实施药学监护路径对急性冠状动脉综合征患者临床疗效的影响

Effect of Implementing Pharmaceutical Care Pathway on Clinical Efficacy of Patients with Acute Coronary Syndrome

目的:评价对急性冠状动脉综合征(ACS)患者实施药学监护路径的疗效影响。方法:选取本院心内科住院ACS患者为研究对象,收集实施药学监护路径前2016年6-12月ACS患者60例作为对照组,实施药学监护路径后连续收集2017年6-12月ACS患者60例作为干预组,将患者药物治疗监护工作分为入院评估、住院监护、出院评估等3个单元,以最新指南为依据制订各单元的监护内容,比较实施药学监护路径前后患者的临床疗效。结果:干预组血压和心率达标率、β受体阻滞剂和ACEI/ARB类药物使用率均明显提高,差异均有统计学意义(P<0.05);干预组住院期间出血事件、肝肾功能损害等主要不良事件发生率、平均住院时间均较对照组明显降低,差异均有统计学意义(P<0.05);而干预组心律失常、栓塞事件发生率和住院药物治疗费用与对照组相似,差异均无统计学意义(P>0.05)。两组患者出院后1、3个月因心血管事件再次入院率比较,差异均无统计学意义(P>0.05),但出院后6个月干预组再入院率较对照组显著降低(P<0.05)。结论:通过实施药学监护路径可显著提高ACS患者二级预防用药的使用率,降低不良事件发生率和再次入院率,减少住院天数,改善患者预后。

Objective:To evaluate the effect of pharmaceutical care pathway on clinical efficacy on patients with acute coronary syndrome(ACS).Method:The patients with ACS in Department of Cardiology of our hospital were selected as the study subjects.Sixty patients before the implementation of pharmaceutical care pathway from June to December 2016 were collected as the control group,sixty patients after the implementation of pharmaceutical care pathway from June to December 2017 were collected continuously as the intervention group. The work of drug treatment monitoring was divided into three units:admission evaluation,in-patient monitoring and discharge evaluation,each unit was formulated according to the latest guidelines,the monitoring content of the unit was compared with the clinical efficacy before and after the implementation of pharmaceutical care pathway. Result:The rates of blood pressure and heart rate,β-blockers and ACEI/ARB in the intervention group were significantly higher than those in the control group(P<0.05),and the incidence of major adverse events such as bleeding events,liver and kidney dysfunction and average hospital stay were significantly lower than those in the control group(P<0.05),while the incidence of arrhythmia,embolism events and hospitalization drugs were significantly lower compared with the control group(P<0.05).The incidence of arrhythmia,embolism and the cost of drug treatment in the intervention group were similar to those in the control group,there were no significant differences(P>0.05).There were no significant differences in re-admission rate due to cardiovascular events between two groups at 1 and 3 months after discharge(P>0.05),but the re-admission rate in the intervention group decreased significantly at 6 months after discharge(P<0.05).Conclusion:The implementation of pharmaceutical care pathway can significantly improve the use of secondary preventive drugs in patients with ACS,reduce the incidence of adverse events,hospitalization days and readmission rate,and improve the prognosis of patients.