综合干预措施对骨科围手术期预防抗凝药物合理使用的效果评价  

The Effect of Comprehensive Intervention Measures on the Rational Use of Antithrombotic Agents in Perioperative Period of Orthopedic Surgery

作　　者：徐红青[1] 管晓敏[2] 陈霞[1] 苏建彬[1] 周佳琪 XU Hongqing;GUAN Xiaomin;CHEN Xia;SU Jianbing;ZHOU Jiaqi(Department of Pharmacy,the First People's Hospital of Nantong,Nantong 226001,China;Department of Pharmacy,the SecondPeople's Hospital of Nantong,Nantong 226001,China)

机构地区：[1]南通市第一人民医院药剂科,南通226001 [2]南通市第二人民医院药剂科,南通226001

出　　处：《药学与临床研究》2020年第2期145-148,共4页Pharmaceutical and Clinical Research

基　　金：南通市卫生和计生委员会青年医学人才科研基金(WKZL2018086)。

摘　　要：目的:分析综合干预措施在提升骨科围手术期预防性抗凝药物合理使用中的可行性。方法:根据相关“指南”及专家共识、抗血栓药物说明书,制定骨科围手术期预防抗血栓使用规范及评价标准,采取医嘱审核、全程药学监护、不良反应监测、信息系统路径管理等技术措施和绩效考核手段,对围手术期预防抗血栓药物进行综合干预。从医院信息系统调取2018年1月到6月(干预前)的病例926份为未干预组,2019年1月到6月(干预后)的病例1024份为干预组,对照分析干预前后围手术期预防深静脉血栓的措施、预防抗血栓药物使用时机、疗程、用法用量及不良反应、住院时间等方面的差别,评估此干预方法的效果。结果:根据Caprini模型评估所评2分、3~4分、≥5分的患者,采取药物预防的比例由干预前的41.7%、51.0%、59.6%上升到干预后的76.2%、92.2%、95.5%;骨科手术患者围手术期预防抗血栓药物使用不合理原因包括:给药品种选择不合理、给药时机不合理、疗程不合理、给药剂量不合理、用药禁忌症,其不合理比例由干预前的39.0%、32.1%、46.0%、32.1%、23.8%下降至干预后的4.3%、4.8%、6.1%、2.2%、1.8%;总体预防抗凝药物不合理使用比例由干预前的55.4%减少到干预后的12.0%,以上指标干预前后比较,差异均有统计学意义(P<0.05)。结论:综合干预措施能够有效降低骨科静脉血栓发生率,改善骨科预防抗血栓药物不合理应用的情况,提高患者的医疗质量水平。Objective:To evaluate the feasibility of comprehensive interventions on improving the rational application of antithrombotic agents in perioperative period of orthopedic surgery.Methods:The management of perioperative thromboembolism prophylaxis in orthopedic patients was standardized based on relevant guidelines,expert consensus documents and package inserts.The comprehensive intervention measures were carried out,including prescriptions check,integrated pharmaceutical care,adverse drug reactions monitoring and path management of information systems.Medical records were collected from hospital information system during Jan.-Jun.2018(the pre-intervention group,926 cases)and Jan.-Jun.2019(the post-intervention group,1024 cases).To compare the differences between the pre-and post-intervention,methods to prevent deep venous thrombosis,time and duration of administration,dosage and administration,adverse effects and the length of hospital stay were analyzed.Results:Rates of pharmacologic prophylaxis increased from 41.7%,51.0%and 59.6%before intervention to 76.2%,92.2%and 95.5%after intervention,respectively,in patients with Caprini scores of 2,3 to 4 and≥5.Meanwhile,unreasonable drug selection,improper timing of drug administration,unsuitable course of treatment,inappropriate dosage and contraindications,which were the reasons for irrational use of antithrombotic drugs,decreased from 39.0%,32.1%,46.0%,32.1%and 23.8%before intervention to 4.3%,4.8%,6.1%,2.2%and 1.8%after intervention,respectively.The proportion of irrational use of anticoagulants before intervention was higher(55.4%)than that after intervention(12.0%).The differences in all the indexes mentioned above were statistically significant(P<0.05).Conclusions:Comprehensive intervention resulted in a decrease in incidence of venous thrombosis,an increase in rational use of antithrombotics in orthopedic patients and an improvement on the quality of medical service.

关 键 词：围手术期 预防抗血栓药物 综合干预措施 合理用药 

分 类 号：R969.3[医药卫生—药理学]