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三级肺科中心危重症儿科患者中潜在的药物相互作用

Potential Drug-Drug Interactions Among Critically Ill Pediatric Patients in a Tertiary Pulmonary Center.

作者信息

Hassanzad Maryam, Arenas-Lopez Sara, Baniasadi Shadi

机构信息

Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, London, UK.

出版信息

J Clin Pharmacol. 2018 Feb;58(2):221-227. doi: 10.1002/jcph.996. Epub 2017 Aug 23.

Abstract

Patients in the pediatric intensive care unit (PICU) are at increased risk of potential drug-drug interactions (pDDIs) because of the complexity of pharmacotherapy. The current study aimed to assess the rate, pattern, risk factors, and management of pDDIs in the PICU of an academic pulmonary hospital. A prospective observational study was conducted for 6 months. Pharmacotherapy data of PICU-admitted patients were evaluated by a clinical pharmacologist. Interacting drugs, reliability, mechanism, potential outcome, and clinical management of pDDIs were identified using the Lexi-Interact database. Logistic regression was applied to analyze the risk factors that could be associated with the interactions. One hundred and twenty-three medication profiles were evaluated during the study period. Diseases of the respiratory system were the main diagnoses among intensive care unit (ICU)-admitted patients (56.1%). A total of 38.6% of the patients exposed to at least 1 major and/or contraindicated interaction during ICU admission. Most pDDIs occurred through metabolic (35.4%) and additive (34.8%) mechanisms. The existence of pDDIs was significantly associated with the number of prescribed medications. Exposure to pDDIs is frequent in critically ill pediatric patients and related to the number of medications. Daily and close cooperation between clinicians and clinical pharmacologists is recommended to prevent harmful outcomes of DDIs.

摘要

由于药物治疗的复杂性,儿科重症监护病房(PICU)的患者发生潜在药物相互作用(pDDI)的风险增加。本研究旨在评估一所学术性肺病医院PICU中pDDI的发生率、模式、危险因素及管理情况。进行了为期6个月的前瞻性观察研究。由一名临床药理学家评估入住PICU患者的药物治疗数据。使用Lexi-Interact数据库确定相互作用药物、可靠性、机制、潜在结果及pDDI的临床管理。应用逻辑回归分析可能与相互作用相关的危险因素。研究期间共评估了123份用药记录。呼吸系统疾病是重症监护病房(ICU)收治患者的主要诊断(56.1%)。共有38.6%的患者在入住ICU期间发生至少1次主要和/或禁忌相互作用。大多数pDDI通过代谢(35.4%)和相加(34.8%)机制发生。pDDI的存在与处方药物数量显著相关。危重症儿科患者中pDDI暴露很常见,且与药物数量有关。建议临床医生和临床药理学家每日密切合作,以预防药物相互作用的有害后果。

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