妊娠期糖尿病的药学服务及其临床效果分析  

Clinical effects of pharmaceutical services on patients with gestational diabetes mellitus

作　　者：郭惠娟[1] 江美芳[2] 刘静慧[1] 钟明[1] 陈瑜[1] 刘莉莉[1] 陈霓[1] 

机构地区：[1]深圳市宝安区妇幼保健院,广东深圳518101 [2]深圳市宝安区人民医院药剂科,广东深圳518101

出　　处：《中国医院药学杂志》2017年第24期2500-2504,共5页Chinese Journal of Hospital Pharmacy

摘　　要：目的:探讨药学服务对妊娠期糖尿病用药依从、药物不良事件(ADE)、用药偏差、自我管理技能、血糖控制及妊娠结局的影响,为改善药学干预的安全性和有效性提供依据。方法:选取在进行胰岛素治疗的孕中期(24~28周)妊娠糖尿病孕妇为观察组,共计102例;据观察组75 g葡萄糖耐量试验(OGTT)血糖水平和异常项目数,按单纯随机分组和盲法分配方法,1∶1匹配同期胰岛素治疗的102例妊娠糖尿病患者作为对照组;对照组进行传统医疗(常规治疗+饮食控制+运动疗法);观察组进行传统医疗+药学服务的干预,时间持续至分娩和出院后24周。结果:与对照组相比,观察组在用药依从、药物不良事件(ADE)、用药偏差和自我管理技能等方面得到显著改善(χ~2=4.140,4.412,7.257,4.408;P<0.05);血糖控制满意率(87.3%)显著高于对照组(76.5%)(χ~2=3.995,P<0.05);孕妇剖宫产、妊高征、羊水过多、胎膜早破、早产、胎儿窘迫发生率及分娩新生儿中巨大儿、高胆红素血症、新生儿窒息率均显著低于对照组(P<0.05),观察组产后6周和24周失访率(3.9%,6.9%)及糖代谢受损发生率(12.2%,18.9%)也显著低于对照组(14.7%,23.5%;20.9%,37.2%)(χ~2=7.022,10.993,P<0.01;4.448,7.197,P<0.05)。结论:药学服务能显著有效改善妊娠期糖尿病患者用药依从、药物不良事件(ADE)、用药偏差和血糖控制及妊娠结局,药师应该更多提供和完善药学服务计划。OBJECTIVE To improve the safety and effectiveness of the pharmaceutical services through evaluating the effects of pharmaceutical care on the medication compliance,adverse drug events（ADE）,medication discrepancies,self management skills,and control of blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus（GDM）.METHODSTotally 102 pregnant women with GDM receiving insulin treatment in the second trimester（24-28 weeks）were enrolled into the observation group.A hospital based 1∶1 matched case control study was conducted.Each case was matched with one control with 75 g OGGT blood glucose level and abnormal item number.Totally 102 patients were included in control group over the same period.All patients in observation and control groups were treated with standard regimen.Patients received traditional therapeutic regimen（conventional treatment＋diet control＋exercise therapy）in observation group,and traditional medicine＋pharmaceutical care in control group,till delivery and 24 weeks after discharge.Ttest and chi square test were used.RESULTS Compared with control group,medication discrepancies,self management skills and control of blood glucose were significantly improved（χ^2=4.140,4.412,7.257,4.408,3.995,P0.05）.The rates of pregnant complication in the control group were significantly higher than those in the observed group.Rate of caesarean section,pregnancy induced hypertension,polyhydramnios,premature rupture of fetal membranes,fetal macrosomia,neonatal asphyxia,fetal distress,premature labor were significantly lower than those in control group（P0.05）.Additionally,the rates of lost to follow up after delivery after 6 and 24 weeks（3.9%,6.9%）and gestational impaired glucose（12.2%,18.9%）were significantly lower than those in control group（14.7%,23.5%;20.9%,37.2%）（χ^2=7.022,10.993,P0.01;4.448,7.197,P0.05）.CONCLUSION The pharmaceutical services can significantly improve mediation compliance,reduce adverse drug events（ADE）,medication discrepa

关 键 词：妊娠 糖尿病 药学服务 妊娠结局 效果 

分 类 号：R969[医药卫生—药理学]