本文關鍵詞：抗高血壓藥物在某醫(yī)院的應用及典型藥物有效性和安全性的Meta分析　出處：《山西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

  更多相關文章： 抗高血壓藥物 聯(lián)合用藥 左旋氨氯地平 氨氯地平 Meta分析

【摘要】：研究目的 本研究旨在通過了解山西省太原市某三甲醫(yī)院門診7類口服抗高血壓藥物應用情況；以及抗高血壓藥物鈣通道阻滯劑中典型藥物左旋氨氯地平和氨氯地平的有效性和安全性進行系統(tǒng)性的評價，為臨床用藥提供經(jīng)濟、合理、安全、有效的依據(jù)。 研究方法 統(tǒng)計2012年高血壓處方，以藥品通用名為依據(jù)進行分類匯總，采用Microsoft excel軟件，對2012年1月至12月抗高血壓藥物種類、數(shù)量、金額總數(shù)進行統(tǒng)計并排序，計算各種類所占的比例。 計算機檢索外文Pubmed數(shù)據(jù)庫，中文數(shù)據(jù)庫中的萬方數(shù)據(jù)庫、中國知識資源總庫（CNKI）、維普數(shù)據(jù)庫（VIP），對納入比較抗高血壓典型藥物氨氯地平與左旋氨氯地平治療高血壓的隨機對照試驗（RCT），并對研究方法學進行質量評價，應用ReMan4.2軟件進行統(tǒng)計分析。 研究結果 （1）統(tǒng)計該醫(yī)院7類抗高血壓藥物銷售金額，以CCB、ARB、β-RB銷售金額分別位居一、二、三位，利尿劑與a1受體阻滯劑的利用相對較少。 （2）統(tǒng)計7類抗高血壓藥物的DDDs值，鈣拮抗劑與其他抗高血壓藥物應用頻度相比更高，提示抗高血壓藥物中以鈣拮抗劑使用頻數(shù)最大。 （3）DDDs排列前10名的抗高血壓藥物中以鈣通道阻滯劑占主導地位，其中有左旋氨氯地平、硝苯地平、氨氯地平分別位于一、三、四位。 （4）抗高血壓藥在《國家基本藥物目錄》與《山西省增補目錄》的應用情況符合非基層醫(yī)院基本藥物使用金額比例以及衛(wèi)生部的相關要求，并且覆蓋品種數(shù)各有特色，沒有重復品種。 （5）在鈣通道阻滯劑中，以DDC值比較低的硝苯地平緩釋片和左旋氨氯地平，DDC值較高的進口藥物氨氯地平的銷售量大。CCB類合資藥物DDC值比國產(chǎn)藥物稍高，以長效及合資的藥物DDDs值高。 （6）藥物的聯(lián)合使用以兩種藥物聯(lián)合應用為主，以CCB與ARB、CCB與β-RB、CCB與ACEI聯(lián)用最多，，藥物的聯(lián)合應用以CCB為基礎，其符合ESH/ESC高血壓研究指南提出優(yōu)勢搭配組合的建議，同時也符合文獻報道的應用最多的搭配組合。 （7）文獻檢索，共納入左旋氨氯地平與氨氯地平治療高血壓的隨機對照試驗（RCT），37項RCT，合計5297例患者。Meta分析結果表明，左旋氨氯地平和氨氯地平均能有效降低血壓，總有效率OR＝0.82，95%CI（0.69，0.97），P＝0.02；但是24小時平均舒張壓下降值合并效應量WMD＝-0.82，95%CI（-1.50，-0.14），P＝0.02；診室收縮壓下降值SMD＝－5.8，95%CI（－8.81，－1.75），P＝0.03；增加劑量人數(shù)合并效應量OR＝0.73，95%CI（0.54，0.99），P＝0.04；不良反應發(fā)生率OR＝0.36，95％CI（0.29，0.45），P＜0.00001；均有統(tǒng)計學意義。24小時平均收縮壓下降值WMD＝0.24，95%CI（-0.40，0.88），P＝0.47，診室舒張壓下降值兩組比較差異無統(tǒng)計學意義，合并效應量SMD＝-1.37，95％CI（－3.15，0.40），P＝0.13。 結論 （1）該醫(yī)院應用抗高血壓藥物以CCB、ARB、β-RB的銷售金額及DDDs排列前三。 （2）抗高血壓藥物中基本藥物的銷售金額超過總銷售抗高血壓藥物金額的25%至30%，該醫(yī)院使用基本藥品的量符合相關規(guī)定。 （3）在DDDs值排前十的藥物中，左旋氨氯地平、氨氯地平分別位于一、四位。 (4)藥物的DDC值95%集中在0~6.99元之間，常用的抗高血壓藥物的價格主要集中在低中價位。 (5)藥物聯(lián)合應用以兩種藥物聯(lián)合應用為主，三聯(lián)、四聯(lián)用藥的處方比較少，聯(lián)合用藥以CCB為基礎。 (6)藥物聯(lián)合應用符合ESH／ESC高血壓研究指南提出優(yōu)勢搭配組合的建議，同時也符合文獻報道的應用最多的搭配組合。 (7)左旋氨氯地平治療高血壓的療效優(yōu)于氨氯地平，降低24小時動態(tài)舒張壓、診室收縮壓的效果更好，不良反應更少；24小時收縮壓的下降值在統(tǒng)計學上沒有意義，但是在臨床效果上左旋氨氯地平優(yōu)于氨氯地平；在診室舒張壓下降值中2組比較沒有統(tǒng)計學意義，臨床效果也相當。綜合來看，左旋氨氯地平效果較好。
[Abstract]:research objective
This study aims to understand the Shanxi city of Taiyuan province in a hospital outpatient 7 kinds of oral application of anti hypertension drugs; and to evaluate the efficacy and safety of antihypertensive drugs and calcium channel blockers in typical drug amlodipine and amlodipine system, for clinical use to provide economic, reasonable, safe and effective. On the basis of.
research method
The prescriptions of hypertension in 2012 were collected and classified according to the general name of drugs. The Microsoft Excel software was used to make statistics and sort the categories, amount and total amount of antihypertensive drugs from January 2012 to December, and calculate the proportion of all kinds of drugs.
Computer retrieval of foreign Chinese database in Pubmed database, Wanfang database, Chinese knowledge resources database (CNKI), VIP database (VIP), randomized controlled trials of antihypertensive drugs included in the comparison of typical amlodipine and amlodipine in the treatment of hypertension (RCT), and the research methodology to evaluate the quality of the application ReMan4.2 software was used for statistical analysis.
Research results
(1) the sales volume of 7 kinds of antihypertensive drugs in the hospital was counted. The sales amount of CCB, ARB, and beta -RB ranked two, three, respectively, and the utilization of diuretics and A1 receptor blockers was relatively small.
(2) statistics of the DDDs values of the 7 kinds of antihypertensive drugs. Calcium antagonists and other antihypertensive drugs have higher application frequency, suggesting that the frequency of calcium antagonists is the largest among antihypertensive drugs.
