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Volume 39 Issue 4
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WANG Xiaonü, TAO Wenbin, YANG Lulu, GONG Yuanyuan, XU Xinming, XU Fan. Analysis of drug consumption in field training of joint logistic support force in Yunnan[J]. Journal of Pharmaceutical Practice and Service, 2021, 39(4): 379-383. doi: 10.12206/j.issn.1006-0111.202103025
Citation: WANG Xiaonü, TAO Wenbin, YANG Lulu, GONG Yuanyuan, XU Xinming, XU Fan. Analysis of drug consumption in field training of joint logistic support force in Yunnan[J]. Journal of Pharmaceutical Practice and Service, 2021, 39(4): 379-383. doi: 10.12206/j.issn.1006-0111.202103025

Analysis of drug consumption in field training of joint logistic support force in Yunnan

doi: 10.12206/j.issn.1006-0111.202103025
  • Received Date: 2021-03-17
  • Rev Recd Date: 2021-06-28
  • Available Online: 2021-07-21
  • Publish Date: 2021-07-25
  •   Objective  To analyze the drug consumption of the joint logistics support force during field training in Yunnan, summarize the drug use characteristics of medical staff, and analyze the drug use rules, so as to provide the basis for modular drug support.  Methods  The basic information and drug use of the personnel in an institution of the joint logistics support force during the resident training period from April to June 2020 were collected and sorted out. The drug use indicators were calculated by using the defined daily dose (DDD) as the unit, including: daily drug dose (DDDs), daily drug dose cost (DDDc), drug use intensity (DUI), drug utilization rate (DUR) and drug ranking ratio (R) were used to describe drug use characteristics.  Results  During the resident training period, the amount of musculoskeletal system drugs was large, and the number of users was large. The dosage of cardiovascular system drugs, digestive system drugs and hormone drugs was large, but the number of users was small. Sensory organ drugs, dermatological drugs, heat-clearing agents (Chinese patent medicine) and respiratory system drugs were small in dosages, but the number of users was large. Ranked by DDDs, the top 3 drugs with the highest dosage were Yunnan Baiyao plaster, Yunnan Baiyao Band-Aid and Loratadine Tablets. Ranked by DDDc, the largest daily cost was Budesonide and Formoterol Fumarate Powder for Inhalation. As age increases, the intensity of drug use increased; The intensity of drug use in women was greater than that in men. The intensity of drug use was different for different categories personnel.  Conclusion  Musculoskeletal system drugs are important drugs for field training. The task personnel should formulate a list of medicines for basic diseases based on their own medication for basic diseases and the duration of the task, and submit it to the medicinal material guarantee department to ensure the carrying drugs. The factors affecting modular drug support in field training include: task type, region, solar term, duration and personnel composition, etc.
  • [1] 尤洋阳, 黄秋霞, 黄博, 等. 温室设计课程的创新设计: 基于云南多样性气候、地理特征的现代化温室[J]. 农业开发与装备, 2019(8):86-87, 89. doi:  10.3969/j.issn.1673-9205.2019.08.063
    [2] 汪金生, 文雄, 杨少华, 等. 新时期多样化海军军事行动卫勤保障难点与要求[J]. 海军医学杂志, 2010, 31(4):313-314. doi:  10.3969/j.issn.1009-0754.2010.04.012
    [3] 阳绪华, 米宁, 李炜. 军队医院承担多样化卫勤保障任务的思考[J]. 人民军医, 2013, 56(2):240-241.
    [4] 陈新谦, 金有豫, 汤光. 新编药物学[M]. 17版. 北京: 人民卫生出版社, 2011: 34-1044.
    [5] 卫生部合理用药专家委员会组织. 中国医师药师临床用药指南[M]. 2版. 重庆: 重庆出版社, 2014: 1824.
    [6] 马依林, 杜志谦. 基于频数分析法的骨伤科中成药用药规律研究[J]. 中国医院药学杂志, 2020, 40(12):1385-1389.
    [7] 周红海, 宋晓动, 胡梦婷, 等. 50种骨伤科中成药用药规律和特色简析[J]. 广西中医药, 2019, 42(3):27-30. doi:  10.3969/j.issn.1003-0719.2019.03.009
    [8] 贾程辉, 张寅, 谢雁鸣, 等. 基于HIS数据的48398例四肢骨折患者临床用药规律分析[J]. 中国中药杂志, 2016, 41(13):2555-2560.
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Analysis of drug consumption in field training of joint logistic support force in Yunnan

