目的：回顾性分析我院住院患者2016年质子泵抑制剂（PPIs）的使用情况，了解PPIs在我院的合理应用情况，针对PPIs专项整治活动的开展提出建议。方法：调取2016年住院患者PPIs用药数据，包括药品名称、使用金额、临床诊断、用法用量、疗程、使用人数等，并对PPIs使用率排名前10位的临床科室随机抽取500份病历（50份/科）进行用药合理性分析。结果：我院PPIs的不合理使用存在的主要问题有无指征用药、品种选择不当、疗程过长、用法用量不合理、存在药物相互作用等。结论：应尽快开展PPIs专项整治活动。由行政部门制定点评方案并实施；由药剂科临床药学室具体开展PPIs专项整治工作，确定评价内容和抽检病历方案，并对不合理病历进行干预和点评后再干预工作；在PPIs专项整治工作早期开展宣传和培训工作，以期推动我院PPIs的合理应用。
Objective: To retrospectively analyze the application of proton pump inhibitors (PPIs) of inpatients in our hospital in 2016, to understand the situation of the rational use of PPIs, and to put forward Suggestions for the special rectifcation for PPIs. Methods: Data concerning the medication of PPIs of inpatients including drug name, amount of use, clinical diagnosis, usage and dosage, medical course, and number of users, etc. were collected. 500 medical records (50 per department) were randomly selected from the top 10 clinical departments by using PPIs and the rational use of PPIs was analyzed. Results: The main problem of the irrational use of PPIs consisted of medication without indication, inappropriate variety selection, long medical course, unreasonable usage and dosage as well as drug interactions. Conclusion: The special rectifcation for PPIs should be carried out as soon as possible. The review plan should be formulated and implemented by administrative departments. The special rectification work should be carried out by the division of clinical pharmacy of the department of pharmacy, such as the confrmation of evaluation content and the plan of sampling the medical records, reviewing the unreasonable medical records and the reevaluation. The publicity and training work should be carried out in the early stage of the special rectifcation in order to promote rational use of PPIs.
[1] Forgacs I,Loganayagam A. Overprescribing Proton Pump Inhibitors[J]. BMJ,2008,336(7634):2-3.
[2] Use of Proton Pump Inhibitors and the Risk of Listeriosis:A Nationwide Registry-based Case-control Study[J]. Clin Infect Dis,2017,64(7):845-851.
[3] 黄瑾,刘正跃,田泾. 长期大剂量使用质子泵抑制剂的严重不良反应和药学监护[J]. 中国医院药学杂志, 2012,32,(20):1648-1651.
[4] 于磊,于丽媛,孙鲁宁,等. 质子泵抑制剂致肾脏不良反应研究进展[J]. 中国医院药学杂志,2017, (16):106-109.
[5] 甘国保,雷招宝. 质子泵抑制剂与低镁血症[J]. 国际药学研究杂志,2017,44(4):311-314.
[6] Daniel E. Freedberg, Lawrence S. Kim,Yu-Xiao Yang. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors:Expert Review and Best Practice Advice From the American Gastroenterological Association[J]. Gastroenterology,2017,152(4):706-715.
[7] William D. Chey,Grigorios I. Leontiadis,Colin W. Howden,et al. ACG Clinical Guideline:Treatment of Helicobacter Pylori Infection[J].Am J Gastroenterol, 2017,(1):1-27.
[8] 刘文忠,谢勇,陆红,等. 第五次全国幽门螺旋杆菌感染处理共识报告[J]. 中华消化杂志,2017,37(6):364-378.
[9] 中国医师协会胰腺病学专业委员会. 中国急性胰腺炎多学科(MDT)诊治共识意见(草案)[J].中华胰腺病杂志,2015,15(4):217-224.
[10] 中华消化杂志编委会. 消化性溃疡病诊断与治疗规范:2013年深圳[J]. 中华消化杂志,2014,34(2):73-76.
[11] 中华医学会老年医学分会. 老年人质子泵抑制剂合理应用专家共识[J]. 中华老年医学杂志,2015,34(10):1045-1051.
