我院住院患者注射用质子泵抑制剂使用情况调查及不合理用药分析

目的：分析我院住院患者注射用质子泵抑制剂的临床合理用药情况。方法：制定质子泵抑制剂用药评价标准,组织抽查小组,现场抽查病例．对注射用质子泵抑制剂的适应症、用法用量等进行合理性分析。结果：共抽查6个重点病房91份病例,涉及奥美拉唑钠针（洛赛克针、奥克针）、泮托拉唑针（泮立苏针、韦迪针）,存在注射用质子泵抑制剂不合理用药的病例21例,合格率为76.92％。外科病房不合理使用情况较内科病房严重。多数不合理为使用无明确指征,部分存在使用疗程偏长现象。结论：住院患者注射用质子泵抑制剂存在不合理用药情况,医院应制定注射用质子泵抑制剂使用规范．临床使用中应严格把握用药指征,避免过度使用。     

吉林大学第一医院住院患者质子泵抑制剂应用分析

目的：了解2011年1月—2011年12月我院住院患者质子泵抑制剂使用情况及用药趋势,为临床合理用药提供参考。方法：采用用药频度（DDDs）排序与销售金额排序法,并对我院2011年质子泵抑制剂的DDDs、销售金额、限定日费用（DDC）进行统计与分析。结果：我院注射用质子泵抑制剂的用量与DDDs远远大于口服制剂,注射用质子泵抑制剂的同步性比口服制剂的同步性好。结论：建议医院制定质子泵抑制剂合理应用指南,临床用药严格把握用药指征,避免过度使用。     

杭州地区19家医院2004～2008年质子泵抑制剂利用分析

目的:评价杭州地区19家医院质子泵抑制剂的应用情况及趋势,为该类药物的研发、生产、销售和临床应用提供参考。方法:统计杭州地区19家医院2004～2008年质子泵抑制剂的销售金额、用药频度和限定日费用。结果:5年来该地区医院质子泵抑制剂的销售金额、用药频度均大幅增长,口服奥美拉唑(包括胶囊和片剂)的用量最大、增长平稳,新一代质子泵抑制剂雷贝拉唑和埃索美拉唑用量增长迅速。结论:质子泵抑制剂是一类很有发展潜力的药物,奥美拉唑作为相对成熟的质子泵抑制剂,在临床应用仍最为广泛。     

2010-2012年某三甲医院质子泵抑制剂用药分析

目的 评价某三甲医院2010-2012年质子泵抑制剂的使用情况,提高质子泵抑制剂在临床的合理使用.方法 统计该院2010-2012年质子泵抑制剂所有品种,以限定日剂量值、用药频度和日均费用为主要指标进行统计分析.结果 该院质子泵抑制剂的销售金额逐年上升,3年来DDDs排名前三位质子泵抑制剂的均为泮托拉唑针、奥美拉唑针及雷贝拉唑肠溶片,大部分种类质子泵抑制剂的DDDs保持稳定.结论 该院质子泵抑制剂使用基本合理.     

Persistence and adherence to proton pump inhibitors in daily clinical practice

BACKGROUND: Proton pump inhibitors are widely used, but little is known about the usage pattern in different indications. AIM: To analyse proton pump inhibitor usage patterns in the general population. METHODS: A cohort of 16 311 incident proton pump inhibitor users was identified in the Integrated Primary Care Information database, a Dutch general practice research database. Persistence and adherence were calculated by indication. Risk factors were identified by logistic regression analysis. RESULTS: One-year persistence was 31% in patients using proton pump inhibitors for gastro-oesophageal reflux. Persistence was higher in oesophagitis grade A/B (54%), grade C/D (73%) and Barrett's oesophagus (72%), compared to patients with only reflux symptoms (27%). Approximately 25% of patients with non-reflux dyspepsia or Helicobacter pylori-associated indications used proton pump inhibitors for more than 6 months. Half of all patients used proton pump inhibitors <80% of time indicating intermittent use, which was independent of indication. Exception were patients with Barrett's oesophagus, who were most adherent. CONCLUSIONS: A substantial proportion of patients with indications not requiring long-term treatment use proton pump inhibitors for an extended period. Half of the patients used proton pump inhibitors on-demand or intermittently. Such usage pattern is probably sufficient for most patients, but may be inadequate if proton pump inhibitors are used for serious diseases, such as severe oesophagitis or Barrett's oesophagus.     

