临床实践中接受他汀类药物治疗患者的肝功能检查静脉穿刺率：一个治疗困境。

Venipuncture Rate of Liver Function Tests for Patients being Treatment with Statin in Clinical Practice: A Therapeutic Dilemma.

作者信息

Ananwattanasuk Teetouch, Chiewchalermsri Chirawat, Tongdee Pattama, Nimkuntod Porntip

出版信息

J Med Assoc Thai. 2016 Oct;99 Suppl 7:S69-75.

PMID:29901925

Abstract

BACKGROUND

Statin or 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors are hypolipidemic agent. Its main functionality is to reduce cholesterol. The low-density lipoprotein cholesterol is the major cause of myocardial infarction. The adverse effect of this medication is hepatotoxicity. Doctors always request patient on statin treatment to obtain blood by venipuncture for liver function tests (LFTs) frequently. There are no researches studying the rate and expenditure of venipuncture for LFTs in patients being treated with statin.

OBJECTIVE

To study unnecessary rate on venipuncture for LFTs in patients being treatment with statin at an outpatient clinic.

MATERIAL AND METHOD

Retrospective cohort study. Data are collected from medical records that being treatment with statin at an outpatient clinic, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University between March 1, 2012 and March 1, 2014. The 441 patients are divided into two groups. The first group is treated with the appropriate venipuncture for LFTs and the second group is treated with unnecessary venipuncture for LFTs. The expenditure for both groups are used to calculate and compare costs.

RESULTS

The number of unnecessary venipuncture in the LFTs group is 308 samples (69.84%). The sample proportions are 85.06% come from staff (262 samples) and 14.94% come from interns (46 samples). The number of appropriate venipuncture for LFTs is 133 samples (30.16%). The sample proportions are 77.44% come from staff (103 samples) and 22.56% come from interns (30 samples). The expenditure of the unnecessary venipuncture for LFTs had a statistically significant difference from the appropriate venipuncture for LFTs [75,500 vs. 4,400 baht (THB)] (p<0.05).

CONCLUSION

The expenditure for the unnecessary venipuncture LFTs in patient being treated with statin at the outpatient clinic is statistically higher than the appropriate venipuncture (p<0.05).

摘要

背景

他汀类药物或3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂是降血脂药物。其主要功能是降低胆固醇。低密度脂蛋白胆固醇是心肌梗死的主要原因。这种药物的不良反应是肝毒性。医生总是要求接受他汀类药物治疗的患者频繁进行静脉穿刺采血以进行肝功能检查（LFTs）。目前尚无研究探讨接受他汀类药物治疗的患者进行肝功能检查静脉穿刺的频率和费用。

目的

研究门诊接受他汀类药物治疗的患者进行肝功能检查静脉穿刺的不必要率。

材料与方法

回顾性队列研究。数据收集自2012年3月1日至2014年3月1日在诗纳卡宁威洛大学攀亚南塔披奇胡春蓬拉丹医疗中心门诊接受他汀类药物治疗的病历。441例患者分为两组。第一组接受适当的肝功能检查静脉穿刺，第二组接受不必要的肝功能检查静脉穿刺。计算并比较两组的费用。

结果

肝功能检查组不必要静脉穿刺的样本数为308例（69.84%）。样本比例为85.06%来自工作人员（262例样本），14.94%来自实习生（46例样本）。适当的肝功能检查静脉穿刺样本数为133例（30.16%）。样本比例为77.44%来自工作人员（103例样本），22.56%来自实习生（30例样本）。不必要的肝功能检查静脉穿刺费用与适当的肝功能检查静脉穿刺费用有统计学显著差异[75,500泰铢对4,400泰铢（THB）]（p<0.05）。