儿科住院不合理用药现状和危险因素分析

目的：探讨某院儿科住院不合理用药现状和危险因素。方法：采用等距抽样法在该院病案室抽取2016年1月-12月儿科出院病历600份。由临床药师对抽样病历进行审核，统计不合理用药的份数、类型分布、构成比等，采用帕累托图及其法则对数据进行分析，并分析导致不合理用药的危险因素。结果：共发现49份病历存在不合理用药，不合理用药率为8.17%，其中34份为超说明书用药，占不合理用药病历数的69.39%（34/49），占总病历数的5.67%（34/600）。不合理用药的主要类型为超给药剂量（34.69%）、超给药频率（14.29%）、无指征应用抗菌药物（14.29%）和超给药途径（12.24%）。不合理用药涉及药物的主要种类为呼吸系统药物（44.90%），次要种类为抗菌药物（42.86%）。超说明书用药的主要类型为超给药剂量（50.00%）和超给药频率（20.59%），次要类型为超给药途径（17.65%），涉及药物的主要种类为呼吸系统药物（55.88%）。年龄小、管床医生职称低是导致不合理用药的危险因素。结论：需要相关部门针对该院不合理用药现状和主要原因，完善和实施相关制度和措施，保证儿童临床用药的安全性。

Analysis on current situation and risk factors of irrational drug use in pediatric inpatients

OBJECTIVE To investigate the current situation and risk factors of irrational drug use in pediatric inpatients of a hospital. METHODS A total of 600 medical records of pediatric patients discharged from January to December in 2016 were selected by isometric sampling method in the medical record room of the hospital. The sampled medical records were reviewed by clinical pharmacists, and the number, type distribution, composition ratio of irrational drug use were counted. Pareto diagram and its rules were used to analyze the data, and the risk factors leading to irrational drug use were also identified. RESULTS The irrational drug use rate was 8.17% in 49 medical records, 34 of which were off-label drugs, accounting for 69.39%(34/49) and 5.67%(34/600) of the total medical records. The main types of irrational drug use were overdose(34.69%), overdose frequency(14.29%), unindicated use of antibiotics(14.29%) and overdose routes(12.24%). The main drugs involved in irrational drug use were respiratory drugs(44.90%) and antibiotics(42.86%). The main types of off-label drug use were over-dose(50.00%) and over-dose frequency(20.59%), and the secondary type was over-dose routes(17.65%). The main types of drugs involved were respiratory drugs(55.88%). Young age and low professional titles of clinician were the risk factors for irrational drug use. CONCLUSION Relevant departments should improve and implement relevant systems and measures to ensure the safety of clinical medication for children in view of the current situation and main reasons of irrational drug use in our hospital, so as to ensure the safety of clinical medication for children.