目的 建立人促红素注射液（rhEPO）合理性评价体系，分析目前临床使用过程中存在的问题，为临床合理用药提供参考。方法 以rhEPO的说明书为基础，参考相关专家共识和指南制定用药合理性评价标准。根据入排标准随机抽取安徽医科大学附属亳州医院2023年4月—2024年4月使用rhEPO的归档病历，应用属性层次模型（AHM）法对其进行合理性评价，并与传统点评方法进行一致性检验，确定AHM法的可行性。结果 372份病历中，病历评分（MRS）≥90分156例（占比41.94%），75分≤MRS＜90分55例（占比14.78%），60分≤MRS＜75分的60例（占比16.13%），MRS＜60分101例（占比27.15%）；不合理类型主要表现为适应证54例次（占比14.52%），用药或停药时机151例次（占比40.59%），用药剂量179例次（占比48.12%）以及用药调整163例次（占比43.82%）等。与传统点评方法比较，AHM法一致率为90.59%（Kappa＝0.785，P＜0.001）。结论 基于AHM法建立的rhEPO评价体系切实可行，评价结果显示本院rhEPO使用存在不合理现象，医院需在适应证、用药或停药时机、用药剂量及用药调整等方面进一步规范、合理使用。

Objective To establish the rational evaluation system of recombinant human erythropoietin injection (rhEPO), so as to identify problems existing in the current clinical use and provide references for its clinical application. Methods Based on the instructions of rhEPO, the rational evaluation criteria were formulated according to the relevant expert consensus and guidelines. According to the entry criteria, rhEPO in Bozhou Hospital Affiliated to Anhui Medical University from April 2023 to April 2024, and the attribute hierarchy model (AHM) method was applied to evaluate its rationality, and the consistency test with the traditional review method was conducted to determine the feasibility of AHM method. Results Among a total of 372 cases, MRS was ≥ 90 (n = 156, 41.94%), 75 ≤ MRS ＜ 90 (n = 55, 14.78%), 60 ≤ MRS ＜ 75 (n = 60, 16.13%), and MRS < 60 (n = 101, 27.15%). The unreasonable types were mainly manifested as 54 indications (14.52%), 151 indications or withdrawal time (40.59%), 179 indications (48.12%) and 163 medication adjustment (43.82%). Compared with the traditional review method, the AHM agreement rate was 90.59% (Kappa = 0.785, P < 0.001). Conclusion The rhEPO evaluation system based on AHM method is feasible, and the evaluation results show that the use of rhEPO in the hospital needs to further standardize and rationally use it in terms of indication, medication or withdrawal time, dosage and adjustment.

R973

安徽省重点研究与开发计划项目（2022e07020066）