临床药师参与的多学科协作全院血糖管理模式介绍与效果评价  

Introduction and evaluation of multidisciplinary collaborative blood glucose management mode of the whole hospital with the participation of clinical pharmacists

作　　者：计成[1,2] 代晶 李林通[1] 李佳希 葛卫红[1] JI Cheng;DAI Jing;LI Lintong;LI Jiaxi;GE Weihong(Dept.of Pharmacy,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,China;Dept.of Endocrinology,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,China;Dept.of Pharmacy,the Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China;College of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,南京210008 [2]南京大学医学院附属鼓楼医院内分泌科,南京210008 [3]苏州大学附属第二医院药学部,江苏苏州215004 [4]中国药科大学基础医学与临床药学学院,南京210009

出　　处：《中国药房》2022年第17期2152-2156,共5页China Pharmacy

基　　金：江苏省医学重点学科项目(No.ZDXKB2016012);广东省药学会研究基金项目(No.2020ZX03);南京临床医学中心建设项目(No.宁卫科教[2020]1号);南京鼓楼医院临床研究专项资金项目(No.2021-LCYJ-PY-33)。

摘　　要：目的 介绍临床药师参与的多学科协作全院血糖管理(以下简称“全院血糖管理”)模式,评价其在围手术期糖尿病患者血糖管理中的应用效果。方法 介绍南京大学医学院附属鼓楼医院全院血糖管理模式的流程、临床药师工作内容。纳入择期手术的2型糖尿病患者300例,随机分为普通会诊组(对照组)和全院血糖管理组(干预组),比较两组患者血糖管理效果和术前等待时间、住院天数等指标。结果 全院血糖管理团队以内分泌科全院血糖管理医师、临床药师、护士为核心成员,主要服务流程分为初次管理、日常管理、出院管理和随访。临床药师作为团队秘书,主要负责每天汇总管理患者的血糖水平及特殊状况,定期进行管理效果评价,开展药学查房、医嘱审核、药学监护,及时对患者血糖进行评估以及指导患者合理用药等工作。与干预前比较,干预3 d后,两组患者的空腹血糖、餐后血糖水平均显著降低(P<0.05),且干预组显著低于对照组(P<0.05);与对照组比较,干预组患者的血糖波动幅度显著减小(P<0.05),其血糖水平标准差已达到目标控制水平,餐后血糖波动幅度、最大血糖波动幅度接近目标控制水平;术前血糖达标率、出院时血糖达标率均显著升高(P<0.05);术前等待时间和住院天数均显著缩短(P<0.05)。结论 临床药师参与的多学科协作全院血糖管理模式,可以更加平稳、有效地控制围手术期糖尿病患者的血糖水平,对改善患者的疾病治疗及预后有着现实意义。OBJECTIVE To introduce multidisciplinary collaborative blood glucose management mode(hereinafter referred as to blood glucose management mode of the whole hospital)of the whole hospital with the participation of clinical pharmacists,and to evaluation it effects on the blood glucose management of perioperative diabetes patients. METHODS The process of blood glucose management mode of the whole hospital in Drum Tower Hospital Affiliated to Medical School of Nanjing University and the work content of clinical pharmacists were introduced. Three hundred patients with type 2 diabetes mellitus who underwent elective surgery were included and randomly divided into general consultation group(control group) and hospital-wide glucose management group(intervention group). The effect of glucose management and indicators such as preoperative waiting time and total length of stay were compared between 2 groups. RESULTS In the blood glucose management team of the whole hospital,the physicians,clinical pharmacists and nurses of blood glucose management in endocrinology department were the core members,and the management process was divided into initial management,daily management,discharge management and follow-up. As the team secretary,the clinical pharmacists were mainly responsible for daily summarizing and managing the blood glucose level and special conditions of patients,regularly evaluating the management effect,carrying out pharmaceutical ward rounds,medical order review, pharmaceutical care, timely assessing the blood glucose of patients and guiding the rational use of drugs.Compared with before intervention, after 3 days of intervention,the levels of fasting plasma glucose(FPG) and postprandial blood glucose(PBG) were decreased significantly in 2 groups(P<0.05);intervention group was significantly lower than control group(P<0.05). Compared with control group, the fluctuation of blood glucose in intervention group was significantly reduced(P<0.05),standard deviation of blood glucose had reached the targeted control level

关 键 词：全院血糖管理 多学科协作 药学服务 临床药师 

分 类 号：R95[医药卫生—药学]