Jean R, Ducasse J L, Montastruc J L, Lapeyre-Mestre M
Centre Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, University Hospital, Faculty of Medicine, Toulouse, France.
Eur J Clin Pharmacol. 2001 Nov;57(9):685-9. doi: 10.1007/s002280100366.
Use of analgesic drugs in acute renal colic varies widely in different countries. In order to assess the prescribing patterns in acute renal colic in French emergency departments (EDs), the present study compared intentions of prescription, real prescription and evidence-based data in a sample of emergency practitioners.
A sample of 51 emergency practitioners (27 medical doctors and 24 residents) randomly selected in nine EDs in the southwest of France participated in this observational study. In a first step (January 2000), participants were asked about a simulated case of acute renal colic. In a second step, real prescriptions for the same indication were retrospectively identified and collected among hospital medical databases during a period of 6 months (July-December 1999).
In simulated cases, non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in 100% of cases, in addition to propacetamol (70%), antispasmodic drugs (53%) and opiate analgesics (100%). Daily dose of these drugs was underestimated in approximately 30% of cases. In real prescription, there was no significant difference in the use of NSAIDs, propacetamol and anti-spasmodic drugs. However, daily doses were more frequently underestimated, and opiate analgesics were less prescribed. Several points could explain these discrepancies: lack of knowledge about pharmacological properties, inadequate daily review of drug intake, underutilisation of opiates and insufficient clinical evaluation of pain in several centres.
These results show a clear difference between intention to treat and real prescriptions for patients suffering from acute renal colic.
不同国家在急性肾绞痛中使用止痛药物的情况差异很大。为了评估法国急诊科急性肾绞痛的处方模式，本研究比较了急诊从业者样本中的处方意图、实际处方和循证数据。
在法国西南部九个急诊科随机抽取的51名急诊从业者（27名医生和24名住院医师）参与了这项观察性研究。第一步（2000年1月），让参与者处理一个模拟的急性肾绞痛病例。第二步，回顾性地在医院医疗数据库中识别并收集了1999年7月至12月这6个月期间相同适应症的实际处方。
在模拟病例中，100%的病例开具了非甾体类抗炎药（NSAIDs），此外还有丙帕他莫（70%）、解痉药（53%）和阿片类镇痛药（100%）。这些药物的日剂量在约30%的病例中被低估。在实际处方中，NSAIDs、丙帕他莫和解痉药的使用没有显著差异。然而，日剂量更常被低估，且阿片类镇痛药的处方量较少。有几点可以解释这些差异：对药理特性缺乏了解、对药物摄入的每日审查不足、阿片类药物使用不足以及几个中心对疼痛的临床评估不足。
这些结果表明，急性肾绞痛患者的治疗意图与实际处方之间存在明显差异。
