發(fā)布時(shí)間：2018-03-22 01:21

  本文選題：肝炎病毒　切入點(diǎn)：干擾素　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：為了規(guī)范醫(yī)院藥品的使用與管理,切合三甲醫(yī)院評(píng)審的要求,完善藥事管理工作,以我院主流藥品抗肝炎病毒藥物為主線,通過分析抗肝炎病毒藥物使用與管理方面存在的問題,建立可行性的研究與解決方法,進(jìn)一步探索適合我院實(shí)際情況的符合三甲醫(yī)院評(píng)審要求的藥品使用與管理模式。 方法：通過對(duì)抗肝炎病毒藥物藥物的用法用量、適應(yīng)癥、耐藥性、治療指南的變化分析藥物的合理應(yīng)用。采用處方分析的方法對(duì)含有抗肝炎病毒藥物的處方進(jìn)行分析,研究使用抗肝炎病毒藥物的情況,分析應(yīng)用的合理性,調(diào)查抗肝炎病毒藥物聯(lián)合應(yīng)用的種類、模式,評(píng)價(jià)聯(lián)合用藥對(duì)肝炎治療效果的影響；采用藥物利用評(píng)價(jià)的方法,分析我院2009年—2013年抗肝炎病毒藥物的出庫金額和種類分布,對(duì)抗肝炎病毒藥物的使用進(jìn)行統(tǒng)計(jì),分析其規(guī)律性；采用庫存管理的ABC分析法和動(dòng)態(tài)庫存分析法,分析抗肝炎病毒藥物的庫存金額、周轉(zhuǎn)率、周轉(zhuǎn)天數(shù)的變化,并進(jìn)行動(dòng)態(tài)庫存監(jiān)督。 結(jié)果：藥物說明書、指南是藥物使用的依據(jù)。藥物市場(chǎng)份額的變化與藥物的療效不良反應(yīng)有關(guān)。20000張?zhí)幏椒治鲲@示,有4336例接受抗病毒治療的患者,包括342例慢性丙型肝炎,3019例慢性乙型肝炎；其中代償性肝硬化850例,失代償性肝硬化125例。81%的患者接受單藥抗病毒治療,19%的患者接受聯(lián)合用藥治療。藥物利用研究表明,抗肝炎病毒藥物總體呈現(xiàn)增長趨勢(shì),核苷(酸)類藥物占抗病毒藥物總銷售額的73%,成為抗病毒治療的主流藥物。干擾素類藥物中,500萬IU重組人干擾素α-2b和180萬IU聚乙二醇干擾素α-2a占主導(dǎo)地位。從DDDs值來看,阿德福韋酯、拉米夫定的DDDs5年中一直居前。對(duì)藥品庫存進(jìn)行優(yōu)化管理后,在藥品銷售額變化無統(tǒng)計(jì)學(xué)差異的情況下(P0.05),優(yōu)化后的藥品庫存金額、庫存周轉(zhuǎn)率、庫存周轉(zhuǎn)天數(shù)均與優(yōu)化前相比有極顯著性差異(P0.01)。通過對(duì)單品種藥品的動(dòng)態(tài)監(jiān)測(cè)來看,藥品阿德福韋酯片、恩替卡韋膠囊、恩替卡韋片的累積入庫曲線與累積出庫曲線之間的距離均比實(shí)施零庫存之前短。 結(jié)論：我院抗肝炎病毒藥物應(yīng)用基本合理,但尚需加強(qiáng)兒童患者用藥研究、聯(lián)合抗病毒治療的研究以及患者耐藥后的管理；藥物的療效、安全性、經(jīng)濟(jì)性是肝病抗病毒藥物選擇的影響因素；實(shí)施零庫存之后,抗肝炎病毒藥品庫存大大降低,在提高周轉(zhuǎn)率的同時(shí)降低了藥品周轉(zhuǎn)天數(shù),減少了資金的占用。以上分析研究表明規(guī)范藥品的使用與管理工作是當(dāng)今醫(yī)院提高核心競(jìng)爭(zhēng)力的有力武器之一。規(guī)范醫(yī)院藥事管理工作,加強(qiáng)醫(yī)院藥品全過程的管理,建立長期的監(jiān)管機(jī)制,是可行的和有必要的。
[Abstract]:Objective: in order to standardize the use and management of hospital drugs, meet the requirements of the third Class A hospital review, improve the drug management, take the mainstream drugs and anti-hepatitis virus drugs in our hospital as the main line. By analyzing the problems existing in the use and management of antiviral drugs and establishing feasible research and solutions, this paper further explores the drug use and management model suitable for the needs of the third Class A Hospitals in our hospital. Methods: the rational use of antiviral drugs was analyzed by using dosage, indication, drug resistance and treatment guidelines. Prescription analysis was used to analyze the prescriptions containing antiviral drugs. To study the use of anti-hepatitis virus drugs, to analyze the rationality of their application, to investigate the types and patterns of combined use of anti-hepatitis virus drugs, to evaluate the effect of combined use of drugs on the treatment of hepatitis, and to use the method of drug utilization evaluation. The amount and distribution of antiviral drugs in our hospital from 2009 to 2013 were analyzed, and the use of anti-hepatitis virus drugs was analyzed. Analyze the changes of stock amount, turnover rate and turnover days of antiviral drugs, and carry out dynamic inventory monitoring. Results: drug instructions, guidelines are the basis for drug use. Changes in drug market share are related to adverse drug efficacy. Analysis of 20, 000 prescriptions showed that 4336 patients received antiviral therapy. Including 342 cases of chronic hepatitis C and 3019 cases of chronic hepatitis B, 850 cases of compensatory cirrhosis and 125 cases of decompensated cirrhosis of liver were treated with single antiviral therapy. Anti-hepatitis virus drugs generally show an increasing trend. Nucleoside (acid) drugs account for 73% of the total sales of antiviral drugs, and have become the mainstream of antiviral therapy. Of the interferon drugs, 5 million IU recombinant human interferon 偽 -2b and 1.8 million IU polyethylene glycol interferon 偽 -2a are dominant. Adefovir ester, DDDs5 of lamivudine has been in the top position in the middle of the year. After optimizing the management of drug inventory, without statistical difference in the change of drug sales, the optimized amount of drug inventory, inventory turnover rate, The days of inventory turnover were significantly different from those before optimization (P 0.01). According to the dynamic monitoring of single drug varieties, Adefovir tablets, entecavir capsules, The distance between cumulative entry curve and cumulative exit curve of entecavir sheet is shorter than that before zero inventory. Conclusion: the use of antiviral drugs in our hospital is basically reasonable, but it is still necessary to strengthen the study of drug use in children patients, the study of combined antiviral therapy and the management of patients after drug resistance, the efficacy and safety of drugs, Economy is the influence factor of antiviral drug selection in liver disease. After zero stock is implemented, the antiviral drug stock is greatly reduced, which increases the turnover rate and reduces the number of days of drug turnover at the same time. The above analysis shows that standardizing the use and management of drugs is one of the powerful weapons to improve the core competitiveness of hospitals. The establishment of a long-term regulatory mechanism is feasible and necessary.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R95

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1 王海英;抗肝炎病毒藥物應(yīng)用情況調(diào)研及庫存優(yōu)化管理[D];山東大學(xué);2014年

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本文編號(hào)：1646429