目的 评估临床药师通过进行用药教育、解答抗凝用药咨询等,参与肺栓塞患者抗凝治疗管理的效果。方法 以2015年3月至2017年4月于北京朝阳医院呼吸科住院的肺栓塞患者共计204例为研究对象,比较药师教育组(干预组)与其他未接受药师教育组(对照组)INR在目标范围时间的百分比(the percentage of INRs within the therapeutic range, TTR)、INR在扩大范围内时间百分比(the percentage of INRs within the expanded range, TER)、INR监测间隔时间、出血事件、再次住院率及急诊就诊率。结果 干预组的TTR和TER分别为(70.89±26.02)%和(87.71±20.01)%,INR达标率显著高于对照组的(47.79±22.31)%和(71.23±21.47)%(P=0.000);干预组的INR监测间隔时间为(27.48±12.81)d,较对照组(43.35±13.65)d有显著缩短(P=0.000)。对照组及干预组患者的总出血事件(41.96% vs 29.35%,P=0.062)、严重出血事件(3.57% vs 2.17%,P=0.864)和轻微出血事件(38.39% vs 27.17%,P=0.091),差异均无统计学意义。干预组患者院外的急诊就诊次数显著低于对照组(9.82% vs 1.09%,P=0.008),两组患者再次入院率无明显差异(8.04% vs 2.17%,P=0.125)。结论 临床药师参与肺栓塞患者抗凝治疗管理可帮助患者更规律地监测INR,提高INR达标率,减少出院后的急诊就诊频次。
Abstract
OBJECTIVE To evaluate the effectiveness of pharmacist-participated warfarin anticoagulation management by patient education and medication consultation on patients with pulmonary embolism(PE). METHODS A total of 204 PE patients were hospitalized in respiratory wards from March 2015 to April 2017 enrolled eventually. Evaluation endpoints including the percentage of INRs within the therapeutic range(TTR), the percentage of INRs within the expanded range(TER), INR recall intervals, bleeding events, emergency department visits and hospitalizations related to anticoagulation therapy. RESULTS TTR and TER of intervention group were(70.89±26.02)% and(87.71±20.01)% respectively, which were both significantly higher than(47.79±22.31)% and(71.23±21.47)% in control group(P=0.000). INR recall intervals were(27.48±12.81) d versus(43.35±13.65) d (P=0.000). There were no significant differences between two groups in total bleeding events(41.96% vs 29.35%, P=0.062), minor bleeding events(38.39% vs 27.17%, P=0.091) and major bleeding events(3.57% vs 2.17%, P=0.864). And a significantly decreased in emergency department visits of intervention group(9.82% vs 1.09%, P=0.008), whereas no difference was observed in hospitalizations(8.04% vs 2.17%, P=0.125). CONCLUSION Clinical pharmacists participated in anticoagulation management of pulmonary embolism patients, which helped patients to monitor INRs more regularly, INR controlling better and decrease frequency of emergency department visits.
关键词
临床药师 /
抗凝治疗管理 /
华法林 /
患者教育 /
国际标准化比值
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Key words
clinical pharmacist /
anticoagulation medication management /
warfarin /
patient education /
international normalized ratio
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中图分类号：
R969.3
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