doi: 10.12206/j.issn.1006-0111.202103025

Abstract:   Objective  To analyze the drug consumption of the joint logistics support force during field training in Yunnan, summarize the drug use characteristics of medical staff, and analyze the drug use rules, so as to provide the basis for modular drug support.  Methods  The basic information and drug use of the personnel in an institution of the joint logistics support force during the resident training period from April to June 2020 were collected and sorted out. The drug use indicators were calculated by using the defined daily dose (DDD) as the unit, including: daily drug dose (DDDs), daily drug dose cost (DDDc), drug use intensity (DUI), drug utilization rate (DUR) and drug ranking ratio (R) were used to describe drug use characteristics.  Results  During the resident training period, the amount of musculoskeletal system drugs was large, and the number of users was large. The dosage of cardiovascular system drugs, digestive system drugs and hormone drugs was large, but the number of users was small. Sensory organ drugs, dermatological drugs, heat-clearing agents (Chinese patent medicine) and respiratory system drugs were small in dosages, but the number of users was large. Ranked by DDDs, the top 3 drugs with the highest dosage were Yunnan Baiyao plaster, Yunnan Baiyao Band-Aid and Loratadine Tablets. Ranked by DDDc, the largest daily cost was Budesonide and Formoterol Fumarate Powder for Inhalation. As age increases, the intensity of drug use increased; The intensity of drug use in women was greater than that in men. The intensity of drug use was different for different categories personnel.  Conclusion  Musculoskeletal system drugs are important drugs for field training. The task personnel should formulate a list of medicines for basic diseases based on their own medication for basic diseases and the duration of the task, and submit it to the medicinal material guarantee department to ensure the carrying drugs. The factors affecting modular drug support in field training include: task type, region, solar term, duration and personnel composition, etc.

WANG Xiaonü, TAO Wenbin, YANG Lulu, GONG Yuanyuan, XU Xinming, XU Fan. Analysis of drug consumption in field training of joint logistic support force in Yunnan[J]. Journal of Pharmaceutical Practice and Service, 2021, 39(4): 379-383. doi: 10.12206/j.issn.1006-0111.202103025
Citation: WANG Xiaonü, TAO Wenbin, YANG Lulu, GONG Yuanyuan, XU Xinming, XU Fan. Analysis of drug consumption in field training of joint logistic support force in Yunnan[J]. Journal of Pharmaceutical Practice and Service, 2021, 39(4): 379-383. doi: 10.12206/j.issn.1006-0111.202103025
  • 云南,地处中国西南边陲,邻近缅甸、越南、老挝,属于低纬度高原,地理位置特殊,地形地貌复杂,气候复杂多变,昼夜温差大,气温随地势高低垂直变化异常明显[1]。随着驻军参与抢险救灾、边境维稳、疫情防控等非战争军事任务日益增多,军事活动的复杂性、突发性、多样性特点日趋突出[2]。因此,基于不同任务类型,探索药材保障的方法和对策,以应对新时期多样化军事行动卫勤保障需要,确保圆满完成部队卫勤保障任务具有重要意义[3]。笔者基于2020年4至6月,在云南境内展开的某联勤保障部队卫勤应急驻训任务,对此次驻训期间的用药情况进行统计分析,以期为云南地区模块化药品保障提供参考依据。

  • 2020年4至6月,某联勤保障部队卫勤机构履行野外驻训保障任务,驻训期间共收治患者363人次。

  • 收集患者的年龄、性别、人员类别以及药品的名称、单位、规格、使用数量、用药金额等,根据《新编药物学》(第17版)[4]和《中国医师药师临床用药指南》(第2版)[5]对药品进行分类,采用世界卫生组织(WHO)推荐的限定日剂量(DDD)为计量单位的统计方法,计算药品日剂量数(DDDs)、药品日剂量费用(DDDc)、药品使用强度(drug use intensity,DUI)、药物使用率(drug utilization rate,DUR)及药品排名比(drug ranking ratio,R)。参照WHO推荐值和药品说明书确定DDD值。DDDs=某药的总用药量/该药的DDD值,反映一个药物的用量多寡,不同药品的DDDs可以相加,用于比较不同类别药物的用量大小。DDDc =某药用量总金额(元) /该药的DDDs,是使用某药的1日费用,反映该药的可负担性。DUI=某人群使用某药的DDDs/该人群人数,表示该人群使用某药的强度,可用于比较不同时期、不同地域、不同人群的用药差别。DUR=(使用某药人数/驻训总人数)×100%,反映目标药物使用人数所占比例。R=某药DDDs排名/该药DUR排名。R值越趋近1,说明该药物的用量和使用人数越相当;R值>1且偏离度越大,说明驻训期间该药物的用量小,但使用人数多,属于一过性疾病用药;R值<1且偏离度越大,说明驻训期间该药物的用量大,但使用人数不多,属于基础疾病用药。分析时应重点关注偏离度大的R值。

