• 四川大學(xué)華西醫(yī)院中西醫(yī)結(jié)合科（成都，610041）;

【摘要】　目的　 總結(jié)慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD） 患者院外用藥情況，并分析其院外用藥情況、痰真菌檢出率以及激素不良反應(yīng)發(fā)生率的變化。　方法　 調(diào)查2011年1-6月住院的161 例COPD 患者院外用藥情況，將其分為遵醫(yī)囑使用糖皮質(zhì)激素組（A組，包括口服和吸入激素）、使用非準(zhǔn)字號(hào)藥物組（B組）和未使用以上兩種藥物組（C組），對(duì)各組的痰真菌檢出率進(jìn)行統(tǒng)計(jì)學(xué)分析，并對(duì)A、B組激素不良反應(yīng)的發(fā)生率進(jìn)行分析。再將現(xiàn)階段的調(diào)查結(jié)果與2006年同樣研究結(jié)果進(jìn)行比較。　結(jié)果　 161例患者中使用口服糖皮質(zhì)激素6例，使用吸入激素29例，使用非準(zhǔn)字號(hào)藥物32例，未使用以上兩種藥物94例。痰真菌檢出率情況:B組檢出率為62.5%，明顯高于A組的17.14%、C組的27.66%；組間比較有統(tǒng)計(jì)學(xué)意義（P lt;0.001）。B組的藥物不良反應(yīng)發(fā)生率為37.5%；A組中口服激素發(fā)生率為50%，而使用吸入激素發(fā)生率為0%。與2006年同樣研究結(jié)果比較，B組患者的比例明顯下降，A組患者明顯增多。　結(jié)論　 使用非準(zhǔn)字號(hào)藥物的患者，真菌感染的危險(xiǎn)性及激素不良反應(yīng)的發(fā)生率較高，健康教育對(duì)于減少這些不良現(xiàn)象的發(fā)生發(fā)揮了重要作用。
【Abstract】　Objective　 To investigate the use of drugs in patients with chronic obstructive pulmonary disease (COPD) outside the hospital, and analyze the detection rate of fungus and the side effects of glucocorticosteroids (GCs), and their changes.　Methods　 We investigated the drugs used outside the hospital in 161 patients with stable COPD between January and June 2011, who were divided into prescribed medication GCs group (group A, including oral GCs group and inhaled GCs group), drugs without authorization by SFDA (DWAS) group (group B) and other drugs group (group C). Then we made a statistical analysis on the detection rate of fungus, and the incidence rate of the side effects of GCs in the three groups. Finally we compared the present findings with the similar studies five years ago.　Results　 Among the 161 patients, 6 took oral GCs, 29 used inhaled GCs, 32 used DWAS, and 94 used other drugs. The detection rate of fungus in group B was 62.5%, obviously higher than the other groups (17.14% in group A, and 27.66% in group B, P lt;0.05). The rate of side effects of GCs in group B was 37.5%, and 50% in oral GCs group, while no side effects of GCs was found in the inhaled GCs group. Compared with the similar study five years ago, the use of DWAS decreased, and the use of prescribed medication GCs among the patients increased significantly.　Conclusions　 Patients taking DWAS have a high incidence rate of mycotic infection and side effects of GCs. Health education plays an important role in reducing the occurrences of these undesirable phenomena.

引用本文： 王科,閔婕,樊濤,鐘云清. 慢性阻塞性肺疾病患者院外用藥情況的調(diào)查研究. 華西醫(yī)學(xué), 2011, 26(10): 1484-1487. doi: 復(fù)制

