摘要
目的:评价临床药师干预对癌痛控制的效果。方法:以2015年9月—2016年1月在某院肿瘤内科收治入院的成人癌痛患者为研究对象。将符合纳入、排除标准的100名患者随机分为干预组和对照组。对照组50名患者接受医生和护士的常规诊疗,干预组50名患者在对照组基础上增加了临床药师干预。干预措施包括镇痛药物剂量调整、患者教育、镇痛药物疗效评估、向医生提出个体化用药建议、及时报告阿片类药物相关不良反应等。比较2组患者在1,2,3,7,14 d时的疼痛评分,干预前后用药依从性、便秘改善情况,对干预过程中药师提出的用药建议进行汇总。采用SPSS13.0进行统计分析,以P<0.05为有统计学差异。结果:和对照组相比,干预组在24 h(4.12 vs 4.84,P=0.048)、48 h(3.10 vs 4.60,P<0.001)、72 h(2.68vs 3.92,P<0.001)、7 d(2.71 vs 3.74,P<0.001)、14 d(2.28 vs 3.42,P<0.001)。干预组患者在经药师宣教后,用药依从性好的患者人数增加了近1倍,差异有统计学意义(P<0.05),而对照组在诊疗前后用药依从性无变化(P=0.499)。干预组50例患者中,有34例发生便秘,23例便秘得到有效改善,有效率为67.65%;对照组有33例患者发生便秘,14例得到有效改善,有效率为42.42%。2组便秘改善有效率具有明显的组间差异(P=0.038)。临床药师针对干预组患者的药学监护共提出了122条建议,医生共采纳74条,采纳率为60.65%。结论:临床药师干预可降低患者疼痛强度和镇痛药物相关不良反应发生率、提高疼痛缓解率与用药依从性,作为多学科癌痛治疗团队中的一员,临床药师在癌痛管理中发挥着重要作用。
OBJECTIVE To assess the effect of clinical pharmacist intervention on cancer pain management.METHODS Adult cancer pain patients were enrolled from Oncology Department of Beijing Shijitan Hospital from September 2015 to January2016.Totally 100 patients met the inclusion criteria and were randomly assigned to intervention group（n=50）and control group（n=50）by random number generated using Excel.Patients received routine clinical practice of doctors and nurses in control group,while in intervention group,on the basis of control group,patients were given clinical pharmacist intervention such as analgesic drug dose adjustments,patient education,curative effect evaluation,providing individualized medication therapy recommendations to doctors,reporting analgesic drug related adverse reaction.Pain score and pain remission rate were compared between two groups at day 1,2,3,7 and 14.Medication adherence and constipation remission rate were compared before and after intervention.To gather in the intervention process,data were analyzed with SPSS13.0software.RESULTS Compared with the control group,the intervention group had lower pain score at 24 h（4.12 vs 4.84,P=0.048）,48 h（3.10 vs 4.60,P〈0.001）,72 h（2.68 vs 3.92,P〈0.001）,7 d（2.71 vs 3.74,P〈0.001）and 14 d（2.28 vs 3.42,P〈0.001）.After pharmacist intervention,the number of patients with good medication adherence doubled in the intervention group（P〈0.05）,but did not change in control group.Thirty four patients in the intervention group had constipation,of which23 patients had effectively improved constipation remission,the efficient rate was 67.65%.Thirty three patients in the control group had constipation,of which 14 patients had effectively improved constipation remission,the efficient rate was 42.42%.The constipation remission rate was significantly different between two groups（P=0.038）.Clinical pharmacist provided pharmaceutical care for 122 times for patients in intervention group.Finally the doctors adopted 74 times by an adoption rate of 60.65%.CONCLUSION Clinical pharmacist intervention can reduce pain score and adverse drug reaction rate related to analgesic drugs and improve pain remission rate,adherence to medication.As a member of the multidisciplinary team of pain treatment,clinical pharmacist plays an important role in pain management.
作者
谢铮铮
梁瑶
杜朝阳
赵莹
孙路路
XIE Zheng-zheng LIANG Yao DU Zhao-yang ZHAO Ying SUN Lu-lu(Department of Pharmacy, Beijing Shiji- tan Hospital, Capital Medical University, Beijing 100038, China)
出处
《中国医院药学杂志》
CAS
北大核心
2017年第6期558-561,共4页
Chinese Journal of Hospital Pharmacy
关键词
癌痛
临床药师
随机对照
cancer pain
clinical pharmacist
randomized controlled study
