基于回顾性研究的糖尿病患者围手术期血糖管理分级药学服务制度的建立

Establishment of a hierarchical pharmaceutical care system for perioperative blood glucose management in diabetic patients based on retrospective study

目的:调查上海交通大学医学院附属第九人民医院行择期手术的糖尿病患者围手术期血糖管理的现状,根据调查结果建立糖尿病患者围手术期血糖管理分级药学服务制度。方法:对本院2018年6月至2018年12月行择期手术的糖尿病患者的临床资料进行回顾性调查,统计患者的基本信息、术前糖尿病评估、围手术期血糖控制水平、主要医嘱问题等,以此为依据,确定药学服务的分级标准和主要项目。结果:150例行择期手术的糖尿病患者中,92.7%的患者入院查空腹血糖,32.4%的患者查糖化血红蛋白(HbA1c),术前、术后进行规律血糖监测(每天≥3次)的病例分别占74.7%和74.0%;术前3 d、术中和术后3 d平均血糖控制达标率分别为68.8%、86.2%和56.0%。围手术期血糖管理相关医嘱问题主要包括胰岛素剂量调整不及时、围手术期仍使用口服降糖药物、患者血糖升高后未进行规律降糖治疗等。将择期手术的糖尿病患者分为3级,对不同级别的患者提供不同频率的药学服务。结论:在患者围手术期血糖管理中,本院在围手术期血糖监测、胰岛素的合理使用、患者的用药教育等方面仍需进一步加强。以血糖管理现状为依据,建立围手术期血糖管理分级药学服务制度,有助于提高临床药师的工作效率,为患者提供更好的药学服务。

Objective:To investigate the status of perioperative blood glucose management in patients with diabetes undergoing elective surgery in the Shanghai Ninth People’s Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,and establish a hierarchical pharmaceutical care system for perioperative blood glucose management.Methods:The clinical data of patients with diabetes who underwent elective surgery from June 2018 to December 2018 in this hospital were retrospectively investigated,and then the classification criteria and main items of hierarchical pharmaceutical care system were determined.Results:Of the 150 patients included in the study,92.7%of them were checked on fasting blood glucose at admission,and 32.4%of them were checked on HbA1c.The rates of preoperative and postoperative regular blood glucose monitoring accounted for 74.7%and 74.0%,respectively,and the rates of blood glucose-reaching the set standards 3 days before operation,during operation and 3 days after operation were 68.8%,86.2%and 56.0%,respectively.The main problems occurred during perioperative blood glucose management included:failure to adjust dosage of insulin promptly,persistent use of oral hypoglycemic drugs during perioperative period,and lack of regular hypoglycemic treatment for perioperative hyperglycemia.The pharmaceutical care of diabetic patients during perioperative period was divided into three levels,and the main items of pharmaceutical care were determined according to the defects of clinical blood glucose management and the needs of patients.Conclusion:In perioperative management of diabetic patients,perioperative blood glucose monitoring,rational use of insulin,medication education of patients should be further strengthened.Based on the current status of blood glucose management,the establishment of a hierarchical pharmaceutical care system applied during perioperative period could help to improve the work efficiency of clinical pharmacists,and at the same time would offer better pharmaceutical care for patients.