目的： 疼痛為一種主觀的感覺，如何安全且有效的控制疼痛則為疼痛治療的最大課題。Meperidine 止痛時間短且其止痛效果一般，卻可能因活性代謝物normeperidine 蓄積進而誘發神經毒性發生。為使meperidine使用符合臨床準則，針對某區域教學醫院meperidine 處方型態進行使用評估。
方法： 以回溯性世代研究，利用電腦資料庫及病歷回溯分析2012 年1 月至2014 年12 月某區域教學醫院使用meperidine 之門、急、住診所有病人其meperidine 每日總劑量、連續使用時間及用藥原因，另統計2012年1月至2014 年12 月meperidine 與morphine 之年耗用比例，評估自2014 年1月起藥師介入管制藥品管理委員會進行使用案例評估並定期進行meperidine 合理使用宣導之改善成效。
結果： 研究期間共納入11,822 位病人，meperidine 連續使用超過48 小時之發生率，從介入前為2012 年490位 (13.3%)，2013 年543 位 (13.0%) 降低為介入後2014 年352 位 (8.9%)，p < 0.0001。在連續使用meperidine 超過48 小時之病人中，大於65 歲老年人在介入前2012 年225 位 (51.4%)，2013 年232 位(42.7%)，介入後2014 年則降為130 位 (36.9%)，p = 0.033。院內meperidine 與morphine 之年耗用比例，則由介入前2012 年40.4%，2013 年45.4%，降為介入後2014 年32.9%，p < 0.0001。
結論： 藉由藥師透過管制藥品管理委員會宣導meperidine 合理使用範圍與臨床使用準則，確實大為改善meperidine 不當使用比例，期望能透過系統建置進行管控，以避免meperidine 潛在使用風險，確保病人用藥安全。
Objective: Meperidine has similar analgesic effects but shorter duration to other opioids. It metabolizes into active metabolite nor-meperidine causing significant neuro-toxicities. We evaluate the use of meperidine in a regional teaching hospital to inspect the appropriateness of use.
Methods: This study is a retrospective analysis of patients from OPD, IPD and ER settings who received meperidine in a regional teaching hospital from 1st January 2012 to 31st December 2014. An intervention was introduced since January 2014. Clinical pharmacist began to take part in the Control Substance Committee and discussed the rationale of meperidine use and giving education to the clinicians. We analyze the total daily dose, exposure time, indication of meperidine, and the consumption ratio of meperidine to morphine, as the indicator of the outcomes of pharmacists’ intervention.
Results: A total of 11,822 patients were included in the study. We concerned about the population who received 48-hours-continues-meperidine regimen. During the study period, the number of patients belonging to this population is: 490 (13.3%), 543 (13.0%), 352 (8.9%) in 2012, 2013, and 2014 respectively. It shows significant decrease (p < 0.0001) after clinical pharmacist’s intervention. The distribution of elderly belonging to this population is: 225 (51.4%), 232 (42.7%),130 (36.9%) in 2012, 2013, and 2014 respectively. Similarly, it decreased (p = 0.033) after we gave the intervention. The consumption ratio of meperidine to morphine is 40.4%, 45.4%, 32.9% in 2012, 2013, and 2014 respectively. The significant reduction (p < 0.0001) indicate decline of meperidine exposure.
Conclusions: The above results show giving intervention and education to the clinician can effectively improve the inappropriateness of meperidine use.