  • 按照药品分类和单个药品分别计算DDDs、DDDc、DUR和R;再按性别、年龄段(≤29岁、30~49岁、≥50岁)、人员类别(干部、聘用、文职、战士、职工)等不同人群分别计算DDDs和DUI,并列表分析不同人群间药品消耗的情况。结果见表1表2表3表4表5

    排序药品分类品种数DDDc
    (元)
    DDDsDUR
    (%)
    R
    1感觉器官药物和皮肤科用药288.90157.0023.001.50
    2消化系统药物143.60152.566.670.80
    3心血管系统药物102.32209.224.000.25
    4肌肉骨骼系统药物85.54525.0029.001.00
    5抗感染药物81.8257.603.671.11
    6维生素及矿物质缺乏症用药73.12139.755.670.83
    7呼吸系统药物611.27107.337.331.50
    8清热剂(中成药)63.67103.008.672.33
    9解热镇痛抗炎药55.1654.673.331.10
    10感冒药(西药)42.2775.674.671.14
    11解表剂(中成药)32.8318.001.331.18
    12中枢神经系统药物22.3010.000.670.93
    13其他27.539.671.331.25
    14激素类药物10.7566.670.670.69
    15血液和造血器官药14.2032.000.670.86
    合计1051718.12
  • 表1可见,这次驻训期间用药品种达105种,DDDs值总计1718.12。DDDc排名第1的是呼吸系统药物,排名第2的是感觉器官药物和皮肤科用药,排名第3的是其他类。DDDs和DUR均排名第1的是肌肉骨骼系统药物,该类药物R值为1,说明驻训期间的肌肉骨骼损伤较为频发,该药物的用量大,使用人数多,该类药物需重点保障。DDDs排名第2的是心血管系统药物,该药物在DUR中排名第8,R值为0.25,R值<1且偏离度最大,说明驻训期间该药物的用量大,但使用人数不多,属于基础疾病用药。DDDs排名第3的是感觉器官药物和皮肤科用药,该类药物在DUR中排名第2,R值为1.50,R值>1且偏离度大,说明驻训期间该药物的用量小,但使用人数多,属于一过性疾病用药。DUR排名第3的是清热剂(中成药),该类药物在DDDs中排名第7,R值为2.33,R值>1且偏离度最大,说明驻训期间由于环境及气候影响,驻训人员对清热剂(中成药)的需求较大,但用量不多,该类药物应多种少量配备。呼吸系统药物R值为1.50,与感觉器官药物和皮肤科用药及清热剂(中成药)的R值相近,说明该类药物用量小,但使用人数多。

  • 表2可见,DDDs排名第1的是云南白药膏,该药品在DUR中也排名第1,说明在驻训期间受训人员易出现跌打损伤,该药品的用量和使用人数都最多,因此是需要重点保障的药品。DDDs排名第2的是云南白药创可贴,该药品在DUR中排名第3,说明该药品的用量大,使用人数多,也需重点保障。DDDs排名第3的是氯雷他定片,该药品在DUR中排名第10,R值为3/10=0.30,R值<1,且偏离度大,说明驻训期间该药品的用量大,但使用人数不多,属于基础疾病用药。DUR排名第2的是云南白药气雾剂,该药品在DDDs中排名第18,R值为18/2=9.00,R值>1,且偏离度最大,说明驻训期间该药品的用量不大,但使用人数多,属于一过性疾病用药。厄贝沙坦片的R值为0.12,R值<1且偏离度最大,该药品DDDs排名第4,DUR排名第33,说明驻训期间该药品的用量较大,但使用人数少,属于基础疾病用药。DDDc排名第1的是布地奈德福莫特罗粉吸入剂,排名第2的是重组人表皮生长因子外用溶液,排名第3的是布地奈德鼻喷雾剂,属于单价较贵的药品。

