电视胸腔镜手术患者术前药物相关问题评价及影响因素分析  

Evaluation and Factor Analysis of Preoperative Medication-Related Issues in Patients Undergoing Video-Assisted Thoracoscopic Surgery

作　　者：刘英坤 庞宁 马超群 樊榕榕[5] 刘一[1] 刘彦国[5] 黄琳[1] 张晓红[1] LIU Yingkun;PANG Ning;MA Chaoqun;FAN Rongrong;LIU Yi;LIU Yanguo;HUANG Lin;ZHANG Xiaohong(Department of Pharmacy,Peking University People's Hospital,Beijing 100044,China;Department of Pharmacy,the Affiliated Hospital of Chifeng College,Chifeng 024000,China;Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy,Beijing Miyun District Traditional Chinese Medicine Hospital,Beijing 101599,China;Department of Thoracic Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院药学部,北京100044 [2]赤峰学院附属医院药学部,赤峰024000 [3]北京大学第三医院药学部,北京100191 [4]北京密云区中医医院药学部,北京101599 [5]北京大学人民医院胸外科,北京100044

出　　处：《医药导报》2025年第5期764-770,共7页Herald of Medicine

基　　金：白求恩求索-药学科研能力建设项目(B-19-H-20200622)。

摘　　要：目的对胸外科接受电视胸腔镜手术(VATS)的患者术前药物相关问题(DRPs)进行评价并分析影响因素。方法纳入2023年3月1日—5月31日接受VATS且至少存在1种合并症的患者,临床药师采用欧洲医药保健网(PCNE)分类系统(V 9.1)对DRPs进行评价,并分析发生(或潜在)DRPs的影响因素。结果共纳入患者300例,其中174例共涉及DRPs 200次。最常见的DRPs是治疗安全性问题(47.50%),其次是治疗有效性问题(46.00%)和其他问题(6.50%)。产生问题原因最多的是药物选择原因(33.83%),其次是其他原因(33.33%)和患者相关原因(19.90%)。针对DRPs进行了367次干预,干预手段最多的是药物层面(55.86%),其次是医生层面(39.24%)和患者层面(3.54%)。最终96.00%的干预方案被接受,86.50%的问题得到全部解决。合并症、用药品种数、身体质量指数(BMI)、住院时间在发生DRPs组与未发生DRPs组间差异有统计学意义(P<0.05)。多因素分析结果显示:合并症、用药品种数、BMI是胸外科VATS患者术前发生(或潜在)DRPs的独立危险因素(OR>1,P<0.05)。结论临床药师使用PCNE分类系统可有效评价胸外科VATS患者术前DRPs,合并症、用药品种数、BMI是术前DRPs发生的影响因素。临床实践中应重点关注这些影响因素,以优化治疗策略,减少DRPs发生。Objective To evaluate drug-related problems(DRPs)and to analyze the influencing factors of patients undergoing video-assisted thoracoscopic surgery(VATS)before operation in thoracic surgery.Methods Clinical pharmacists used the Pharmaceutical Care Network Europe(PCNE)classification system(version 9.1)to analyze DRPs and influencing factors of patients who received VATS from March 1 to May 31,2023,and had at least one comorbidity.Results Out of 300 patients,174 were involved in a total of 200 DRPs.The most common category of DRPs is treatment safety(47.50%),followed by treatment effectiveness(46.00%)and others(6.50%).The most common cause of the problem is drug selection(33.83%),followed by other(33.33%)and patient cause(19.90%).367 interventions were conducted for DRPs,with the most interventions being at the drug level(55.86%),followed by the doctor level(39.24%)and the patient level(3.54%).In the end,96.00%of the intervention plan was accepted,and 86.50%of the problems were resolved.There were significant differences(P<0.05)in the number of underlying diseases,medication varieties,body mass index(BMI),and length of hospital stay between the group with and without DRPs.The results of multivariate analysis showed that comorbidities,number of medication types,and BMI were independent risk factors for preoperative occurrence(or potential)of DRPs in VATS patients in thoracic surgery(OR>1,P<0.05).Conclusions Clinical pharmacists can effectively evaluate preoperative DRPs in patients undergoing VATS in thoracic surgery through the PCNE classification system.Comorbidities,number of medications,and BMI are influential factors for the occurrence of preoperative DRPs.Future clinical practice should focus on these risk factors to optimize treatment strategies and reduce the occurrence of DRPs.

关 键 词：药物相关问题 电视胸腔镜手术 欧洲医药保健网分类系统 

分 类 号：R982[医药卫生—药品] R969.3[医药卫生—药学]