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临床药师主导的药学强化干预对高血压患者缺血性脑卒中风险

的影响
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刘秀梅 ，华之卉，魏炳飞，刘相端，葛春丽，陈 楠 [河南中医药大学第五临床医学院（郑州人民医院）药学部，
郑州 450003]

中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2023）02-0228-05
DOI 10.6039/j.issn.1001-0408.2023.02.19

摘 要 目的 探讨临床药师主导的药学强化干预对中高危缺血性脑卒中风险的高血压患者的影响。方法 选取 2019 年 10
月－2020年4月在郑州人民医院就诊且经改良弗明汉卒中量表评估的缺血性脑卒中中高危高血压门诊患者，随机分为对照组和
干预组，每组200例。对照组患者接受常规治疗，不接受药学干预；干预组患者在常规治疗的基础上，接受由临床药师提供的为期
12个月的药学强化干预（依从性分级管理+定期随访，包括用药教育及指导，血糖、血压、血脂管理和健康生活指导）。比较两组患
者入组时和入组12个月后的血糖指标、血脂指标、血压达标率、服药依从性、未来10年卒中发病风险和脑卒中发病率。结果 入组
12个月后，干预组患者的低密度脂蛋白胆固醇（LDL-C）水平显著低于同组入组时，且其空腹血糖、糖化血红蛋白、总胆固醇、LDL-
C水平均显著低于同期对照组（P＜0.05或P＜0.01）；干预组患者的血压达标率、服药依从性均显著高于或优于对照组（P＜0.01）；
对照组和干预组分别有12、15例患者转为低危，且干预组高危患者的比例较对照组显著降低（P＜0.01），中危患者的比例较对照组
显著升高（P＜0.05）；干预组的脑卒中发病率显著低于对照组（1.0% vs. 4.5%，P＜0.05）。结论 由临床药师主导的药学强化干预可
降低高血压门诊患者的血糖和血脂水平，提高其血压达标率和服药依从性，并有助于降低脑卒中发病风险。
关键词 临床药师；药学强化干预；高血压；脑卒中风险；门诊患者

Effects of intensive pharmaceutical intervention led by clinical pharmacists on the risk of ischemic stroke
in hypertensive patients
LIU Xiumei，HUA Zhihui，WEI Bingfei，LIU Xiangduan，GE Chunli，CHEN Nan[Dept. of Pharmacy，the Fifth
Clinical Medical College of Henan University of Chinese Medicine（Zhengzhou People’s Hospital），Zhengzhou
450003，China]

ABSTRACT OBJECTIVE To explore the effects of intensive pharmaceutical intervention led by clinical pharmacists on
hypertension patients with medium and high risk of ischemic stroke. METHODS The hypertension outpatients with medium and
high risk of ischemic stroke， who were assessed by the modified Framingham stroke scale in Zhengzhou People’s Hospital from
Oct. 2019 to Apr. 2020， were randomly divided into control group and intervention group， with 200 cases in each group. Patients in
the control group received conventional treatment without pharmaceutical intervention； on the basis of conventional treatment，
patients in the intervention group received 12-month intensive pharmaceutical intervention （grading management of compliance+
regular follow-up， involving medication education and guidance， blood glucose， blood pressure， blood lipid management and
healthy life guidance） provided by clinical pharmacists. The blood glucose indexes， blood lipid indexes， blood pressure compliance
rate， medication compliance， 10-year stroke risk and stroke incidence were compared between two groups at baseline and 12
months after enrollment. RESULTS After 12 months of enrollment， the level of low-density lipoprotein cholesterol （LDL-C） in
intervention group was significantly lower than that in the same group at baseline， and the levels of fasting blood glucose，
glycosylated hemoglobin， total cholesterol and LDL-C in intervention group were significantly lower than those in control group at
the same time points （P＜0.05 or P＜0.01）. The compliance
Δ 基金项目 河南省医学科技攻关计划（联合共建）项目（No.
2018020846，No.LHGJ20191090）；中国药学会全国医药经济信息网科 rate of blood pressure and medication compliance in
技传播创新工程重点项目（No.CMEI2018KPYJ00411） intervention group were significantly higher or better than
＊第一作者 副主任药师，硕士。研究方向：临床药学。电话： those in control group （P＜0.01）. There were 12 and 15
0371-67079038。E-mail：liuxiumei@bjmu.edu.cn
# 通信作者 主任药师，硕士。研究方向：医院药学。电话：0371- patients in control group and intervention group turned into
67079038。E-mail：13598878231@163.com low-risk ones respectively， and the proportion of high-risk

· 228 · China Pharmacy 2023 Vol. 34 No. 2 中国药房 2023年第34卷第2期