临床药师对腹膜透析患者实施肾性贫血药物治疗管理服务实践效果

Medication therapy management for peritoneal dialysis patients with renal anemia

目的观察临床药师在腹膜透析肾性贫血患者中实施药物治疗管理服务(MTMs)的效果。方法随机选取行腹膜透析治疗的肾性贫血患者200例,分为对照组100例与试验组100例。两组随访期均为6个月,试验组每月随访一次,对照组仅在出院后第6个月随访一次。两组随访结束时记录患者复诊的血红蛋白(Hb)、红细胞计数(RBC)、红细胞压积(Hct)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)等检查检验指标。试验组住院期间及出院之后持续接受由临床药师提供的肾性贫血MTMs,每月评估试验组患者疾病情况,制订个体化用药方案。结果经过6个月随访,试验组和对照组的Hb水平均显著高于观察起始时水平(P<0.05),且试验组患者Hb水平显著高于对照组[(108.97±11.70)vs(82.28±18.24)g·L^(-1),P<0.01],同时试验组Hb达标率较对照组显著提升(P<0.01)。铁代谢指标方面,试验组与对照组SF[(281.49±252.05)vs(301.42±261.66)μg·L^(-1),P=0.584]和TSAT[(39.85±15.95)vs(39.39±18.37)%,P=0.852]差异均无统计学意义,随访期间始终维持在正常范围,肾性贫血得到改善的同时铁代谢未出现异常。结论药师以MTMs模式应用于腹膜透析肾性贫血患者,与传统模式相比极大地改善了腹膜透析肾性贫血患者的病情,促进了患者合理用药,体现了临床药师的价值,可为其他慢病管理提供参考。

Objective To observe the effict of medication therapy management services(MTMs)for peritoneal dialysis patients with renal anemia.Methods Totally 200 patients with renal anemia undergoing peritoneal dialysis were randomly selected and evenly divided into a control group and a test group.The follow-up period was 6 months,with the test group being followed up once a month and the control group only once in the 6th month after the discharge.The hemoglobin(Hb),red blood cell count(RBC),red blood cell pressure(Hct),serum ferritin(SF),transferrin saturation(TSAT)and others were recorded at the end of follow-up.The test group received MTM for renal anemia provided by the clinical pharmacists during the hospitalization and after the discharge.We assessed the patients of the test group patients on a monthly basis to develop individualized medication regimens.Results After the 6-month follow-up,the Hb levels in both the test group and the control group were significantly higher than those at the beginning of the observation(P<0.05);the Hb levels of patients in the test group was significantly higher than those in the control group[(108.97±11.70)vs(82.28±18.24)g·L^(-1),P<0.01];the Hb compliance rate in the test group was improved as compared with the control group(P<0.01).In terms of iron metabolism indexes,no significant difference was found between the test group and the control group in SF[(281.49±252.05)vs(301.42±261.66)μg·L^(-1),P=0.584]and TSAT[(39.85±15.95)vs(39.39±18.37)%,P=0.852],which were maintained in the normal range throughout the follow-up period.Iron metabolism was not abnormal while renal anemia was improved.Conclusion Pharmacists help peritoneal dialysis patients with renal anemia with the MTM model,greatly improve the condition of patients as compared with the traditional model,and promote the rational use of medication.