目的 建立人促紅素注射液（rhEPO）合理性評(píng)價(jià)體系，分析目前臨床使用過(guò)程中存在的問(wèn)題，為臨床合理用藥提供參考。方法 以rhEPO的說(shuō)明書為基礎(chǔ)，參考相關(guān)專家共識(shí)和指南制定用藥合理性評(píng)價(jià)標(biāo)準(zhǔn)。根據(jù)入排標(biāo)準(zhǔn)隨機(jī)抽取安徽醫(yī)科大學(xué)附屬亳州醫(yī)院2023年4月—2024年4月使用rhEPO的歸檔病歷，應(yīng)用屬性層次模型（AHM）法對(duì)其進(jìn)行合理性評(píng)價(jià)，并與傳統(tǒng)點(diǎn)評(píng)方法進(jìn)行一致性檢驗(yàn)，確定AHM法的可行性。結(jié)果 372份病歷中，病歷評(píng)分（MRS）≥90分156例（占比41.94%），75分≤MRS＜90分55例（占比14.78%），60分≤MRS＜75分的60例（占比16.13%），MRS＜60分101例（占比27.15%）；不合理類型主要表現(xiàn)為適應(yīng)證54例次（占比14.52%），用藥或停藥時(shí)機(jī)151例次（占比40.59%），用藥劑量179例次（占比48.12%）以及用藥調(diào)整163例次（占比43.82%）等。與傳統(tǒng)點(diǎn)評(píng)方法比較，AHM法一致率為90.59%（Kappa＝0.785，P＜0.001）。結(jié)論 基于AHM法建立的rhEPO評(píng)價(jià)體系切實(shí)可行，評(píng)價(jià)結(jié)果顯示本院rhEPO使用存在不合理現(xiàn)象，醫(yī)院需在適應(yīng)證、用藥或停藥時(shí)機(jī)、用藥劑量及用藥調(diào)整等方面進(jìn)一步規(guī)范、合理使用。

Objective To establish the rational evaluation system of recombinant human erythropoietin injection (rhEPO), so as to identify problems existing in the current clinical use and provide references for its clinical application. Methods Based on the instructions of rhEPO, the rational evaluation criteria were formulated according to the relevant expert consensus and guidelines. According to the entry criteria, rhEPO in Bozhou Hospital Affiliated to Anhui Medical University from April 2023 to April 2024, and the attribute hierarchy model (AHM) method was applied to evaluate its rationality, and the consistency test with the traditional review method was conducted to determine the feasibility of AHM method. Results Among a total of 372 cases, MRS was ≥ 90 (n = 156, 41.94%), 75 ≤ MRS ＜ 90 (n = 55, 14.78%), 60 ≤ MRS ＜ 75 (n = 60, 16.13%), and MRS < 60 (n = 101, 27.15%). The unreasonable types were mainly manifested as 54 indications (14.52%), 151 indications or withdrawal time (40.59%), 179 indications (48.12%) and 163 medication adjustment (43.82%). Compared with the traditional review method, the AHM agreement rate was 90.59% (Kappa = 0.785, P < 0.001). Conclusion The rhEPO evaluation system based on AHM method is feasible, and the evaluation results show that the use of rhEPO in the hospital needs to further standardize and rationally use it in terms of indication, medication or withdrawal time, dosage and adjustment.

R973

安徽省重點(diǎn)研究與開(kāi)發(fā)計(jì)劃項(xiàng)目（2022e07020066）