儿童医院螺内酯片使用情况调查及分剂量对策思考

Investigation on the Use of Spironolactone Tablet in Children's Hospital and Thinking on the Countermeasures of Splitting

关键词:  儿童  螺内酯  片剂  药品分剂量  精准化  个体化

Key words:  children  spironolactone  tablet  splitting  precision  individualization

摘要:

目的 调查儿童医院螺内酯片的使用情况，探讨可改善螺内酯片分剂量现状的可行性方案，满足儿科临床精准化、个体化的给药需求。方法 调取浙江大学医学院附属儿童医院2021年1月1日—2022年12月31日住院患儿使用螺内酯片(每片20 mg)的医嘱，分析患儿年龄、分剂量规格、就诊科室分布及常用分剂量给药存在的问题，结合文献检索与团队实践探究适宜对策。结果 本次调查共纳入11 239条使用螺内酯片医嘱，其中分剂量医嘱占比83.91%；在分剂量医嘱中，呈现年龄段小，分剂量规格多，用药专科性强，用药时间长等特点。制定药品分剂量操作规范、借助合适的分剂量工具，有助于提高分剂量操作的准确度，减少给药剂量不准所导致的不良事件；而临时调配液体制剂和医疗机构制剂的探索，有助于提高给药剂量的准确性和稳定性，实现个体化给药。结论 本研究以探究螺内酯片剂适宜分剂量方案为例，从临床实际需求出发，结合团队实践与文献检索分析探究分剂量准确、质量可控、患儿依从性高的可行性对策，为寻找适宜的儿科片剂分剂量给药方案提供参考。

Abstract:

OBJECTIVE To investigate the use of spironolactone tablet in children's hospital, and to explore the feasible scheme that can improve the current dosage distribution of spironolactone tablets, so as to meet the needs of precise and individualized clinical administration of pediatric patients. METHODS All the prescriptions including spironolactone tablet (20 mg per tablet) were obtained from 1st January 2021 to 31th December 2022 in Children's Hospital, Zhejiang University School of Medicine. The children's age, splitting specification, department distribution and problems of common tablet splitting were analyzed, appropriate countermeasures were explored according to literature and team practice. RESULTS A total of 11 239 spironolactone tablet prescriptions were included, among which, the proportion of splitting was 83.91%; in the splitting prescriptions, it showed the characteristics of young age, multi-dose specifications, strong drug specialization and long drug duration. Formulating the practice specification for manipulation of drugs, with the right dosing tool, contribute to improve the accuracy of manipulation of drugs and reduce adverse events caused by incorrect dosing; while, the exploration of extemporaneous liquid preparations and preparations in medical institutions, contributed to improve the accuracy and stability of dosing, and realize individualized drug delivery. CONCLUSION In this study, exploring the appropriate dosage regimen for spironolactone tablet as an example, feasible countermeasures with accurate fractional dose, controllable quality and high compliance of children are explored in combination with team practice and literature retrieval analysis, which is based on the actual clinical needs, so as to provide reference for finding appropriate fractional dose administration schemes for pediatric tablets.