浙江省质子泵抑制剂院内合理应用管控专家共识

Expert consensus on the rational application management and control of proton pump inhibitors in the Hospitals of Zhejiang Province (2020 version)

关键词:  质子泵抑制剂  合理应用  院内管控

Key words:  proton pump inhibitor  rational application  management and control in the hospitals

摘要:

质子泵抑制剂（proton pump inhibitor，PPI）可以通过抑制胃壁细胞上的H+/K+-ATP酶，强效而持久地抑制胃酸分泌。它的出现彻底改变了酸相关性疾病的治疗方案，其有效性与安全性已得到充分证实，是适应证明确的治疗用药。 近年来，国内外PPI使用量不断增长，其潜在风险和不合理应用问题逐渐凸显，成为一个全球性的问题。相关研究指出，PPI预防性用药不合理使用问题突出，包括无适应证用药、给药途径不适宜、疗程过长、单次剂量过大、品种选择不适宜、溶媒品种及剂量选择不合理、联合用药和特殊人群用药不适宜等。目前PPI是各大医疗机构合理用药重点关注药品，但是现有管控方式普遍存在不科学、不合理的情况，因此探索一套科学规范的管控方案是有效控制此类药品临床不合理使用的当务之急。鉴于当前我国上市的PPI厂家品种规格众多，各种PPI说明书的适应证存在较大差异，而相关指南存在多个不清晰的地方，因此，亟待建立统一的PPI管理方案以指导临床安全合理用药。 因此，浙江省质子泵抑制剂院内合理应用管控专家意见共识组在广泛征求临床医学、药学和医院管理等领域相关专家意见后，撰写了本意见，旨在为各地区各级医疗机构建立规范的PPI处方点评标准，对院内PPI不合理用药实施管控提供指导和建议，以期规范医师处方，促进合理用药，提高处方质量，完善药事服务，保障患者的用药权益。

Abstract:

Proton pump inhibitor (PPI) can inhibit the secretion of gastric acid strongly and persistently by inhibiting the H+/K+-ATPase on gastric parietal cells. Its appearance has completely changed the treatment plan for acid-related diseases. Its effectiveness and safety have been fully confirmed, and it is a therapeutic drug with clear indications. In recent years, the use of PPI at home and abroad has been increasing, and its potential risks and unreasonable application problems have gradually become prominent and become a global problem. Relevant studies have pointed out that the problem of unreasonable use of PPI preventive drugs is prominent, including the use of drugs without indications, inappropriate routes of administration, too long a course of treatment, excessive single doses, inappropriate selection of varieties, unreasonable selection of solvent varieties and doses, unsuitable combination medication and medication for special populations, etc. At present, PPI is the focus of the rational use of drugs in major medical institutions, but the existing control methods are generally unscientific and unreasonable. Therefore, exploring a set of scientific and standardized control programs is an urgent task to effectively control the clinical irrational use of such drugs. In view of the large variety and specifications of PPI manufacturers currently on the market in my country, the indications of various PPI instructions are quite different, and there are many unclear points in the relevant guidelines. Therefore, it is urgent to establish a unified PPI management plan to guide clinical safe and rational drug use. After extensively soliciting the opinions of relevant experts in the fields of clinical medicine, pharmacy, and hospital management, the expert opinion consensus group on the rational application of PPI in the Hospital of Zhejiang Province wrote this consensus, aiming to establish a PPI prescription evaluation standard for medical institutions at all levels in various regions, providing guidance and suggestions for the management and control of the irrational use of PPI in hospitals, with a view to standardizing physician prescriptions, promoting rational use of drugs, improving prescription quality, improving pharmaceutical services, and protecting patients"" rights and interests in drug use.