国内临床药师干预对癌痛控制效果的系统评价

Intervention Effect of Clinical Pharmacists on Cancer Pain Control in China: a Systematic Review

目的:系统评价国内临床药师实施的药学干预对癌性疼痛控制的影响。方法:计算机检索Wan Fang Data、Sino Med、VIP、CNKI、Medline、The Cochrane Library和Embase数据库,收集有关国内临床药师实施的药学干预对癌性疼痛控制影响的随机对照试验,检索时限均从各数据库建库至2017年10月,由两位研究者独立筛选试验、提取数据和评价方法学质量后,采用Rev Man 5.3和Stata 12.0软件进行Meta分析。结果:最终纳入10项研究,共1 653例癌痛患者。临床药师干预组疼痛评估数字分级法(NRS)疼痛评分明显低于对照组,癌痛知识及止痛知识评分高于对照组,用药依从性优于对照组。Meta分析结果表明临床药师干预组消化道不良反应发生率明显低于对照组[便秘:OR=0.63,95%CI(0.49,0.81),P=0.000 4;恶心:OR=0.56,95%CI(0.39,0.80),P=0.002;呕吐:OR=0.60,95%CI(0.41,0.88),P=0.008]。结论:临床药师实施的药学干预能明显提高癌痛患者的用药依从性和癌痛治疗效果,并能明显减少阿片类药物消化系统不良反应发生率。由于研究存在一定局限,尚需要更多大样本和高质量的随机对照试验加以验证。

Objective： To systematically review the impact of pharmaceutical care for cancer pain control performed by clinical pharmacists in China. Methods： Retrieved from Wan Fang database,Sino Med,VIP,CNKI,Medline and The Cochrane Library and Embase,the randomized controlled trials（ RCTs） about the effect of pharmaceutical care for cancer pain control performed by clinical pharmacists in China were collected. The studies were screened,the data were extracted,and the methodological quality was assessed by two reviewers independently. Meta-analysis was performed by using Rev Man 5. 3 and Stata 12. 0 statistical software. Results： A total of 10 RCTs involving 1 653 patients with cancer pain were included. The results showed that the pain scores of NRS in clinical pharmacist intervention group were obviously lower than those in the control group,the cancer pain knowledge and analgesics knowledge scores in the intervention group were evidently higher than those in the control group,the medication adherence in the intervention group was higher than that in the control group,and the meta-analysis showed that the risk of adverse reactions of digestive tract in the intervention group was significantly lower than that in the control group [constipation： OR = 0. 63,95% CI（ 0. 49,0. 81）,P =0. 000 4; nausea： OR = 0. 56,95% CI（ 0. 39,0. 80）,P = 0. 002; vomiting： OR = 0. 60,95% CI（ 0. 41,0. 88）,P = 0. 008]. Conclusion： Clinical pharmacist＇s intervention can significantly improve the medication adherence and therapeutic effect of cancer pain;moreover,it can reduce the incidence of digestive tract reactions of opioid drugs. Because of certain limitations of our study,the conclusions need to be further demonstrated by more RCTs with larger-scale samples and higher quality.