人工全膝关节置换术围术期疼痛用药管理路径的建立及效果

The establishment and effect of management path of perioperative pain medication in artificial total knee arthroplasty

目的建立基于用药教育的人工全膝关节置换术(TKA)围术期疼痛用药管理路径及实施方案,明确临床药师通过标准化疼痛用药管理路径参与临床实践的作用。方法基于Beers标准、STOPP/START标准,参照临床路径思路、药品说明书及临床指南等,建立基于用药教育的TKA围术期疼痛用药管理路径及实施方案;并选取2019年4月至2020年6月于中国中医科学院望京医院行TKA的86例重度骨关节炎患者作为研究对象,采用随机数字表法分为观察组和对照组,每组患者43例。临床药师按照拟定的疼痛用药管理路径及实施方案对观察组实施干预。对照组继续采用既往医护工作模式,临床药师不予干预。结果建立了基于用药教育的TKA围术期疼痛用药管理路径及实施方案;出院日用药依从性评分观察组为(0.2±0.4)分,对照组为(1.9±1.3)分,术后第28天随访时用药依从性评分观察组为(0.6±0.7)分,对照组为(1.9±1.3)分,观察组用药依从性均显著高于对照组,差异有统计学意义(P<0.05);术后第4天静息、第7天活动、第14天活动、第28天活动及静息状态下的疼痛数字评分(NRS),观察组较对照组降低;术后第7天观察组膝关节主动活动度较对照组增加;两组均发生了恶心呕吐、便秘等不良反应,观察组便秘的发生率低于对照组,差异有统计学意义(P<0.05)。结论临床药师通过标准化疼痛用药管理路径参与临床实践提高患者用药依从性,降低患者在TKA术后近期静息或活动性疼痛,增加膝关节主动活动度。

Objective To establish a management path and implementation plan for perioperative pain medications of total knee arthroplasty(TKA)based on medication education for clinical pharmacists,and clarify the role of clinical pharmacists in participating in clinical practice through standardized pain medication management pathways. Methods According to Beers,STOPP/START,instructions,clinical guidelines,etc.,we established a management route and implementation plan for perioperative pain medication based on TKA. A prospective randomized controlled clinical trial was designed to clarify the role of clinical pharmacists. A random number table was used for grouping,a total of 86 patients were divide into observation group or control group,with 43 patients in each group. Clinical pharmacists intervened the observation group based on the proposed pain medication management path and implementation plan. The control group continued to adopt the previous medical work mode,with out clinical pharmacists’ intervention. Results The management route and implementation plan of perioperative pain medication based on TKA were established. The medication compliance score on discharge day was(0. 2±0. 4)scores in the observation group and(1. 9±1. 3)scores in the control group. The medication compliance score at 28 days after operation was(0. 6±0. 7)scores in the observation group and(1. 9±1. 2)scores in the control group. The medication compliance of the observation group was significantly higher than that of the control group,and the difference was statistically significant( P<0. 05). The numerical rating scale(NRS),after 4 days of rest,7 days of activity,14 days of activity,28 days of activity and resting state,the observation group was lower than the control group;the active range of motion of knee joint in the observation group was higher than that in the control group on the 7 thday;adverse reactions such as nausea,vomiting and constipation occurred in both groups. The incidence of constipation in the observation group was lower than that in the control group,and the differences were statistically significant(P<0. 05). Conclusion Clinical pharmacists participate in clinical practice through standardized pain medication management pathway,has a role in improving patient medication compliance,reducing patients short-term resting or active pain after TKA,and increasing knee active activity.