输液顺序智能调控对促进静脉合理用药的效果分析

邱季 潘爱红 杨樟卫 邓婷婷 刘婷 刘云洁 朱文靖

摘 要 目的：评价输液顺序智能调控对促进静脉合理用药的效果。方法：在智能提醒人工标注输液顺序的基础上，采用马尔科夫链机器学习法实现输液顺序智能调控。选取合肥市滨湖医院2017年1-9月164 800例住院患者的用药医嘱为输液顺序智能调控前样本，2018年1-12月264 600例住院患者的用药医嘱为输液顺序智能调控后样本。比较调控前后配伍禁忌、储存时限、给药频次、时辰药理学、预防用药、药物相互作用、辅助用药、静脉刺激性药物的输液顺序正确率以及冲管次数、冲管输液费用、输液管内液体性状变化情况。结果：調控后配伍禁忌、储存时限、给药频次、时辰药理学、药物相互作用、辅助用药的输液顺序正确率均显著高于调控前，预防用药、静脉刺激性药物的输液顺序正确率以及冲管次数、冲管输液费用、输液管内液体变化例数（占比）均显著低于调控前（P<0.001）。结论：输液顺序智能调控可一定程度地提高患者静脉用药顺序的合理性。

关键词 静脉用药;输液顺序智能调控;输液顺序;正确性

ABSTRACT   OBJECTIVE： To evaluate the effects of infusion sequence regulation on the promotion of intravenous rational drug use. METHODS： The intelligent control of infusion sequence was realized with Markov chain machine learning method on the basis of intelligent reminder manual labeling infusion sequence. Selected from Binhu Hospital of Hefei during Jan. to Sept. 2017， 164 800 inpatients medication orders were collected as data before intelligent control of infusion sequence， and 264 600 inpatients medication orders were collected as data after intelligent control of infusion sequence. The correct rate of incompatibility， storage time limit， administration frequency， chronopharmacology， preventive drugs， drug interaction， auxiliary drugs and infusion sequence for intravenous irritant drugs were compared before and after regulation; the times of flushing tube， the cost of flushing tube infusion and the change of liquid property in the infusion tube were compared before and after regulation. RESULTS： The correct rate of incompatibility， storage time limit， administration frequency， chronopharmacology， drug interaction and infusion sequence for auxiliary drugs after regulation were significantly higher than before regulation; the correct rate of infusion sequence for preventive drugs and intravenous irritant drugs， the times of flushing tube， the cost of flushing tube infusion and the case number of the liquid change （proportion） in infusion tube were significantly lower than before regulation （P<0.001）. CONCLUSIONS： Intelligent regulation of infusion sequence can improve the rationality of intravenous medication sequence to a certain extend.

KEYWORDS   Intravenous medication; Intelligent regulation of infusion sequence; Infusion sequence; Correctness

我国住院患者人均每日静脉输液约4～5袋[1]，若输液顺序不当会出现输液管内浑浊、沉淀或变色等现象，从而导致药物调配后的稳定性下降[2]、用药安全性无法保障、不良反应增加或最佳治疗效果难以发挥等问题[3]。静脉用药调配中心（PIVAS）每日需调配大量的成品输液，但由于患者及其医嘱的多样性，加之医嘱处于动态变化中，使得拟定的输液顺序随时在发生变化，因此如何对每位住院患者的输液顺序进行调控，以提高患者用药的有效性和安全性，仅靠人工难以完成。……