药师参与肝癌肝切除患者围术期人血白蛋白合理使用的管理模式探讨

目的:通过药师参与人血白蛋白在肝胆外科合理性使用管理,规范肝癌肝切除患者围术期白蛋白的使用,建立药师参与临床合理用药管理工作模式。方法:查阅文献和指南,制定《肝癌肝切除患者围术期人血白蛋白使用规范》(以下简称《规范》)。将2014年1月至2015年5月收治入院的肝癌肝切除患者随机分为试验组(药师干预)和对照组(非药师干预)。试验组44例是在临床药师干预下,按照《规范》予以补充白蛋白;对照组46例按临床经验和医生习惯予以补充白蛋白。观察肝切除术后不同白蛋白补充方案的术前、术后1天以及术后8天的血白蛋白水平、术后住院时间、白蛋白费用、住院费用、住院药费、术后并发症。结果:两组患者年龄、性别、肝硬化比例,术前、术后1天以及术后8天血白蛋白水平、术后住院时间、术后并发症等比较差异均无统计学意义(均P>0.05);药师干预组在住院期间白蛋白费用、住院费用、住院药费上均明显低于非药师干预组,差异均有统计学意义(均P<0.05)。结论:通过临床药师干预大大减少了行肝癌肝切除术患者住院期间白蛋白费用,患者围术期血白蛋白水平与非干预组相当,且没有增加术后住院时间以及并发症的发生率。由临床药师参与的白蛋白使用措施规范,对于节约医疗资源、临床合理用药、保障患者用药安全方面发挥了关键性作用。

The Life of a Protein Molecule——Protein Quality Control

The research progress in molecular chaperones, unfolded protein response （UPR） and ER-associated degradation （ERAD） involved in the protein quality control was summarized in this paper, and then the existing problems and the future devel- opment prospect were also discussed. It was pointed out that the life process of protein experienced four stages including synthesizing, folding, assembling and degradation, while each stage required strict quality control. In endoplasmic reticulum （ER）, a variety of proteins had been synthesized, folded and modified to form func- tional proteins with certain conformation. When the folding was blocked in ER, the unfolded proteins would aggregate and induce the UPR, which up-regulated the level of modification enzymes folded by a series of molecular chaperones and proteins to help them accomplish folding and assembling. If these proteins were still folded incorrectly, they would enter into ERAD for being degraded.