of neurocritically ill patients[J]. PLoS One, 2023, 18(3): e0283593. DOI: 10.1371/journal.pone.0283593. [17] PARDO E, LESCOT T, PREISER J C, et al. Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study[J]. Crit Care, 2023, 27(1): 7. DOI: 10.1186/s13054-022-04298-1. [18] HELLERMAN ITZHAKI M, SINGER P. Advances in medical nutrition therapy: parenteral nutrition[J]. Nutrients, 2020, 12(3): 717. DOI: 10.3390/nu12030717. [19] SINGER P, BLASER A R, BERGER M M, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit[J]. Clin Nutr, 2023, 42(9): 1671-1689. doi: 10.1016/j.clnu.2023.07.011 [20] MECHANICK J I, APOVIAN C, BRETHAUER S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures-2019 update: cosponsored by american association of clinical endocrinologists/american college of endocrinology, the obesity society, american society for metabolic and bariatric surgery, obesity medicine association, and american society of anesthesiologists[J]. Obesity(Silver Spring), 2020, 28(4): O1-O58. DOI: 10.1002/oby.22719. [21] CEDERHOLM T, JENSEN G, CORREIA M, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community[J]. Clin Nutr, 2019, 38(1): 1-9. doi: 10.1016/j.clnu.2018.08.002 [22] 浙江省医学会重症医学分会. 中国重症患者肠外营养治疗临床实践专家共识(2024)[J]. 中华危重病急救医学, 2024, 36(7): 673-680. doi: 10.3760/cma.j.cn121430-20240123-00080Zhejiang Medical Association Critical Care Medicine Branch. Expert consensus on clinical practice of parenteral nutrition therapy for critically ill patients in China (2024)[J]. Chinese Critical Care Medicine, 2024, 36(7): 673-680. doi: 10.3760/cma.j.cn121430-20240123-00080 -
点击查看大图
表(4)
计量
- 文章访问数: 85
- HTML全文浏览量: 55
- PDF下载量: 19
- 被引次数: 0
