临床药师干预对癌痛控制效果的随机对照研究

发布时间：2018-05-30 23:34

本文选题：癌痛 + 临床药师　；参考：《中国医院药学杂志》2017年06期

【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P0.05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,P0.001)、72 h(2.68vs 3.92,P0.001)、7 d(2.71 vs 3.74,P0.001)、14 d(2.28 vs 3.42,P0.001)。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(P0.05),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。
[Abstract]:Objective: to evaluate the effect of clinical pharmacist intervention on cancer pain control. Methods: adult cancer pain patients admitted to a hospital from September 2015 to January 2016 were studied. 100 patients who met the inclusion and exclusion criteria were randomly divided into intervention group and control group. 50 patients in the control group received routine diagnosis and treatment by doctors and nurses, and 50 patients in the intervention group increased the intervention of clinical pharmacists on the basis of the control group. Intervention measures included dose adjustment of analgesic drugs, patient education, evaluation of the efficacy of analgesic drugs, suggestions to doctors for individualized drug use, timely reporting of opioid related adverse reactions, and so on. The pain scores, drug compliance and constipation improvement were compared between the two groups at 14 days after intervention, and the suggestions of pharmacists during the intervention were summarized. SPSS13.0 was used for statistical analysis, with P0.05 as the statistical difference. Results: compared with the control group, the intervention group was at 24 h, 4.12 vs 4.84 P0. 048 h, 3. 10 vs 4. 60 P0. 001, 72 h(2.68vs, 3. 92, P0. 001, 7 d, 2.71, 3. 74, P, 0. 001, 14 d, 2. 28, 3. 42, P0. 001, 2. 001, 2. 28 vs 3. 42, P0. 001. In the intervention group, the number of patients with good drug compliance increased by nearly twice after the pharmacist's propaganda, the difference was statistically significant (P 0.05), while the control group had no change in drug compliance before and after diagnosis and treatment. In the intervention group, 34 cases had constipation and 23 cases had constipation, the effective rate was 67.65, while in the control group, there were 33 cases with constipation and 14 cases with effective improvement, the effective rate was 42.42.2 group. A total of 122 recommendations were made by the clinical pharmacists for the pharmaceutical care of the patients in the intervention group, 74 of which were accepted by the doctors, and the adoption rate was 60.65. Conclusion: the intervention of clinical pharmacists can reduce the pain intensity and the incidence of analgesic drug-related adverse reactions, improve the pain relief rate and drug compliance, and be a member of the multidisciplinary cancer pain treatment team. Clinical pharmacists play an important role in the management of cancer pain.
【作者单位】：首都医科大学附属北京世纪坛医院药剂科;
【分类号】：R730.5

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