Hammes Jean André, Pfuetzenreiter Felipe, Silveira Fabrízio da, Koenig Alvaro, Westphal Glauco Adrieno
Universidade da Região de Joinville, Joinville, SC, Brasil.
Departamento de Medicina, Universidade da Região de Joinville, Joinville, SC, Brasil.
Rev Bras Ter Intensiva. 2008 Dec;20(4):349-54.
Drug interactions occur when effects and/or toxicity of a drug are affected by presence of another drug. They are usually unpredictable and undesirable. A study was conducted to verify the prevalence and clinical value of potential drug interactions in intensive care units
All patients, of three intensive care units were included in a cross-sectional study, over a period of two months. Patients with less than a 2 days length of stay were excluded. Data were collected from twenty-four hour prescriptions and all possible paired combinations drug-drug were recorded. Prevalence and clinical value (significance) were checked at the end of follow-up.
One hundred and forty patients were analyzed, 67.1% presented with some significant potential drug interactions and of the 1069 prescriptions, 39.2% disclosed the same potential. Of 188 different potential drug interactions, 29 were considered highly significant. Univariate analysis showed that in the group with significant potential drug interactions a higher number of different drugs, drugs/day had been used, there were more prescribing physicians and extended stay in intensive care units. Adjusted to the multivariate logistic regression model, only the number of drugs/day correlated with increased risk of significant potential drug interaction (p = 0.0011) and, furthermore that use of more than 6 drugs/day increased relative risk by 9.8 times.
Critically ill patients are submitted to high risk of potential drug interactions and the number of drugs/day has a high positive predictive value for these interactions. Therefore, it is imperative that critical care physicians be constantly alert to recognize this problem and provide appropriate mechanisms for management, thereby reducing adverse outcomes.
当一种药物的效应和/或毒性受到另一种药物的影响时，就会发生药物相互作用。它们通常不可预测且不受欢迎。开展了一项研究以验证重症监护病房中潜在药物相互作用的发生率及临床价值。
在两个月的时间里，对三个重症监护病房的所有患者进行了一项横断面研究。住院时间少于2天的患者被排除。从24小时处方中收集数据，并记录所有可能的药物-药物配对组合。在随访结束时检查发生率和临床价值（显著性）。
对140例患者进行了分析，67.1%的患者存在一些显著的潜在药物相互作用，在1069张处方中，39.2%显示出同样的潜在相互作用。在188种不同的潜在药物相互作用中，29种被认为具有高度显著性。单因素分析显示，在存在显著潜在药物相互作用的组中，使用的不同药物数量、每日药物数量更多，开处方的医生更多，在重症监护病房的住院时间更长。经多因素逻辑回归模型校正后，只有每日药物数量与显著潜在药物相互作用风险增加相关（p = 0.0011），此外，每天使用超过6种药物会使相对风险增加9.8倍。
危重症患者面临潜在药物相互作用的高风险，每日药物数量对这些相互作用具有较高的阳性预测价值。因此，重症监护医生必须时刻警惕识别这一问题，并提供适当的管理机制，从而减少不良后果。