[12] 中华医学会老年医学分会. 老年人功能性消化不良诊治专家共识[J]. 中华老年医学杂志,2015,34(7):698-704.
[13] 中华医学会消化病学分会. 2014年中国胃食管反流病专家共识意见[J]. 中华消化杂志,2014,34(10):649-661.
[14] 中国医师协会急诊医师分会. 急性上消化道出血急诊诊治流程专家共识[J]. 中国急救医学,2015,35(10):865-873.
[15] 中华内科杂志,中华医学杂志,中华消化杂志,等.急性非静脉曲张性上消化道出血诊治指南(2015年,南昌)[J]. 中华消化杂志,2015,35(12):793-798.
[16] 中国抗癌协会癌症康复与姑息治疗专业委员会. 肿瘤治疗相关呕吐防治指南:2014版[J]. 临床肿瘤学杂志, 2014,19(3):263-273.
[17] 湖南省临床用药质控中心. 湖南省质子泵抑制剂的临床应用指导原则:试行[J]. 中南药学,2016,14(7):673-683.
[18] 应激性溃疡防治专家组. 应激性溃疡防治专家建议:2015版[J]. 中华医学杂志,2015,95(20):1555-1557.
[19] 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华内科杂志,2015,54(6):557-581.
[20] 国家风湿病数据中心,中国系统性红斑狼疮研究协作组.非甾体消炎药相关消化道溃疡与溃疡并发症的预防与治疗规范建议[J]. 中华内科杂志,2017,56(1):81-85.
[21] 陈新谦. 新编药物学[M]. 第17版. 北京:人民卫生出版社,2011.
[22] 高申,邹多武.质子泵抑制剂临床应用的药学监护[M]. 北京:人民卫生出版社,2013:7-8.
[23] 抗栓治疗消化道损伤防治专家组. 抗栓治疗消化道损伤防治中国专家建议(2016.北京)[J]. 中华内科杂志, 2016,55(7):564-567.
[24] 中华预防医学会卒中预防与控制专业委员会介入学组. 2015缺血性脑血管病介入治疗抗血小板策略中国专家共识[J]. 中华医学杂志,2015,95(11):803-809.
[25] 中华医学会外科学分会. 应激性黏膜病变预防与治疗:中国普通外科专家共识(2015)[J]. 中国实用外科杂志,2015,35(7):728-730.
[26] 中国医师协会急诊医师分会. 中国急性胃黏膜病变急诊专家共识[J]. 中国急救医学,2015,35(9):769-775.
[27] Craing DGH,Thimappa R,Anand V,et al. Inappropriate Utilization of Intravenous Proton Pump Inhibitors in Hospital Practice:A Prospective Study of the Extent of the Problem and Predictive Factors[J]. QJM,2010,103(5):327-335.
[28] FDA.FDA Drug Safety Communication:Possible Increased Risk of Fractures of the Hip,Wrist, and With the Use of Proton Pump Inhibitors[EB/OL].(2011-03-23)[2017-04-15]. http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm213206. htm.
[29] Li HB,Zhao RS. Evidence-based Evaluation of Fracture Risk in Clinical Therapy with Proton Pump-inhibitor[J]. Clinical Medication Journal,2014,12:1-8.
[30] Charlot M,Grove EL,Hansen PR,et al. Proton Pump Inhibitor Use and Risk of Adverse Cardiovascular Events in Aspirin Treated Patients with First Time Myocardial Infarction:Nationwide Propensity Score Matched Study[J]. BMJ,2011,342:d2690.
[31] Wedemeyer RS,Blume H. Pharmacokinetic Drug Interaction Profiles of Proton Pump Inhibitors:An Update[J]. Drug Saf,2014,37:201-211.
[32] 赵大贵,聂川江,张晋丹. 2169张门诊口服质子泵抑制剂不合理用药处方分析[J]. 中国药业,2014,23, (1):50-51.
[33] Clark DW,Strandell J. Myopathy Including Polymyositis:A Likely Class Adverse Effect of Proton Pump Inhibitors[J]. Eur J Clin Pharmacol,2006,62(6):473-479.