    排序DDDc(元)DDDsDUR(%)
    药品名称数值药品名称数值药品名称数值
    1布地奈德福莫特罗粉吸入剂220.18云南白药膏245.00云南白药膏9.00
    2重组人表皮生长因子外用溶液62.05云南白药创可贴126.00云南白药气雾剂7.33
    3布地奈德鼻喷雾剂53.78氯雷他定片84.00云南白药创可贴5.33
    4蓝芩口服液50.00厄贝沙坦片72.00连花清瘟胶囊4.67
    5镇痛活络酊38.90奥美拉唑肠溶片70.00双氯酚酸钠贴4.00
    6盐酸氮卓斯汀鼻喷雾剂35.68左甲状腺素钠片66.67妥布霉素滴眼液3.00
    7玻璃酸钠滴眼液35.44双氯酚酸钠贴60.00酚麻美敏片2.67
    8重组人表皮生长因子眼液32.39酚麻美敏片45.00布地奈德鼻喷雾剂2.33
    9云南白药气雾剂29.26板蓝根颗粒40.00硝酸咪康唑乳膏2.33
    10卤米松乳膏27.46氨基葡萄糖胶囊40.00氯雷他定片2.00
    11富马酸依美斯汀滴眼液27.22硝苯地平缓释片(Ⅱ)40.00红霉素软膏2.00
    12熊去氧胆酸胶囊25.22连花清瘟胶囊38.00盐酸氮卓斯汀鼻喷雾剂1.67
    13羟糖甘滴眼液21.33咽立爽口含滴丸36.00板蓝根颗粒1.67
    14宣肺止嗽合剂20.25维生素C片35.00维生素C片1.67
    15莫匹罗星软膏20.18甲钴胺片32.00莫匹罗星软膏1.33
    16赖氨匹林散19.70阿莫西林胶囊30.00复方醋酸地塞米松乳膏1.33
    17骨化三醇胶丸19.60碳酸钙D3片30.00咽立爽口含滴丸1.33
    18氟比洛芬凝胶贴膏19.29云南白药气雾剂25.00牛黄解毒片1.33
    19头孢克洛胶囊18.44碳酸钙咀嚼片25.00阿莫西林胶囊1.33
    20复方氟米松软膏18.31复合维生素B片21.00富马酸依美斯汀滴眼液1.00
  • 表3可见,女性的用药强度大于男性。无论男性还是女性,肌肉骨骼系统药物DDDs均排名第1。女性DDDs排名第2的是消化系统药物,排名第3的是维生素及矿物质缺乏症用药。男性DDDs排名第2的是心血管系统药物,排名第3的是清热剂(中成药)。

    序号药品分类DDDsDUI
    1肌肉骨骼系统药物103.00422.000.912.26
    2心血管系统药物85.00124.220.750.66
    3感觉器官药物和皮肤科用药50.00107.000.440.57
    4消化系统药物14.00138.560.120.74
    5维生素及矿物质缺乏症用药14.00125.750.120.67
    6呼吸系统药物32.3375.000.290.40
    7清热剂(中成药)51.3351.670.450.28
    8感冒药(西药)37.3338.330.330.20
    9激素类药物0.0066.670.000.36
    10抗感染药物25.1032.500.220.17
    11解热镇痛抗炎药8.0046.670.070.25
    12血液和造血器官药0.0032.000.000.17
    13解表剂(中成药)11.676.330.100.03
    14中枢神经系统药物6.004.000.050.02
    15其他7.672.000.070.01
    总计445.431272.703.946.81

    表4可见,DDDs数据显示年龄在30~49岁的用药量最大,≥29岁次之,≥50岁的最小。DUI数据显示年龄≥29岁的人群用药强度最小,30~49岁的人群用药强度次之,≥50岁的人群用药强度最大。两组数据综合说明驻训人员以30~49岁的人群用药为主,用药强度随着年龄的增长而增大。年龄≤29岁,用药最大的是肌肉骨骼系统药物,其次是感觉器官药物和皮肤科用药,第三是清热剂(中成药)。年龄在30~49岁,用药最大的是肌肉骨骼系统药物,其次是心血管系统药物,第三是消化系统药物。年龄≥50岁,用药最大的是心血管系统药物,其次是消化系统药物,第三是肌肉骨骼系统药物。

    序号药品分类DDDsDUI
    ≤29岁30~49岁≥50岁≤29岁30~49岁≥50岁
    1肌肉骨骼系统药物123.00394.008.001.242.011.60
    2心血管系统药物0.00127.2282.000.000.6516.40
    3感觉器官药物和皮肤科用药54.33101.671.000.550.520.20
    4消化系统药物23.67114.8914.000.240.592.80
    5维生素及矿物质缺乏症用药28.00111.750.000.280.570.00
    6呼吸系统药物31.3376.000.000.320.390.00
    7清热剂(中成药)50.0051.002.000.510.260.40
    8感冒药(西药)21.3349.335.000.220.251.00
    9激素类药物0.0066.670.000.000.340.00
    10抗感染药物8.1049.500.000.080.250.00
    11解热镇痛抗炎药17.0037.670.000.170.190.00
    12血液和造血器官药16.0016.000.000.160.080.00
    13解表剂(中成药)17.670.330.000.180.000.00
    14中枢神经系统药物0.004.006.000.000.021.20
    15其他7.672.000.000.080.010.00
    总计398.101202.03118.004.026.1323.60
  • 表5可见,DDDs数据显示,按用药量由大到小分别为聘用、文职、干部、战士及职工。DUI数据显示,人群用药强度由大到小分别为职工、文职、聘用、干部及战士。两组数据综合说明驻训人群用药较多的以聘用及文职为主,从人群用药强度看,职工最大,战士最小。干部用药最大的是心血管系统药物,其次是肌肉骨骼系统药物;聘用人员用药最大的是肌肉骨骼系统药物,其次是心血管系统药物;文职人员用药最大的是肌肉骨骼系统药物,其次是消化系统药物;战士用药最大的是肌肉骨骼系统药物,其次是感冒药(西药)和解热镇痛抗炎药;职工用药最大的是肌肉骨骼系统药物,其次是消化系统药物。

