中国临床药学杂志

目的 构建高致吐风险化疗药物的止吐预处理用药方案，并评估其应用效果，为临床提供参考。方法 由医务科、肿瘤内科和药剂科人员共同讨论，构建高致吐风险化疗药物的止吐预处理用药方案，于2023年4月起实施。纳入2023年1至3月和2024年1至3月确诊为恶性肿瘤并使用高致吐风险化疗药物的164例和186例住院患者，分别作为干预前组和干预后组。比较2组三联止吐方案（地塞米松、5-羟色胺3受体拮抗剂和神经激肽-1受体拮抗剂）的使用率和用药频度，地塞米松和5-羟色胺3受体拮抗剂的用药合理性，神经激肽-1受体拮抗剂、甲氧氯普胺、质子泵抑制剂和镇静药物的使用率及人均用药金额等指标。结果 干预后组的三联止吐方案和神经激肽-1受体拮抗剂使用率及用药频度明显高于干预前组（P<0.05）；甲氧氯普胺、质子泵抑制剂和镇静药物使用率低于干预前组（P<0.05）；地塞米松和5-羟色胺3受体拮抗剂用药不合理病例数占比低于干预前组（P<0.01）；但人均用药金额高于干预前组（P<0.01）。结论 构建高致吐风险化疗药物的止吐预处理用药方案有助于提高止吐药物的用药合理性，值得临床推广。

AIM To develop and assess the effectiveness of antiemetic prophylaxis regimens for high-emetogenic chemotherapy drugs, providing a reference for clinical practice. METHODS Staff from the Department of Medical Affairs, the Department of Medical Oncology, and the Department of Pharmacy collaborated to discuss and develop antiemetic prophylaxis regimens for high-emetogenic chemotherapy drugs, which were implemented in April 2023. A total of 164 and 186 hospitalized patients with malignant tumors who received high-emetogenic chemotherapy drugs from January to March 2023(pre-intervention) and from January to March 2024(post-intervention) were included, respectively. The clinical pharmacy pathway for antiemetic prophylaxis against nausea and vomiting induced by high-emetogenic chemotherapy drugs was developed and implemented. The usage rate and defined daily doses(DDDs) of the triple antiemetic regimen [dexamethasone, 5-hydroxytryptamine-3 receptor antagonist(5-HT3 RA), and neurokinin 1 receptor antagonist(NK-1 RA)] were compared between the 2 groups. The rationality of dexamethasone and 5-HT3 RA use was evaluated. The application rates of NK-1 RA, metoclopramide, proton pump inhibitors(PPIs), and sedatives, as well as the per capita drug expenses, were also assessed. RESULTS After the implementation of the intervention, the usage rates and DDDs of triplet antiemetic regimen and NK-1 RA were significantly increased(P < 0.05), while the usage rates of metoclopramide, PPI, and sedative were significantly reduced(P < 0.05). The unreasonable proportions of dexamethasone and 5-HT₃ RA were both lower than those before implementation(P < 0.01). However, the per capita drug expenses were observed to be higher(P < 0.01). CONCLUSION The establishment of the antiemetic prophylaxis regimens for high-emetogenic chemotherapy drugs is helpful to regulate the rational use of antiemetic drugs, which is worth promoting.