台灣是B型肝炎盛行區，慢性肝炎導致肝硬化常伴隨低凝血酶原血症，維生素K1注射劑常用於校正低凝血酶原狀態之凝血機能異常，由於維生素K1注射劑之使用具有潛在致死的危險性，因此自九十年二月一日至二月二十八日間進行藥物使用評估，回顧病人的病歷以判定維生素K1注射劑是否適當使用。我們的結果顯示，28天之中使用人數為220人，耗用總量為2281支維生素K1注射劑，使用人年齡從一天至89歲主要分布於40~70歲，平均每人使用量為10.4 支，中位數為 6 支。使用總量以肝膽內科最多（743支），使用人數及使用頻率則以腦神經外科最多，佔總使用人數19.6%（43/220）。使用理由83.2%為低凝血酶原血症（41.8%）及止血（41.4%）。使用正確注射支數（每人總量3支）佔40%（88/220）。使用正確單次注射劑量者佔96.8%（213/220）。依正確投與間隔每日一次之使用者佔94.5%（208/220）。依正確投與途徑（成人為皮下注射，新生兒為肌肉注射）使用者佔14.5%（32/220）。不包括新生兒科預防新生兒出血疾病時，注射前偵測凝血酶原時間者只佔13.9%（26/187），而注射結束有評估其效果再偵測凝血酶原時間者則佔41.7%（78/187）。符合修訂之使用標準為適當使用者之比例只有14.5%（32/220），而且維生素K1在注射時並未避光保護。因此，加強醫師對於維生素K1注射劑使用的適應症、投與途徑、使用的劑量、監測藥物的使用效果與副作用等，以增加維生素K1注射劑使用之適當性。並依據所訂的準則做緊密的追蹤監測是十分必要的。
Liver cirrhosis associated hypoprothrombinemia is frequently found in Taiwan. Vitamin K1 injection is commonly used to correct hypoprothrombinemia. Intravenous vitamin K1 may cause sudden death. Considering the possible serious side effects, retrospective drug utilization evaluation of vitamin K1 was conducted. Total of 2281 ampoules were used to 220 patients during February 01 to February 28, 2001. These patients, aged from 1 day to 89 years, used 10.4 ampoules per patient in average. The most frequent prescription was found in the neuro-surgical department. The most common indication for prescription was hypothrombinemia (41.8%) and hemostasis (41.4%). The prescription rate of correct amount (less than 30mg) was 40%. The prescription rate of accurate route of administration (subcutaneous injection in adult and intra-muscular injection in newborn) was 14.5%. Only 13.9% of prescription, excluding newborn, had checked prothrombin time before injection; and 41.7% had followed prothrombin time to evaluate the therapeutic effect. Only 14.5% of usage was adequate at this evaluation. The mistake that vitamin K1 was not protected from light during injection was also found. Education to doctors about the indications, administration route, and the total amount of vitamin K1 injection prescribedalong with monitoring the prothrombin time and side effectswere the most important procedures to increase the adequacy of prescription of vitamin K1 injection.
