某医联体内奈玛特韦片/利托那韦片药学监护实践效果  

Pharmaceutical Care of Nirmatrelvir Tablets/Ritonavir Tablets in a Medical Alliance

作　　者：邱瑶 徐嵘[1] 赵新才 江静舟[2] 刘翎 戴旸[3] 姚顺 杨琦 瞿隆 张剑萍[1] 郭澄[1] QIU Yao;XU Rong;ZHAO Xincai;JIANG Jingzhou;LIU Ling;DAI Yang;YAO Shun;YANG Qi;QU Long;ZHANG Jianping;GUO Cheng(Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,China 200233;Kangjian Street Community Health Service Center of Xuhui District,Shanghai,China 200235;Tianlin Street Community Health Service Center of Xuhui District,Shanghai,China 200233;Lingyun Street Community Health Service Center of Xuhui District,Shanghai,China 200237)

机构地区：[1]上海交通大学医学院附属第六人民医院,上海200233 [2]上海市徐汇区康健街道社区卫生服务中心,上海200235 [3]上海市徐汇区田林街道社区卫生服务中心,上海200233 [4]上海市徐汇区凌云街道社区卫生服务中心,上海200237

出　　处：《中国药业》2024年第12期28-32,共5页China Pharmaceuticals

基　　金：上海交通大学医学院新型冠状病毒感染肺炎抗疫相关药事管理与合理用药研究专项基金[JDYX2020KYZX001]。

摘　　要：目的促进临床新型冠状病毒感染小分子药物(简称新冠小分子药物)的合理使用。方法以上海交通大学医学院附属第六人民医院及上海市徐汇区康健街道、凌云街道、田林街道社区卫生服务中心组建医疗联合体(简称医联体),构建新冠小分子药物药学监护模式,包括社区药师培训、开展药学监护及三级医院药师指导评价等环节。收集3个社区卫生服务中心2023年1月至2月使用奈玛特韦片/利托那韦片(NMV/RTV)新冠病毒感染门诊患者的资料,分析患者的用药情况,以及药物相关问题(DRP)的发生情况。结果共纳入79例患者,其中78例(98.73%)年龄≥60岁;合并疾病(3.04±1.71)种,主要为心血管疾病(64例次、81.01%),糖尿病(35例次、44.30%),高脂血症(16例次、20.25%);使用药品(6.00±3.66)种;使用中成药36例(45.57%)。社区药师共完成150次随访,发现并干预87件DRP,其中NMV/RTV 77件,主要为药物相互作用(70件),涉及药物类型排前3的分别为钙离子通道阻滞剂(31件、44.29%),抗焦虑药(12件、17.14%),羟甲基戊二酰辅酶A还原酶抑制剂(11件、15.71%)。根据出现的DRP,医联体药师提出了减量服用、暂停给药、密切监测相关指标(如疗效、药品不良反应、血压、血栓风险)等用药建议。结论社区新冠病毒感染老年患者占比较高,用药复杂,NMV/RTV使用过程中存在较多DRP。基于医联体的新冠小分子药物药学监护模式可帮助社区药师规范化开展药学监护工作,及时发现并干预DRP,有利于促进医联体内药学服务同质化,为后续新冠小分子药物的用药管理提供依据。Objective To promote the rational use of small-molecule drugs against Corona Virus Disease 2019(COVID-19)in clinical practice.Methods A medical alliance was set up by the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,community health service centers of Kangjian Street,Lingyun Street and Tianlin Street in Xuhui District,Shanghai.The pharmaceutical care mode for small-molecule drugs against COVID-19 was constructed,including the links such as community pharmacist training,carring out pharmaceutical care,providing guidance and evaluation by pharmacists in tertiary hospitals.The data of outpatients with COVID-19 using Nirmatrelvir Tablets/Ritonavir Tablets(NMV/RTV)from January to February 2023 in above three community health service centers were collected,the medication information and occurrence of drug-related problem(DRP)was analyzed.Results A total of 79 patients were included,of which 78(98.73%)were or over 60 years.Each patient had(3.04±1.71)types of comorbidities on average,mainly cardiovascular diseases(64 case times,81.01%),diabetes mellitus(35 case times,44.30%),hyperlipidemia(16 case times,20.25%).Each patient used(6.00±3.66)kinds of drugs on average,and 36 patients(45.57%)used Chinese patent medicines.A total of 150 follow-up visits were conducted by community pharmacists,and 87 cases of DRPs were identified and intervened,among which 77 were involved in NMV/RTV,mainly DDIs(70 cases),and the top three drugs involved were calcium channel blockers(31 cases,44.29%),antianxiety drugs(12 cases,17.14%),hydroxy methylglutaryl coenzyme A reductase inhibitor(11 cases,15.71%).Based on the current DRPs,pharmacists in medical alliance proposed medication recommendations such as decreasing dosage,suspending medication and closely monitoring relevant indicators(such as efficacy,adverse drug reactions,blood pressure and thrombotic risk).Conclusion The proportion of elderly patients with COVID-19 in the community is high,the medication is complex,and there are more DRPs

关 键 词：新型冠状病毒感染 小分子药物 奈玛特韦片/利托那韦片 医疗联合体 药学监护 三级医院 社区卫生服务中心 

分 类 号：R95[医药卫生—药学]