Investigation and analysis of problems related to clinical application of hypoglycemic drugs in diabetic patients
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摘要:
目的 基于西班牙分类法(Granada-Ⅱ)对住院糖尿病患者降糖药临床应用中的药物相关问题(DRPs)进行调查和分析。 方法 采用回顾性研究，选取2023年1—12月于蚌埠市第二人民医院出院的400例糖尿病患者作为研究对象。根据西班牙分类法(Granada-Ⅱ)对患者的药物治疗方案进行评估和分类。 结果 共纳入400例住院糖尿病患者，男性202例、女性198例，涉及16个科室。根据Granada-Ⅱ分类法对这些患者的药物治疗方案进行评估和分类，结果显示，研究对象DRPs发生人数77例(发生率为19.25%)，包括DRP3(55例，13.75%)、DRP5(50例，12.50%)、DRP6(23例，5.75%)。总药次为150药次。其中，用法不适宜(65药次，43.33%)问题最为突出，其次为超推荐剂量用药(24药次，16.00%)、配伍禁忌(23药次，15.33%)，联合相互作用药物(20药次，13.33%)、禁忌证用药(18药次，12.00%)发生率较低。 结论 蚌埠市第二人民医院住院糖尿病患者降糖药的使用仍存在一定问题，包括配伍禁忌、用法不适宜等，可采用Granada-Ⅱ分类法进行评估。针对药物剂量错误、药物相互作用等常见DRPs，临床治疗应加强患者教育、优化药物治疗方案、提供个体化的用药指导，以减少DRPs的发生。 -
关键词:
- 糖尿病 /
- Granada-Ⅱ分类法 /
- 住院患者 /
- 降糖药 /
- 药物相关问题
Abstract:Objective Based on the Spanish classification (GRANADA-Ⅱ), drug-related problems (DRPs) in the clinical application of hypoglycemic drugs in inpatients with diabetes is investigated and analyzed. Methods A retrospective study was conducted to select 400 hospitalized patients with diabetes admitted to Bengbu Municipal Second People Hospital from January 2023 to December 2023 as the study objects. Drug regimens were evaluated and classified according to the Spanish classification (Granada-Ⅱ). Results A total of 400 hospitalized diabetic patients were included, including 202 males and 198 females, involving a total of 16 departments. Drug regimens for these patients were evaluated and classified according to the Granada-Ⅱ classification. The results showed that there were DRPs occurred in 77 cases (19.25%), including DRP3 (55 cases, 13.75%), DRP5 (50 cases, 12.50%), and DRP6 (23 cases, 5.75%). The total dosage was 150 doses. Among them, the inappropriate usage [65 doses (43.33%)] was the most prominent, followed by over-recommended dose medication [24 doses (16.00%)] and incompatibility[23 doses (15.33%)], combined interaction drugs [20 doses (13.33%)] and the lowest incidence was contraindications [18 doses (12.00%)]. Conclusion There are still some problems in the use of hypoglycemic drugs in patients with diabetes in Bengbu Municipal Second People Hospital, including incompatibility and inappropriate usage, which can be evaluated by Granada-Ⅱ classification. For common DRPs such as drug dose errors and drug interactions, clinical treatment should strengthen patient education, optimize drug treatment plan, and provide individualized medication guidance to reduce the occurrence of DRPs. -
Key words:
- Diabetes /
- Granada-Ⅱ classification /
- Hospitalized patients /
- Hypoglycemic drugs /
- Drug related problems
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表 1 基于Granada-Ⅱ分类法评价住院患者应用降糖药的DRPs分类标准
Table 1. DRPs classification criteria for evaluating hypoglycemic drug use in inpatients based on the Granada-Ⅱ classification
项目 分类 药物相关问题 主要表现 必要性 DRP1 疾病未得到适当药物治疗 未使用所需药物 DRP2 使用不必要药物 无用药指征，适应证不适宜 有效性 DRP3 药物非定量的无效 错误地使用药物 DRP4 药物定量的无效 药物使用剂量过低，使用次数过少，疗程不足 安全性 DRP5 药物非定量的安全问题 患者使用存在潜在安全问题的药物，禁忌证用药，药物不良反应，配伍禁忌，药物相互作用，用药途径不适宜，联合用药未冲管。 DRP6 药物定量的安全问题 重复用药，剂量过量，疗效过长 
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表 2 蚌埠市第二人民医院各科室住院糖尿病患者降糖药DRPs发生情况
Table 2. Occurrence of hypoglycemic DRPs in diabetic inpatients across various departments of Bengbu Municipal Second People' s Hospital
科室 例数 发生DRPs患者例数 DRP3 DRP5 DRP6 呼吸与危重症医学科 52 6 用法不适宜 配伍禁忌 无 (1药次，6例) (1药次，5例) 联合相互作用的药物
(1药次，1例)
(2药次，1例)
禁忌证用药
(1药次，1例)骨科 8 0 无 无 无 全科医学科 10 1 无 联合相互作用的药物 无 (1药次，1例) 内分泌科 103 30 用法不适宜 配伍禁忌 超推荐剂量用药 (1药次，15例)
(2药次，5例)(1药次，11例)
(2药次，1例)(1药次，18例)
(2药次，1例)(4药次，1例) 联合相互作用的药物 (1药次，3例)
(2药次，1例)普外科 5 0 无 无 无 神经内科 37 3 用法不适宜 配伍禁忌 无 (1药次，2例) (1药次，1例) (2药次，1例) 神经外科 8 0 无 无 无 肾内科 5 0 无 无 无 消化内科 5 2 无 无 超推荐剂量用药 (1药次，2例) 心律失常科 19 5 用法不适宜 禁忌证用药 超推荐剂量用药 (1药次，4例) (1药次，3例) (1药次，1例) 心胸血管外科 2 0 无 无 无 心血管科 1 0 无 无 无 心血管内科 139 30 用法不适宜 配伍禁忌 超推荐剂量用药 (1药次，20例) (1药次，1例) (1药次，1例) (2药次，1例) 联合相互作用的药物 (1药次，5例)
(2药次，1例)
(4药次，1例)
禁忌证用药
(1药次，14例)心血管外科 1 0 无 无 无 眼科 4 0 无 无 无 中医科 1 0 无 无 无 总计 400 77
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表 3 蚌埠市第二人民医院住院患者降糖药各类DRPs分布情况
Table 3. Distribution of hypoglycemic drug-related DRPs in inpatients at Bengbu Municipal Second People' s Hospita
分类 主要表现 1药次
(例)2药次
(例)3药次
(例)4药次
(例)5药次
(例)6药次
(例)总药次
[例(%)]DRP3 用法不适宜 47 7 0 1 0 0 65(43.33) DRP5 配伍禁忌 21 1 0 0 0 0 23(15.33) 禁忌证用药 18 0 0 0 0 0 18(12.00) 联合相互作用药物 10 3 0 1 0 0 20(13.33) DRP6 超推荐剂量用药 22 1 0 0 0 0 24(16.00)
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