Page 116 - 202006
P. 116
CHF routine examination and drug treatment at admission;on this basis,the patients in the intervention group received clinical
pharmacist chronic disease management as inpatient pharmaceutical care,medication education at discharge and pharamceutical
follow-up at discharge. The cardiac function indexes (NYHA cardiac function classification,LVEF,NT-proBNP,LVDd),
comprehensive self-care ability(scores of self-care ability,drug compliance,understanding of disease-related knowledge,and total
score of comprehensive self-care ability),and life quality(emotional score,symptom score,social restriction score,and total
score of life quality)at admission,discharge and 6 months after discharge;economic indicators(total hospitalization expenses,
hospitalization time,drug expenses and drug proportion)during hospitalization;readmission and case fatality within 6 months after
discharge were compared between the two groups. RESULTS:At admission,there was no significant difference in the above
indicators between 2 groups(P>0.05);at discharge,except for LVEF,emotional score and social restriction score,the other
indicators in 2 groups were significantly improved,compared with at admission(P<0.05);six months after discharge,the above
indicators of 2 groups were significantly improved compared with at admission,and LVEF,LVDd,drug compliance score,score
of understanding of disease-related knowledge,total score of comprehensive self-care ability,emotion score,symptom score,total
score of life quality in the intervention group were significantly better than control group (P<0.05). There was no significant
difference in the total hospitalization expenses,hospitalization time,drug expenses and drug proportion between 2 groups(P>
0.05). Within 6 months after discharge,the readmission rate of the intervention group was 14.29%,which was significantly lower
than that(29.33%)of control group(P<0.05). There was no significant difference in case fatality rate between 2 groups(P>
0.05). CONCLUSIONS:The participation of clinical pharmacists in chronic disease management of CHF patients can significantly
improve the cardiac function indexes,comprehensive self-care ability and quality of life,and reduce the readmission rate.
KEYWORDS Chronic heart failure;Chronic disease management;Clinical pharmacist;Cardiac function;Comprehensive self-
care ability;Quality of life
慢性心力衰竭(Chronic heart failure,CHF)是慢病的 准 ,纽约心脏病协会(NYHA)心功能分级Ⅱ~Ⅳ级,超
[7]
一种,不仅会影响患者循环系统功能,还会造成呼吸系 声心电图证实左室射血分数(LVEF)<45%且左室舒张
统及肝肾功能受损,严重影响患者生活质量,给其造成 末期内径(LVDd)男性>55 mm、女性>50 mm;②年龄
[1]
严重的经济负担 。据报道,CHF 患者反复进入失代偿 ≥18 岁;③无其他脏器严重疾病。(2)排除标准:①瓣膜
期是美国和欧洲急诊患者住院的主要原因之一,该类 性或先天性心脏病者;②心肌炎或急性心肌梗死者;③
患者占所有住院急诊患者的 1%~2% 。这些发现意 伴有肝、脾、肺、肾等重要脏器损伤者;④恶性肿瘤者;⑤
[2]
味着必须采取更多措施来防止 CHF 患者频繁再住院和 严重肝、肾功能不全者;⑥言语及精神功能障碍者;⑦非
早期死亡。慢病管理是指药师与医师、护理人员等团队 病死失访者;⑧妊娠期妇女。本研究获得我院医学伦理
成员相互协作,为慢病患者提供可行、持续的管理,以达 委员会批准(伦理批号:20150004),研究对象均知情同
到延缓慢病进程、提高患者生活质量并降低医药费用的 意并签署知情同意书。
[3]
一种科学管理模式 。2013年,美国心力衰竭学会和临 1.2 研究方法
床药学学院心脏病学实践与研究网络专家提议将临床 依据随机、对照和前瞻性的原则,按随机数字表法
药师纳入 CHF 慢病管理团队成员 。国内研究发现,临 将纳入患者分为干预组和对照组,各80例。两组患者入
[4]
床药师参与CHF慢病管理可提高患者的综合自护能力、 院后,临床药师通过药学问诊,收集患者一般信息、疾病
指南推荐药物的使用率及用药依从性,降低患者的再住 情况等资料,为其建立健康档案。出院当日及出院后第
院率,提高其生活质量 [5-6] 。目前,国内已开展了临床药 6 个月,患者回院复诊,临床药师收集考察指标的资料。
师对 CHF 慢病管理的相关研究,但大多样本量较小、随 入组患者按照《中国心力衰竭诊断和治疗指南(2014)》 [7]
访时间较短且缺乏规范的管理模式。因此,为进一步提 接受CHF临床路径中规定的检查和药物治疗,干预组患
高药物治疗效果、改善患者生活质量,我院临床药师在 者在此基础上接受药学监护,具体干预措施包括住院期
CHF患者中试行以药学服务为核心的慢病管理路径,并 间药学监护、出院时用药教育和出院后药学随访等3个
设计前瞻性研究对其实施效果进行评价,旨在探讨在 环节,不同的临床药师对患者均采用以下标准化的慢病
CHF慢病管理中实施药学路径的可行性和有效性。 管理模式。
1 资料与方法 1.2.1 住院期间药学监护 入院第 1 天,临床药师详细
1.1 资料来源 了解患者入院前用药史、药物不良反应史,参与制订和
选取2016年1月-2017年12月我院心血管内科收 评价初始药物治疗方案,制订相关药学服务计划。住院
治且符合条件的 CHF 患者。(1)纳入标准:①均符合《中 期间,临床药师每天进行药学查房,详细告知患者用药
国心力衰竭诊断和治疗指南 2014》中 CHF 的诊断标 方式、药物禁忌及注意事项、药物不良反应及应对措施,
·746 · China Pharmacy 2020 Vol. 31 No. 6 中国药房 2020年第31卷第6期