缺血性脑卒中后重症肺炎患者药物治疗管理模式的探索与实践

Implementation of medication therapy management in cerebral ischemic stroke-associated severe pneumonia patients

目的研究药物治疗管理(medication therapy management,MTM)联合欧洲医药保健网(Pharmaceutical Care Network Europe,PCNE)分类系统对缺血性脑卒中(cerebral ischemic stroke,CIS)后重症肺炎患者开展药学监护的可行性。方法制定CIS后重症肺炎患者MTM流程,采用9.0版PCNE分类系统,对36例CIS后重症肺炎患者存在的药物相关问题(drug-related problems,DRPs)进行分析,制定个体化治疗管理计划,临床药师与医生协作面向患者执行监护计划。结果 36例CIS后重症肺炎患者DRPs主要是治疗有效性(63.41%)和安全性(36.59%)问题,导致DRPs原因主要与药物选择有关(95.12%)。临床药师和医疗团队协作,从医生、患者和药物方面进行了干预,医生层面通过告知医生(19.51%)、请临床药师提供咨询(31.70%)或讨论介入方案(46.34%),患者层面与家属会谈(43.90%),药物层面停用(19.52%)或启用新药物(78.02%)。大部分干预被医生或患者接受(90.24%),DRPs多数被全部解决(41.46%)或部分解决(39.02%)。结论引入PCNE分类系统对CIS后重症肺炎患者药物相关问题进行分析,临床药师协助医疗团队明确了DRPs的真实性,并能规范地进行分类及介入,使MTM工作更加同质化和准确化,提高了全程化药学监护的效率。

Objective To explore the feasibility of medication therapy management (MTM) combined with Pharmaceutical Care Network Europe (PCNE) classification system to carry out pharmaceutical care for patients with severe pneumonia after cerebral ischemic stroke (CIS).Methods The MTM care process of patients with severe pneumonia after CIS was presented and implemented by clinical pharmacists.The PCNE (version 9.0) classification system was used to analyze the drug-related problems (DRPs) of 36 patients with severe pneumonia after CIS,and an individualized treatment management plan was provided.A patient-oriented monitoring program was implemented by clinical pharmacists and physicians.Results The DRPs of 36 patients with severe pneumonia after CIS were mainly related to treatment effectiveness (63.41%) and safety (36.59%),and the causes to DRPs were mainly related to drug selection (95.12%).Clinical pharmacists collaborated with the medical team to intervene from the aspects of physicians,patients and drugs.At the physician level,by informing the physician (19.51%),asking the clinical pharmacist to provide consultation (31.70%) or discussing intervention plans (46.34%).At the patient level,they talked with their family members (43.90%).At the drug level,stopped (19.52%) or started new drugs (78.02%).Most of the interventions were accepted by physicians or patients (90.24%),and most of the DRPs were totally solved (41.46%) or partially solved (39.02%).Conclusion The PCNE classification system was introduced to analyze the DRPs of patients with severe pneumonia after CIS.The clinical pharmacist assisted the medical team to clarify the authenticity of DRPs,and could classify and intervene in a standardized way,making MTM work more homogeneous and accurate,and improving the efficiency of the whole process of pharmaceutical care.