Proton pump inhibitor-induced hypomagnesemic hypoparathyroidism

Proton pump inhibitors are the one of the most widely used drugs in the world. Hypomagnesemic hypoparathyroidism has been reported with different proton pump inhibitors with prolonged oral use. We report the first reported case of possible such effect with intravenous preparation of proton pump inhibitor. This case report raises awareness among physicians worldwide of this often unknown association, as life-threatening cardiac and neuromuscular complications can arise with unrecognized hypocalcemia and hypomagnesemia with proton pump inhibitors.KEY WORDS: Hypocalcemia, hypoparathyroidism, proton pump inhibitors, tetany     

某院内科质子泵抑制剂临床应用分析

目的：调查某院内科质子泵抑制剂使用情况,评估其用药合理性,提出用药建议。方法：以某院内科2013年所有出院患者为研究对象,对使用质子泵抑制剂的住院患者进行回顾性调查,评价质子泵抑制剂使用的合理性。结果：调查到使用质子泵抑制剂的病历215份,其中204份有使用质子泵抑制剂的用药指征,比例为94%。有11份用药指征不够,比例为6%。用药目的中有123份属于预防性用药,有92份属于治疗性用药。结论：质子泵抑制剂的临床应用基本合理,但在预防性用药指征的把握方面,还有待加强监督和管理。     

某医院质子泵抑制剂注射剂应用分析

目的：了解某医院质子泵抑制剂注射剂的使用现状。方法：以某三甲综合性医院2010年住院病人为研究对象,对期间至少使用过1次质子泵抑制剂注射剂的住院患者经简单随机抽样进行回顾性调查,评价质子泵抑制剂注射剂使用的合理性。结果：共调查病例1920例,仅9．9％（190／1920）的病例合理使用质子泵抑制剂注射剂。不合理使用主要表现为用药指征不合理,占76．3％（1465／1920）。91．4％（1755／1920）的病例以预防性用药为主,而以预防应激性溃疡为目的的病例占50．3％（967／1920）。结论：应建立质子泵抑制剂的合理用药指南,加强用药干预,以改善质子泵抑制剂的不合理使用现状。     

A misleading, underestimated side effect of a commonly used therapy. Following your stomach may hurt your heart

We report a case of resistant hypokalaemia with hypertension and arrhythmias. The clinical history included chronic gastro-oesophageal reflux treated with proton pump inhibitors. Blood test revealed hypocalcaemia and hypomagnesaemia. Treatment with magnesium and withdrawal of proton pump inhibitors resulted in complete recovery; however, when the patient was readministered proton pump inhibitors because of epigastric pain, the whole syndrome reappeared. Treatment with proton pump inhibitors was then stopped definitively with release of both hypertension and hypocalcaemia. Proton pump inhibitors induce intestinal magnesium wasting and related cardiovascular complications.     

质子泵抑制剂的分类及药理学特性

选择性抑制胃壁细胞上H^＋/-ATP酶的药物-质子泵抑制剂已成为一代新型抑酸药物,是目前治疗酸相关疾病（消化性溃疡、反流性食管炎等）以及非甾体类抗炎药相关胃肠病变的首选药物。自1988年第一个质子泵抑制剂奥美拉唑上市以来,全球共相继上市了兰索拉唑、泮托拉唑、雷贝拉唑、埃索美拉唑等8个品种,而现在国内上市的质子泵抑制剂有5个。尽管各个质子泵抑制剂拥有共同的苯并咪唑内核及吡啶环的化学结构,但它们在药代动力学和药效学上仍有细微差异。本文就国内已上市的质子泵抑制剂的药理学特性作一简要概述,以期促进质子泵抑制剂在临床上的合理选用。     

Review article: comparison of the pharmacokinetics, acid suppression and efficacy of proton pump inhibitors

