بررسي مصرف منطقي داروهاي مسكن تزريقي در بخش هاي اورژانس و جراحي بيمارستان امام سجاد (ع) رامسر

Investigating the Rational Use of Injectable Analgesics in Emergency and Surgical Wards of Imam Sajjad Hospital, Ramsar

ﻣﻘﺪﻣﻪ ﻫﺪف از اﻧﺠﺎم ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺑﺮرﺳﯽ اﻟﮕﻮي ﻣﺼﺮف ﻣﻨﻄﻘﯽ داروﻫﺎي ﻣﺴﮑﻦ ﺗﺰرﯾﻘﯽ اﻋﻢ از اﭘﯿﻮﺋﯿﺪ و ﻏﯿﺮ اﭘﯿﻮﺋﯿﺪ در ﺑﯿﻤﺎران ﺑﺴﺘﺮي در ﺑﺨﺶﻫﺎي ﺟﺮاﺣﯽ و اورژاﻧﺲ ﺑﯿﻤﺎرﺳﺘﺎن اﻣﺎم ﺳﺠﺎد راﻣﺴﺮ ﺑﻮده اﺳﺖ. روش ﮐﺎر اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺷﮑﻞ ﺗﻮﺻﯿﻔﯽ و ﮔﺬﺷﺘﻪ ﻧﮕﺮ، در ﺑﻬﺎر و ﺗﺎﺑﺴﺘﺎن 1395، ﺑﺮ روي 1181 ﭘﺮوﻧﺪه ﺑﯿﻤﺎران درﯾﺎﻓﺖ ﮐﻨﻨﺪه داروي ﻣﺴﮑﻦ ﺗﺰرﯾﻘﯽ ﺑﺴﺘﺮي ﺷﺪه در ﺑﺨﺶﻫﺎي اورژاﻧﺲ و ﺟﺮاﺣﯽ اﻧﺠﺎم ﺷﺪ. اﻃﻼﻋﺎت ﻣﺨﺘﻠﻒ ﺷﺎﻣﻞ اﻧﺪﯾﮑﺎﺳﯿﻮن، دوزاژ و ﻣﺪت زﻣﺎن درﯾﺎﻓﺖ دارو ﺛﺒﺖ ﮔﺮدﯾﺪه و ﺑﺎ ﮔﺎﯾﺪﻻﯾﻦ AHFS ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﻧﺘﺎﯾﺞ از ﺑﯿﻦ 1181 ﻧﻤﻮﻧﻪ، 506 ﻧﻔﺮ در ﺑﺨﺶ اورژاﻧﺲ و 675 ﻧﻔﺮ در ﺑﺨﺶ ﺟﺮاﺣﯽ ﺑﺴﺘﺮي ﺑﻮدﻧﺪ. ﺑﯿﺸﺘﺮﯾﻦ اﻧﺪﯾﮑﺎﺳﯿﻮن ﻣﺼﺮف داروﻫﺎي ﻣﺴﮑﻦ ﺗﺰرﯾﻘﯽ ﺑﻪ ﺗﺮﺗﯿﺐ ﻣﺮﺑﻮط ﺑﻪ ﺗﺮوﻣﺎ، درد ﻧﺎﺷﯽ از ﺳﺮﻃﺎن ،درد ﻗﻔﺴﻪ ﺳﯿﻨﻪ و دﯾﺴﮏ ﮐﻤﺮ ﺑﻮده اﺳﺖ. 568 ﻧﻔﺮ درﯾﺎﻓﺖ ﮐﻨﻨﺪه داروي اﭘﯿﻮﺋﯿﺪ و 341 ﻧﻔﺮ درﯾﺎﻓﺖ ﮐﻨﻨﺪه داروي ﻏﯿﺮ اﭘﯿﻮﺋﯿﺪ ﺑﻮدهاﻧﺪ و 272 ﻧﻔﺮ ﻧﯿﺰ ﻣﺼﺮف ﮐﻨﻨﺪه اﭘﯿﻮﺋﯿﺪ و ﻏﯿﺮ اﭘﯿﻮﺋﯿﺪ ﺑﺎﻫﻢ ﺑﻮده اﻧﺪ. ﺑﯿﺸﺘﺮﯾﻦ ﻣﯿﺰان ﺗﺠﻮﯾﺰ در ﺑﯿﻦ اﭘﯿﻮﺋﯿﺪﻫﺎ ﻣﺮﺑﻮط ﺑﻪ ﻣﻮرﻓﯿﻦ و در ﺑﯿﻦ داروﻫﺎي ﻏﯿﺮ اﭘﯿﻮﺋﯿﺪ ﻣﺮﺑﻮط ﺑﻪ ﮐﺘﻮروﻻك ﺑﻮده اﺳﺖ. در ﻧﻬﺎﯾﺖ،23/62 % ﺗﺠﻮﯾﺰﻫﺎ ﺑﺎ ﮔﺎﯾﺪﻻﯾﻦ ﺳﺎزﮔﺎري داﺷﺘﻪ و 76/37 % ﺗﺠﻮﯾﺰﻫﺎ ﻓﺎﻗﺪ ﺳﺎزﮔﺎري ﺑﺎ ﮔﺎﯾﺪﻻﯾﻦ ﺑﻮده اﺳﺖ. ﻧﺘﯿﺠﻪﮔﯿﺮي ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﯿﺰان ﺑﺎﻻ ﻋﺪم ﺗﻄﺎﺑﻖ داروﻫﺎي ﺗﺠﻮﯾﺰي ﺑﺎ ﮔﺎﯾﺪﻻﯾﻦ، ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ ﮐﻪ ﺑﺎﯾﺪ ﺗﻮﺟﻪ ﺑﯿﺸﺘﺮي در زﻣﯿﻨﻪ اراﺋﻪ اﻃﻼﻋﺎت ﻻزم ﺑﻪ ﮐﺎدر درﻣﺎﻧﯽ درﺧﺼﻮص ﺗﺠﻮﯾﺰ و ﻧﺤﻮه ﺻﺤﯿﺢ ﻣﺼﺮف اﯾﻦ داروﻫﺎ ﺻﻮرت ﮔﯿﺮد.

Introduction: The aim of this study was the investigating rational use of opioid and non-opioid injectable analgesics in patients admitted to surgery and emergency wards of Imam Sajjad general hospital, Ramsar, Iran. Materials and methods: This descriptive and retrospective study was performed between July to August 2016 on 1181 files of patients receiving injectable analgesics and admitted to surgery and emergency wards of Imam Sajjad general hospital. Different information including indication, dose of administered drug and duration of treatment were recorded and compared to the AHFS guideline. Results: Among 1181 subjects, 675 patients were admitted to surgery and 506 patients to emergency wards. The main indications of injectable analgesic administration were trauma, cancer pain, chest pain and lumbar neuropathic pain, respectively. Of the 1181 patients, 568 cases received opioids, 341 cases received non-opioids and 272 cases received both opioid and non-opioids. Among the opioids, morphine was the most prescribed and among the non-opioids ketorolac was the most. Mostly encountered adverse effects were nausea and vomiting, hypotension and headache. Overall, 23.62% of the prescriptions were in accordance with guideline and 76.37% of them weren’t compatible. Conclusion: Because of high inconsistency with guideline, it seems to need more attention on promoting medical staff information about prescription and rational use of injectable analgesic drugs.