先兆流产或先兆早产患者初次应用硫酸镁注射液的药品不良反应预测模型研究

Predictive model of adverse reactions of initial application of magnesium sulfate injection in patients with threatened abortion or premature delivery

  • 摘要:
      目的  构建先兆流产或先兆早产患者初次应用硫酸镁注射液的药品不良反应(ADR)预测模型用于早期评估用药风险,提高用药安全性。
      方法  回顾性分析1 553例诊断为先兆流产或先兆早产患者的临床资料,患者均为初次应用硫酸镁注射液,依据美国食品药品监督管理局(FDA)对ADR的定义,共报告73例ADR。将发生ADR的73例患者纳入ADR组,未发生ADR的1 480例患者纳入无ADR组,比较2组患者的临床资料,采用多因素Logistic回归分析筛选ADR的危险因素。
      结果  ADR组患者年龄、药物剂量高于无ADR组,孕周长于无ADR组,经产妇、有流产史、有妊娠合并症者占比高于无ADR组,差异有统计学意义(P < 0.05);2组体质量指数、流产原因、护士工作年限比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,年龄大、有妊娠合并症和药物剂量高是患者发生ADR的独立危险因素(P < 0.05)。ADR预测模型为Y=–0.25+0.42×年龄+0.68×妊娠合并症+0.92×药物剂量,受试者工作特征(ROC)曲线显示,该模型评分预测ADR的曲线下面积(AUC)为0.856,临界值为3.5分,敏感度为82.6%,特异度为74.5%。
      结论  构建先兆流产或先兆早产患者初次应用硫酸镁注射液的ADR预测模型,能够更好地指导临床药师和医生早期评估用药风险,提高用药安全性,降低ADR发生率。

     

    Abstract:
      Objective  To construct predictive model of adverse reaction(ADR) induced by magnesium sulfate injection for the first time in patients with threatened abortion or premature delivery, so as to improve the drug safety.
      Methods  Data of 1 553 patients diagnosed as threatened abortion or threatened preterm birth were retrospectively summarized. All of them used magnesium sulfate injection for the first time. A total of 73 patients were reported as ADR according to its definition by FDA. A total of 73 patients with ADR were included in ADR group and 1 480 patients without ADR were included in ADR-free group. The clinical data between the ADR group and the non-ADR group were compared, and the risk factors of ADR were screened by multivariate Logistic regression analysis.
      Results  Compared with the non-ADR group, the age and drug dose of patients were higher, gestational weeks in the ADR group was longer, and proportions of multipara, abortion history and pregnant complications were higher (P < 0.05); there were no differences in body mass index, abortion reason and nurses' working years between the two groups (P>0.05). Logistic regression analysis showed that older age, pregnant complications and higher drug dose were independent risk factors of ADR (P < 0.05). ADR predictive model Y=-0.25+0.42×age+0.68×pregnant complications+0.92×drug dose. Receiver operating curve (ROC) showed that the area under the curve (AUC) of ADR predictive model was 0.856, the critical value scored 3.5, with sensitivity of 82.6%, and specificity of 74.5%.
      Conclusion  Constructing the ADR predictive model of magnesium sulfate injection for the first time in patients with threatened abortion or premature delivery can better guide clinical pharmacists and doctors to evaluate the drug risk in the early stage, improve drug safety, reduce the incidence of ADR.

     

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