2018 年第 3 期 第 13 卷

医院门诊抗高血压药物应用现况研究

作者：王丽君李亚冬高绪霞马立萍

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单位：100029首都医科大学附属北京安贞医院全科医疗科

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• 摘要：

• 目的    调查首都医科大学附属北京安贞医院门诊抗高血压药物的应用现况。方法    回顾性调查2015年5—12月首都医科大学附属北京安贞医院门诊高血压患者的就诊信息；筛选出北京市医疗保险、本院门诊就诊次数＞1且研究期间抗高血压药物治疗方案不变的处方187 047张，涉及患者14 768例。按照就诊科室进行分组，分为全科医疗科、心内科、高血压科、其他科，汇总各科室抗高血压药物治疗方案的处方数，并分析二联用药指南推荐方案的应用情况。结果    筛选出的187 047张处方中，单一用药处方数为92 423张(49.4%)，联合用药处方数为94 624张(50.6%)。高血压科的联合用药占比明显高于全科医疗科、心内科和其他科［69.6%(34 117/48 985)比45.8%(20 582/44 961)、45.1%(23 703/52 612)、40.1%(16 222/40 489)］(均P＜0.05)。高血压科的复方制剂应用占比明显高于全科医疗科、心内科和其他科［49.2%(16 785/34 117)比42.0%(8 647/20 582)、39.5%(9 361/23 703)、31.6%(5 132/16 222)］(均P＜0.05)。高血压科的二联用药指南推荐方案应用占比明显高于其他各科［80.5%(10 211/12 689)比76.7%(7 700/10 037)、76.8%(9 366/12 199)、75.6%(7 103/9 398)］(均P＜0.05)；各科室均以钙离子拮抗剂＋血管紧张素Ⅱ受体拮抗剂方案为主。结论    我院门诊高血压患者药物治疗方案以联合用药为主。高血压科门诊在二联用药方案的选择上较全科医疗科、心内科和其他科更符合指南推荐。

• Objective    To investigate the use status of anti-hypertensive drugs in outpatients. Methods    A retrospective study was conducted in Beijing Anzhen Hospital, Capital Medical University from May to December 2015. Totally 187 047 medical prescriptions of constant anti-hypertensive regimens in 14 768 hypertensive outpatients with Beijing medical insurance and more than 1 time of visiting were included. The prescriptions of anti-hypertensive drugs were analyzed among departments of general medical practice, cardiology, hypertension and other subjects; the application status of dual-drug regimens which were recommended in guidelines was analyzed. Results    In 187 047 prescriptions, single-drug regimen accounted for 92 423(49.4%), and drug combination accounted for 94 624(50.6%). Drug combination rate in hypertension department was significantly higher than that in general medical practice, cardiology and other departments［69.6%(34 117/48 985) vs 45.8%(20 582/44 961), 45.1%(23 703/52 612), 40.1%(16 222/40 489)］(P＜0.05). Compound preparation use rate in hypertension department was significantly higher than that in general medical practice, cardiology and other departments［49.2%(16 785/34 117) vs 42.0%(8 647/20 582), 39.5%(9 361/23 703), 31.6%(5 132/16 222)］(P＜0.05). Use rate of dual-drug recommended in guidelines in hypertension department was significantly higher than that in general medical practice, cardiology and other departments［80.5%(10 211/12 689) vs 76.7%(7 700/10 037), 76.8%(9 366/12 199), 75.6%(7 103/9 398)］(P＜0.05), and the regimen of calcium channel blockers＋angiotensin receptor antagonists was the most widely used. Conclusions    Drug combination is the predominant therapeutic regimen for hypertensive patients. Outpatient use status of anti-hypertensive agents in department of hypertension is acceptable in accordance with guidelines.