Proton pump inhibitors have dramatically influenced the management of acid-peptic disorders in recent years. They all have a broadly similar mechanism of action and are extensively metabolized in the liver via cytochromes P450 2C19 and 3A4. There is some variation in their potential for drug interactions due to differences in enzyme inhibition. Relatively few serious adverse effects have been reported for the proton pump inhibitors. Comparative studies of acid suppression suggest that lansoprazole and pantoprazole have a potency similar to that of omeprazole on a mg for mg basis; however, rabeprazole may have a greater potency than omeprazole. Lansoprazole and rabeprazole display a more rapid onset of maximal acid suppression than the other proton pump inhibitors. Comparative studies using proton pump inhibitors for the treatment of reflux oesophagitis, duodenal ulcer healing and Helicobacter pylori eradication show little overall difference in outcome between the proton pump inhibitors when used in their standard doses. Lansoprazole and rabeprazole provide earlier and better symptom relief than the other proton pump inhibitors in some studies of peptic ulcer treatment. The few studies of gastric ulcer treatment suggest that there is an advantage in using the proton pump inhibitors that have a higher standard daily dose.     

Sub-optimal proton pump inhibitor dosing is prevalent in patients with poorly controlled gastro-oesophageal reflux disease

BACKGROUND: Proton pump inhibitors are the most potent drug treatment for gastro-oesophageal reflux disease. Pre-meal dosing maximizes efficacy while sub-optimal dose timing may limit efficacy. AIM: To determine the prevalence of sub-optimal proton pump inhibitor dosing in a community-based gastro-oesophageal reflux disease population. MATERIALS AND METHODS: One hundred patients on proton pump inhibitors referred for persistent gastro-oesophageal reflux disease symptoms were questioned about their proton pump inhibitor dosing habits and classified as optimal or sub-optimal dosers. Optimal dosers took proton pump inhibitors with or up to 60 min before meals. Sub-optimal dosers took proton pump inhibitors >60 min before meals, after meals, as needed, or at bedtime. RESULTS: Forty-six percent dosed optimally. Fifty-four percent dosed sub-optimally with 21 of 54 (39%) dosing >60 min before meals, 16 (30%) after meals, 15 (28%) at bedtime and two (4%) as needed. Only 6% of the subjects on once-daily proton pump inhibitor regimens and 33% of subjects taking proton pump inhibitors two- to three times daily dosed in a manner that maximized acid suppression (15-30 min before a meal). CONCLUSIONS: In this study, 54% of patients dosed proton pump inhibitors sub-optimally and only 12% dosed in a manner that maximized acid suppression. As sub-optimal proton pump inhibitor dose timing can limit efficacy, patients with refractory symptoms should be asked about dose timing to avoid inappropriate and costly dose escalations.     

质子泵抑制剂长期用药的临床风险

目的了解质子泵抑制剂长期用药的临床风险研究现状。方法以“质子泵抑制剂”、“风险”、“Meta”为关键词,检索CNKI、Pubmed数据库,收集相关文献并对其进行综述。结果与结论长期使用质子泵抑制剂可能带来诸多风险,如骨折、呼吸系统感染、自发性腹膜炎、艰难梭杆菌感染等,临床在制定质子泵抑制剂治疗方案时应结合患者病情综合考虑,尽量避免因长期使用该类药物所带来的临床用药风险。     

Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn

BACKGROUND: The current standard of care in proton pump inhibitor failure is to double the proton pump inhibitor dose, despite limited therapeutic gain. Aims To determine the efficacy of adding acupuncture vs. doubling the proton pump inhibitor dose in gastro-oesophageal reflux disease patients who failed symptomatically on proton pump inhibitors once daily. METHODS: Thirty patients with classic heartburn symptoms who continued to be symptomatic on standard-dose proton pump inhibitors were enrolled into the study. All participants underwent upper endoscopy while on proton pump inhibitors once daily. Subsequently, patients were randomized to either adding acupuncture to their proton pump inhibitor or doubling the proton pump inhibitor dose over a period of 4 weeks. Acupuncture was delivered twice a week by an expert. RESULTS: The two groups did not differ in demographic parameters. The acupuncture + proton pump inhibitor group demonstrated a significant decrease in the mean daytime heartburn, night-time heartburn and acid regurgitation scores at the end of treatment when compared with baseline, while the double-dose proton pump inhibitor group did not demonstrate a significant change in their clinical endpoints. Mean general health score was only significantly improved in the acupuncture + proton pump inhibitor group. CONCLUSION: Adding acupuncture is more effective than doubling the proton pump inhibitor dose in controlling gastro-oesophageal reflux disease-related symptoms in patients who failed standard-dose proton pump inhibitors.     