    序号药品分类DDDsDUI
    干部聘用文职战士职工干部聘用文职战士职工
    1肌肉骨骼系统药物71.00229.00188.0030.007.001.451.622.410.977.00
    2心血管系统药物82.00121.226.000.000.001.670.860.080.000.00
    3感觉器官药物和皮肤科用药21.0062.3366.675.002.000.430.440.850.162.00
    4消化系统药物0.0065.2280.670.006.670.000.461.030.006.67
    5维生素及矿物质缺乏症用药19.5058.0055.257.000.000.400.410.710.230.00
    6呼吸系统药物14.0084.006.003.330.000.290.600.080.110.00
    7清热剂(中成药)10.0050.6731.676.674.000.200.360.410.224.00
    8感冒药(西药)14.0034.3317.3310.000.000.290.240.220.320.00
    9激素类药物0.0033.3333.330.000.000.000.240.430.000.00
    10抗感染药物17.0016.0015.003.606.000.350.110.190.126.00
    11解热镇痛抗炎药2.0018.6724.0010.000.000.040.130.310.320.00
    12血液和造血器官药0.0016.0016.000.000.000.000.110.210.000.00
    13解表剂(中成药)0.336.0011.670.000.000.010.040.150.000.00
    14中枢神经系统药物6.000.004.000.000.000.120.000.050.000.00
    15其他6.671.001.000.001.000.140.010.010.001.00
    总计263.50795.77556.5975.6026.675.385.647.142.4426.67
  • 这次驻训基于肌肉骨骼系统药物仅保障了云南白药系类药品、双氯酚酸钠贴、氨基葡萄糖胶囊、消痛贴膏、氟比洛芬凝胶贴膏、镇痛活络酊,其中内服药只有1种胶囊剂,外用药包括1种酊剂、1种气雾剂、5种膏剂。《中国药典》收载的治疗骨伤科疾病有149种中成药,涉及17种剂型[6],表明该类药品具有较大的选择余地。根据骨伤科三期辨证用药规律[7-8],活血化瘀和消肿止痛类中药组方为主的中成药应作为该类药物中重点保障的品种。

    感觉器官药物和皮肤科用药、清热剂(中成药)及呼吸系统药物同样是使用人数多的药物,说明春夏季云南地区驻训,水土不服及过敏反应是驻训官兵的常见病,其使用特点是单人用量小,属于一过性疾病用药,以短期治疗为主。心血管系统药物、消化系统药物和激素类药物的用量大,但使用人数不多,主要用于治疗固定人群的基础疾病。对使用这几类药物的官兵进行用药指导时,发现配备的药物与其日常治疗用药并不完全一致,有可能存在疗效不佳的风险。

    因此,需要对该类药品的品量配备进行系统研究,细分功能主治,增加保障品规,满足驻训需求。感觉器官药物和皮肤科用药、清热剂(中成药)及呼吸系统药物以短期治疗为主,因而宜多种少量配备。心血管系统药物、消化系统药物和激素类药物,属于固定人群用药,建议在执行任务前,根据各类人员自身的基础疾病,制定个人药品保障清单,提交药材保障部门,做好个人携行药品保障。

    模块化的药品品量设计及组合是实现卫勤任务快速、精准的药品保障的途径和方法之一。以此次驻训用药经验分析,影响野外驻训模块化药品保障的因素包括:任务类型、地域、节气、时长和人员构成等。要完成好全程卫勤保障任务,应当覆盖任务前、中、后三个阶段。任务前期全面分析上述五大要素,配备好个人携运行药品;任务中期及时对用药情况进行统计分析,实现快速足量补充;任务后期对品量表适用情况进行评价,优化药品品量结构。

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