(3) calcium channel blockers dominate the top 10 antihypertensive drugs in DDDs. Among them, Levamlodipine, nifedipine and amlodipine are at three, four respectively.
(4) the application of antihypertensive drugs in the national essential drug list and the Shanxi supplementary catalogue is in line with the proportion of essential drugs used in non basic hospitals and the relevant requirements of the Ministry of health, and the number of varieties covered with different characteristics is not repeated.
(5) in calcium channel blockers, the DDC value of Extended Release Nifedipine Tablets and Levamlodipine were relatively low, the sales of amlodipine with high DDC value and the DDC value of.CCB class joint drugs were slightly higher than those of domestic drugs, and the DDDs value of long-acting and joint venture drugs was high.
(6) the combined use of drugs in the two drug combination, with CCB and ARB, CCB and beta -RB, CCB and ACEI together with the highest combined use of drugs based on CCB, which conforms to the ESH/ESC hypertension research guide presents advantages of collocation suggestions, but also meet the application reported combination up the collocation.
(7) literature retrieval, randomized controlled trials of amlodipine and amlodipine in the treatment of hypertension were included (RCT), 37 RCT, a total of 5297 cases of patients with the results of.Meta analysis showed that amlodipine and amlodipine can effectively reduce blood pressure, the total efficiency of OR = 0.82,95%CI (0.69,0.97, P) = 0.02; but 24 hours average diastolic blood pressure decreased the value of the combined effect of the amount of WMD = -0.82,95%CI (-1.50, -0.14), P = 0.02; consulting room systolic blood pressure decreased value of SMD = 5.8,95%CI (- 8.81, - 1.75), P = 0.03; increase the number of doses of the combined effect of the amount of OR (0.54,0.99) = 0.73,95%CI, P = 0.04 the incidence of adverse reaction; OR = 0.36,95%CI (0.29,0.45), P < 0.00001; there was statistically significant.24 hour average systolic blood pressure decreased value of WMD = 0.24,95%CI (-0.40,0.88), P = 0.47, the consulting room decreased diastolic blood pressure values of the two groups were not statistically significant, the combined effect of the amount of SMD (= -1.37,95%CI 3.15,0.40), P = 0.13.
conclusion
(1) the hospital used antihypertensive drugs for the sales of CCB, ARB, beta -RB and the top three of the DDDs arrangement.
(2) the sales amount of essential drugs in antihypertensive drugs is over 25% to 30% of the total sales of antihypertensive drugs. The amount of essential medicines in the hospital is in conformity with the relevant provisions.
(3) among the ten drugs before the DDDs value, levoamlodipine and amlodipine were one, four, respectively.
(4) the DDC value 95% of the drug is concentrated between the 0~6.99 yuan, and the price of the commonly used antihypertensive drugs is mainly concentrated in the low middle price.
(5) the combination of drugs is mainly used in combination with two kinds of drugs, and the prescription of the combination of the four drugs is relatively small, and the combination of the drugs is based on the CCB.
(6) the combination of ESH / ESC hypertension research guidelines, which conforms to the most applied combination of the literature.
(7) amlodipine in the treatment of hypertension efficacy than amlodipine, reduce 24 hour ambulatory diastolic blood pressure, systolic blood pressure of the consulting room is better, less adverse reaction decreased; 24 hour systolic blood pressure values were not statistically significant, but the levo amlodipine is better than amlodipine in the clinical effect in the consulting room; diastolic blood pressure decreased values in the 2 groups was not statistically significant, the clinical effect is quite good. Overall, s-amlodipine effect.

【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R954

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