2005～2007年我院质子泵抑制剂应用情况分析

目的：了解质子泵抑制剂的应用情况及趋势。方法：对质子泵抑制剂的品种、消耗量、销售金额、用药频度（DDDs）、日均费用（DDDc）进行综合分析。结果：2005～2007年我院质子泵抑制剂的销售金额以每年大于91%的幅度递增,其中,注射用泮托拉唑增长较快。DDDc则呈逐年下降趋势。结论：质子泵抑制剂药是一类很有发展潜力的药物,泮托拉唑的用量将不断上升。     

质子泵抑制剂长期使用的潜在安全性问题

随着质子泵抑制剂的广泛应用,其长期使用的潜在安全性问题也逐渐引起人们的关注。本文介绍与质子泵抑制剂长期使用相关的风险。     

Safety of proton pump inhibitors--an overview.

Drug-induced achlorhydria in experimental animals results in excessive hypergastrinaemia, ECL-cell hyperplasia and ECL-cell carcinoidosis. However, these events have not been observed in long-term studies in patients receiving proton pump inhibitors. Serum gastrin levels increase only modestly during acute and long-term treatment. It is concluded that monitoring of serum gastrin levels and of fundic ECL cells is of no clinical relevance even during long-term therapy with proton pump inhibitors. The clinically available proton pump inhibitors such as pantoprazole, omeprazole and lansoprazole are well tolerated, with a low incidence of side-effects. Minor and serious side-effects classified as possibly related to proton pump therapy have been described in up to 2.5% of patients. This is the same order of magnitude as that found in patients treated with H2-receptor blockers and in placebo-treated controls. In most cases, therefore, the observed side-effects are unrelated to the intake of proton pump inhibitors. Minor adverse events include headache, diarrhoea, dizziness, pruritus and rash. Proton pump inhibitors are metabolized mainly in the liver via the cytochrome P450 system and interactions with drugs metabolized by the same system are possible. Evidence is becoming available which suggests that pantoprazole may have less potential to interact with the cytochrome P450 system than the other proton pump inhibitors. In the case of diazepam metabolism, pantoprazole had the least effect on prolongation of the diazepam effect. This may well be an advantage in the clinical use of the drug.     

2008～2009年我院质子泵抑制剂应用情况分析

目的：了解质子泵抑制剂的应用情况及趋势。方法：对质子泵抑制剂的品种、消耗量、销售金额、用药频度（DDDs）、日均费用（DDC）进行综合分析。结果：2008～2009年我院质子泵抑制剂的销售金额以每年大于75.90%的幅度递增,其中,注射用泮托拉唑钠、雷贝拉唑钠肠溶胶囊增长较快,DDC则呈逐年下降趋势。结论：质子泵抑制剂是一类很有发展潜力的药物,注射用泮托拉唑和雷贝拉唑钠肠溶胶囊的用量将不断上升。     

质子泵抑制剂市场前景看好

目的：消化性溃疡是一种常见病和多发病,质子泵抑制剂是目前治疗消化性溃疡病抑制胃酸分泌最强的药物,质子泵抑制剂市场的现状和进展是人们关注的热点。方法：调查近年来长江流域上海、杭州、南京、武汉、成都和重庆六城市样本医院质子泵抑制剂品种用药金额、排序、份额、增长率及临床评价。结果：常用品种为奥美拉唑、泮托拉唑、埃索美拉唑、雷贝拉唑和兰索拉唑,其中用药金额名列第1是奥美拉唑,第2是泮托拉唑。结论：质子泵抑制剂市场前景看好。