Page 118 - 《中国药房》2021年8期

ABSTRACT OBJECTIVE： To study influential factors for medication compliance of phosphate binder in patients with
maintenance hemodialysis and the effects of pharmacist intervention，and to improve medication compliance and the effects of
disease control. METHODS：The patients with maintenance hemodialysis who were treated in the blood purification center of our
hospital from Jun. to Dec.，2019 were selected for questionnaire survey. The questionnaires involved general information，
medication compliance of phosphate binder，disease and medicine related knowledge，social support，self-efficacy. The t-test，χ 2
test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients
were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with
pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared
between 2 groups. RESULTS：Totally 298 patients completed the survey（effective recovery rate of 96.1％）. Among them，163
patients（54.7％）had good adherence to phosphate binder，while 135 patients（45.3％）had poor compliance. Results of single
factor analysis showed that medication compliance of phosphate binder was closely associated with age，dialysis duration，
parathyroid hormone levels，total daily dose，daily dose of phosphate binder，disease and medicine related knowledge scores，
social support，self-efficacy（P＜0.05）. Results of multivariate Logistic regression analysis showed that total daily dose，daily dose
of phosphate binder，disease and medicine related knowledge scores，social support and self-efficacy were the influential factors for
medication compliance （P＜0.05 or P＜0.01）. Medication compliance，disease control status，disease and medicine related
knowledge score， social support and self-efficacy in pharmaceutical intervention group were significant improved， blood
phosphorus level was significant lower，compared with non-intervention group（P＜0.05）. CONCLUSIONS：Independent risk
factors influencing medication compliance of phosphate binder include total daily dose，daily dose of phosphate binder，disease and
medicine related knowledge scores，social support and self-efficacy. The patients with maintenance hemodialysis have poor
compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk
factors，which can effectively improve the medication compliance and disease prognosis of patients.
KEYWORDS Maintenance hemodialysis； Phosphate binder； Medication compliance； Hyperphosphatemia；Pharmaceutical
intervention

在 我 国 ，血 液 透 析 患 者 高 磷 血 症 的 发 生 率 为 委员会审批实施。
[1]
57.4％ 。长期高磷血症不仅是慢性肾脏病疾病进展的 1.2 调查方法
独立危险因素，也是慢性肾脏病患者发生全因死亡和心 1.2.1 资料收集 采用自行设计的问卷，收集患者以下
[2]
血管死亡的独立危险因素 。高磷血症不仅会促进继发 资料：①人口学资料，包括年龄、性别、文化程度、婚姻状
性甲状旁腺功能亢进、矿物质和骨代谢异常，还会导致 况、付费方式、月收入等；②疾病方面的资料，包括透析
心脏瓣膜钙化、血管和软组织等出现转移性钙化 [3－5] 。 龄、有无高磷血症并发症、主要实验室指标（血磷、血钙、
除限制饮食磷摄入和规律透析外，血液透析患者更需要 甲状旁腺激素水平）；③药物方面的资料，包括每日服药
[6]
服用磷结合剂来降低血磷水平 。数据显示，90％～ 总数量、每日磷结合剂服药数量等。
95％的血液析患者需要服用磷结合剂，这一比例远高于 1.2.2 用药依从性评价 采用Morisky药物依从性量表
[7]
腹膜透析患者 。提高磷结合剂的用药依从性有利于提 （MMAS-8）评估患者的用药依从性。该量表具有较高
高其临床疗效，故近年来血液透析患者磷结合剂用药依 的信度和效度，已广泛应用于各类慢性疾病的研究 。
[8]
从性的研究成为慢性肾脏病研究的热点。本研究旨在 MMAS-8包含了8个问题，总分为8分，依从性等级划分
调查维持性血液透析患者磷结合剂用药依从性，同时探 为良好（≥6分）和差（＜6分）。
讨其影响因素并对其中的危险因素进行药学干预，以期 1.2.3 患者疾病与药物知识掌握水平 本研究在 Shi
提高患者的用药依从性，改善疾病控制的效果。 等 编制的慢性肾脏病矿物质和骨代谢紊乱知识和行为
[9]
1 资料与方法 （CKD-MBD-KB）问卷的基础上，选取其中和高磷血症
1.1 调查对象 与磷结合剂相关的问题，再邀请1名肾脏内科主任医师、
选取 2019 年 6－12 月在我院血液净化中心进行维 2名血液净化中心主任医师、2名肾脏内科专业副主任药
持性血液透析治疗的患者。纳入标准：患者年满 18 周 师、2名血液透析专科护士共7人对问卷进行评定，然后
岁，透析龄 6 个月以上，预计生存期大于 6 个月，伴有高 调整问卷内容，最终形成高磷血症疾病与药物知识问
磷血症且需服用磷结合剂，每周透析3次、每次透析4 h， 卷。问卷内容包括血磷的正常范围，高磷血症的并发
知情同意，有一定阅读理解能力。排除标准：患有严重 症，磷结合剂的作用机制、用法用量、疗程、注意事项等，
精神障碍、老年痴呆等而不能正常沟通者；合并恶性肿 共20道选择题（均为单选，回答正确记1分，回答错误或
瘤、严重感染、心力衰竭患者。本研究经我院医学伦理 不回答记0分）。该测试问卷的得分范围为0～20分，分

·1004 · China Pharmacy 2021 Vol. 32 No. 8 中国药房 2021年第32卷第8期