基于循证证据的围手术期疼痛药物治疗临床路径的构建  

Development of evidence-based clinical medicine pathway for perioperative pain management

作　　者：邢晓敏[1] 荆凡波[1] 韩志武[1] 孙加琳[1] 姜曼[1] 李静[1] XING Xiaomin;JING Fanbo;HAN Zhiwu;SUN Jialin;JIANG Man;LI Jing(Department of Pharmacy,the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China)

机构地区：[1]青岛大学附属医院药学部,山东青岛266000

出　　处：《中国医院药学杂志》2025年第2期209-214,共6页Chinese Journal of Hospital Pharmacy

基　　金：山东省医学会临床科研资金-齐鲁专项(编号:YXH2022ZX02064)。

摘　　要：目的:介绍青岛大学附属医院构建围手术期疼痛药物治疗临床路径(以下简称“药径”)的经验,为其他医疗机构提供参考。方法:以循证证据为基础,明确围手术期疼痛药径的定义与特点、制定原则与目标和药物选择与使用。分析并探讨了构建思路、执行过程和效果评价,并对临床药师在此过程中的作用提出了建议。结果:在制定围手术期疼痛药径时,临床药师可依据临床需求、参考标杆科室、探索治疗药物和多模式镇痛策略,提高临床科室的参与积极性,建立并持续改进执行机制,采用有效的效果评价指标进行评估。2019年7月-2023年6月,在22个外科46个病区实施了药径,临床药师每月对出院病例进行点评,针对存在的问题进行持续改进。药径在胸外科和心外科得到了有效验证,保证了药径执行率,提高了疼痛缓解率,降低了术后阿片类药物用量和均次药费,并降低了不良反应发生率。结论:基于循证证据的围手术期疼痛药径具有良好的可操作性、有效性和安全性,体现了药师价值,提高围手术期的药学服务品质。OBJECTIVE To introduce the experience of establishing a clinical medicine pathway by the Affiliated Hospital of Qingdao University for perioperative pain management,and to provide references for other medical institutions.METHODS This study clarified the definition and characteristics,principles and goals,and drug selection and use of the medicine pathway based on medical evidence.The construction idea,implementation process and effect evaluation were analyzed and discussed,and the role of clinical pharmacists in this process was proposed.RESULTS In the formulation of medicine pathway,clinical pharmacists were responsible for exploring therapeutic drugs and multimodal analgesic strategies based on clinical needs and benchmark departments,thus improving the participation and enthusiasm of clinical departments.The evidence-based clinical medicine pathway was established and continuously modified.It was evaluated by effective parameters.From July 2019 to June 2023,the medicine pathway has been implemented in 46 wards of 22 surgical departments,and clinical pharmacists made monthly discharged case reviews and continuous improvement for existing problems.The medicine pathway has been effectively verified in the department of thoracic and cardiac surgery,ensuring a high pathway implementation rate,pain relief,less usage of postoperative opioid,reduced average drug costs,and decreased incidence of adverse events.CONCLUSION The evidence-based clinical medicine pathway for perioperative pain management has good operability,efficacy and safety,demonstrating pharmacist values,and improving the quality of pharmacy services in the perioperative period.

关 键 词：疼痛 药物治疗临床路径 循证证据 围手术期 临床药师 

分 类 号：R969[医药卫生—药理学] R971[医药卫生—药学]