低分子肝素预防产褥期静脉血栓栓塞性疾病的药物治疗管理效果  

Analysis of effects of low-molecular-weight heparin in the prevention of puerperal venous thromboembolism based on medication therapy management

作　　者：陈芸萱 周慧 肖春 王朝 周慧民 许厚钦 杨志文 CHEN Yunxuan;ZHOU Hui;XIAO Chun;WANG Chao;ZHOU Huimin;XU Houqin;YANG Zhiwen(Department of Pharmacy,Changning Maternity and Child Healthcare Hospital of Shanghai,Shanghai 200051,China;Department of Obstetrics,Changning Maternity and Child Healthcare Hospital of Shanghai,Shanghai 200051,China)

机构地区：[1]上海市长宁区妇幼保健院药剂科,上海200051 [2]上海市长宁区妇幼保健院产科,上海200051

出　　处：《中国临床药学杂志》2024年第9期667-672,共6页Chinese Journal of Clinical Pharmacy

基　　金：上海市长宁区医疗卫生科研专项课题(编号CNKW2020Y30)。

摘　　要：目的 基于药物治疗管理(MTM)探讨低分子肝素对产褥期静脉血栓栓塞性疾病(VTE)预防的疗效和安全性。方法 选取2021年1月至2022年12月收治的139例产妇,随机分为常规治疗组68例和MTM组71例。根据VTE风险评分,将常规治疗组分为中危常规治疗组(37例)和高危常规治疗组(31例),将MTM组分为中危MTM组(38例)和高危MTM组(33例)。比较4组用药前后凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)和D-二聚体(D-D)]、血小板(PLT)计数、肝肾功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Scr)]及不良反应发生情况。结果 中危MTM组和中危常规治疗组用药1 d后PT、APTT和AST水平均高于用药前(P <0.01)。中危MTM组用药1 d后D-D低于中危常规治疗组(P <0.05)。高危MTM组和高危常规治疗组用药7 d后D-D低于用药前,用药7 d后APTT、PLT计数、ALT和AST水平高于用药前,FIB水平低于用药前(P <0.05)。中危MTM组共发生不良反应1例,高危MTM组共发生不良反应3例,高危常规治疗组共发生不良反应7例。中危MTM组的疾病认知度低于高危MTM组(P <0.01)。接受MTM后高危MTM组的用药依从性提高(P <0.01)。结论 低分子肝素能够改善产褥期产妇高凝状态,长期使用需关注对肝功能及凝血功能的影响。MTM能够提高VTE的防治水平、产妇对疾病的认知度和用药依从性。AIM To explore the efficacy and safety of low-molecular-weight heparin in the prevention of venous thromboembolism (VTE) based on medication therapy management (MTM). METHODS From January 2021 to December 2022, a total of 139 participants were stratified by VTE risk score and randomly divided into 4 groups: medium-risk conventional treatment group (37 patients), medium-risk MTM group (38 patients), high-risk conventional treatment group (31 patients) and high-risk MTM group (33 patients). All results were compared within 4 groups before and after using medication, including coagulation function[activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D)], platelet (PLT) count, liver and kidney function[alanine aminotransferase (ALT), glutamic oxalacetic transaminase (AST), creatinine (Scr)]and adverse reactions. RESULTS PT and APTT were prolonged in 2 medium-risk groups (P<0.01) after a day of medication. After a day of medication, the D-D level in the medium-risk MTM group was lower than that in the medium-risk conventional treatment group (P<0.05). After 7 days of medication, the D-D levels in both the high-risk MTM group and the high-risk conventional treatment group were lower than prior medication. Increased APTT, PLT counts and ALT levels could be observed in 2 high-risk groups after 7 days of medication. AST level was increased in all groups after medication (P<0.05). At the same time, the level of FIB was decreased (P<0.05). There was a case of adverse reaction in the medium-risk MTM group. There were 3 cases of adverse reactions in the high-risk MTM group and 7 cases in the high-risk conventional treatment group. The medium-risk MTM group exhibited a lower degree of disease awareness than the high-risk MTM group (P<0.01). Following the implementation of MTM, an enhancement in medication adherence was observed within the high-risk MTM group (P<0.01). CONCLUSION Low-molecular- weight heparin can significantly improve the coagulation function during the puerperal per

关 键 词：低分子肝素 产褥期 静脉血栓栓塞症 药物治疗管理 

分 类 号：R714.625[医药卫生—妇产科学]