1. 　Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructivepulmonary disease in China: a large, population-based survey[J]. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
2. 　Brines R, Thorne M. Clinical consensus on COPD[J]. Respir Med: COPD Update, 2007, 3(2): 42-48.
3. 　賀正一. 慢性阻塞性肺疾病穩(wěn)定期的治療[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2003, 15(11): 664-666.
4. 　Barr RG, Bourbeau J, Camargo CA, et al. Tiotropium for stablechronic obstructive pulmonary disease: a meta-analysis[J]. Thorax, 2006, 61(10): 854-862.
5. 　中華醫(yī)學(xué)會(huì)呼吸病學(xué)會(huì)阻塞性疾病學(xué)組. 慢性阻塞性肺疾病診治指南[J]. 中華結(jié)核和呼吸雜志, 2007, 1(30): 8-17.
6. 　Vestbo J, TORCH Study Group. The TORCH (towards a revolution in COPD health) survival study protocol[J]. Eur Respir J, 2004, 24(2): 206-210.
7. 　McGarvey LP, John M, Anderson JA, et al. TORCH Clinical Endpoint Committee Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee[J]. Thorax, 2007, 62(5): 411-415.
8. 　Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease [J]. N Engl J Med, 2007, 35(6): 775-789.
9. 　于麗萍, 畢軼平. 慢性阻塞性肺疾病(COPD) 患者應(yīng)用皮質(zhì)類固醇激素后出現(xiàn)骨折或骨質(zhì)疏松的風(fēng)險(xiǎn)分析[J]. 黑龍江醫(yī)藥科學(xué), 2010, 33(6): 103.
10. 　閔婕, 毛兵. 慢性阻塞性肺疾病穩(wěn)定期患者院外藥物使用情況的調(diào)查研究[J]. 華西醫(yī)學(xué), 2008, 23(4): 745-747.
11. 　黃水平. 多個(gè)樣本率間的兩兩比較方法[J]. 徐州醫(yī)學(xué)院學(xué)報(bào), 2002, 22(4): 291-294.
12. 　葛向旌, 陳慶鋒, 喬永莉. 吸入舒利迭治療穩(wěn)定期 COPD 的臨床研究[J]. 臨床肺科雜志, 2010, 15(7): 937-939.
13. 　鄧銳. 吸入糖皮質(zhì)激素治療穩(wěn)定期 COPD療效觀察[J]. 四川醫(yī)學(xué), 2011, 32(1): 58-60.
14. 　漆波, 余巍, 羅明興, 等. 二級(jí)甲等醫(yī)院醫(yī)生對(duì)COPD 診治指南知曉度調(diào)查[J]. 西部醫(yī)學(xué), 2010, 22(12): 2363-2365.
15. 　陳莉. 影響 COPD 患者健康教育效果的病人因素分析及對(duì)策[J]. 中國(guó)社區(qū)醫(yī)師·醫(yī)學(xué)專業(yè), 2011, 16(13): 273.
16. 　鄭澤輝. 社區(qū)慢性呼吸系統(tǒng)疾病的防治策略[J]. 醫(yī)學(xué)與社會(huì), 2008, 21(12): 15-16.
  1. 1. 　Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructivepulmonary disease in China: a large, population-based survey[J]. Am J Respir Crit Care Med, 2007, 176(8): 753-760.
  2. 2. 　Brines R, Thorne M. Clinical consensus on COPD[J]. Respir Med: COPD Update, 2007, 3(2): 42-48.
  3. 3. 　賀正一. 慢性阻塞性肺疾病穩(wěn)定期的治療[J]. 現(xiàn)代實(shí)用醫(yī)學(xué), 2003, 15(11): 664-666.
  4. 4. 　Barr RG, Bourbeau J, Camargo CA, et al. Tiotropium for stablechronic obstructive pulmonary disease: a meta-analysis[J]. Thorax, 2006, 61(10): 854-862.
  5. 5. 　中華醫(yī)學(xué)會(huì)呼吸病學(xué)會(huì)阻塞性疾病學(xué)組. 慢性阻塞性肺疾病診治指南[J]. 中華結(jié)核和呼吸雜志, 2007, 1(30): 8-17.
  6. 6. 　Vestbo J, TORCH Study Group. The TORCH (towards a revolution in COPD health) survival study protocol[J]. Eur Respir J, 2004, 24(2): 206-210.
  7. 7. 　McGarvey LP, John M, Anderson JA, et al. TORCH Clinical Endpoint Committee Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee[J]. Thorax, 2007, 62(5): 411-415.
  8. 8. 　Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease [J]. N Engl J Med, 2007, 35(6): 775-789.
  9. 9. 　于麗萍, 畢軼平. 慢性阻塞性肺疾病(COPD) 患者應(yīng)用皮質(zhì)類固醇激素后出現(xiàn)骨折或骨質(zhì)疏松的風(fēng)險(xiǎn)分析[J]. 黑龍江醫(yī)藥科學(xué), 2010, 33(6): 103.
  10. 10. 　閔婕, 毛兵. 慢性阻塞性肺疾病穩(wěn)定期患者院外藥物使用情況的調(diào)查研究[J]. 華西醫(yī)學(xué), 2008, 23(4): 745-747.
  11. 11. 　黃水平. 多個(gè)樣本率間的兩兩比較方法[J]. 徐州醫(yī)學(xué)院學(xué)報(bào), 2002, 22(4): 291-294.
  12. 12. 　葛向旌, 陳慶鋒, 喬永莉. 吸入舒利迭治療穩(wěn)定期 COPD 的臨床研究[J]. 臨床肺科雜志, 2010, 15(7): 937-939.
  13. 13. 　鄧銳. 吸入糖皮質(zhì)激素治療穩(wěn)定期 COPD療效觀察[J]. 四川醫(yī)學(xué), 2011, 32(1): 58-60.
  14. 14. 　漆波, 余巍, 羅明興, 等. 二級(jí)甲等醫(yī)院醫(yī)生對(duì)COPD 診治指南知曉度調(diào)查[J]. 西部醫(yī)學(xué), 2010, 22(12): 2363-2365.
  15. 15. 　陳莉. 影響 COPD 患者健康教育效果的病人因素分析及對(duì)策[J]. 中國(guó)社區(qū)醫(yī)師·醫(yī)學(xué)專業(yè), 2011, 16(13): 273.
  16. 16. 　鄭澤輝. 社區(qū)慢性呼吸系統(tǒng)疾病的防治策略[J]. 醫(yī)學(xué)與社會(huì), 2008, 21(12): 15-16.