免疫相关性不良妊娠患者临床药学的研究

Study of clinical pharmacy in pregnant women with immune abnormalities

目的对免疫相关性妊娠多学科诊疗(MDT)门诊的全程化药学服务模式、流程及成果进行介绍,为提升药物治疗有效性、安全性和患者依从性提供参考。方法以合并风湿免疫的基础疾病、或者因为免疫异常等因素而存在复发性流产的患者为服务对象,介绍本院免疫相关性妊娠MDT门诊的团队构建、工作模式和临床药师职责。统计分析215例免疫相关性妊娠患者的一般情况、疾病情况、合并用药情况、药学服务内容、患者孕期并发症发生情况及母儿结局。结果药师为215例MDT门诊就诊患者提供了全程化药学服务,包括用药史回顾、医嘱审核、药物重整、用药教育和生活方式指导,回答家属咨询,解答患者疑问,并就用药方案及治疗方案调整提出意见建议,开展患者随访、药物不良反应监测等,患者满意度达100%。在有效随访且有妊娠结局的53例就诊患者中,活产47例,活产率87.04%;2例自然流产,自然流产率3.78%;2例治疗性流产,治疗性流产率3.78%;2例胎死宫内,胎死宫内发生率3.78%;1例出生缺陷,产检发现胎儿脑积水,母亲选择性终止妊娠(羊膜腔穿刺引产),出生缺陷率为1.86%,相较于我国总人群的出生缺陷发生率(5.6%)明显偏低。18例患者出现并发症;其中妊娠糖尿病最多(6例),发生率为11.32%;妊娠高血压(3例)发生率5.66%。结论临床药师通过开设MDT门诊,参与特殊患者全程化药物治疗管理,可提高合理用药水平、患者依从性、药物治疗安全性及治疗效果。

Objective To introduce the practice and results on the mode of integrated pharmaceutical care in multi-disciplinary treatment(MDT)clinic for pregnant women with immune abnormalities,so as to provide reference for the improvement of the safety,effectiveness and adherence of pharmacological therapy.Methods The service mode,team building,clinical pharmacist duties of MDT clinic for pregnant women with immune abnormalities were introduced.The genaral conditions,diseases,combined medications,pharmaceutical care content,complications during pregnancy,and maternal and infant outcomes of 215 patients were statistically analyzed.Results The integrated pharmaceutical care were provided to 215 patients,including assess client’s medication history,medical order review,medication reconciliation,medication education,healthy lifestyle guidance,medication consultation,medication scheme adjustment,long-term follow up,surveillance for adverse reactions,etc.Patient satisfaction were 100%.Among the 53 patients who were followed up effectively and had pregnancy outcomes,there were 47 live births(live birth rate was 87.04%),2 cases of spontaneous abortion(spontaneous abortion rate was 3.78%),2 cases of therapeutic abortion(therapeutic abortion rate was 3.78%),2 cases of intrauterine death(intrauterine death rate was 3.78%),1 case of birth defects(fetal hydrocephalus,birth defect rate was 1.86%).Among 103 pregnant patients,18 patients had complications,there were 6cases(11.32%)of gestational diabetes,3 cases(5.66%)of gestational hypertension.Conclusion Clinical pharmacists participate in MDT clinics to carry out full-course drug treatment management for special patients,which can improve the level of rational drug use,drug treatment safety,treatment effects and patient compliance.