【摘要】 目的 评价在多学科合作团队中，临床药师对住院心力衰竭患者中存在的药物相关问题(DRPs)的识别，以及进行干预后的效果。方法 选取三甲医院心脏中心某病区收治的慢性心力衰竭患者，查阅患者病例资料，结合患者病情变化，发现用药问题，并记录对应的DRPs类别。临床药师在研究前期仅对DRPs进行识别(非干预组),在研究后期在识别DRPs的基础上，提出干预意见(干预组),并对干预效果对进行分析。结果 共纳入54例患者，非干预组32例，干预组22例。研究共识别DRPs167条，非干预组98条，干预组干预前69条，干预后45条，DRPs下降34.8%,平均每例减少1.09条。适应症和安全性方面，干预效果有统计学意义(P=0.001,0.024);有效性方面，干预效果无统计学意义(P=0.170)。干预效果最明显的方向为：药物治疗不足、不良事件、剂量过高。结论 临床药师使住院心衰患者治疗过程中存在的DRPs得到了充分的识别，通过药师的干预能有效的解决药物的治疗不足、不良事件、剂量过高等方面的问题。更多还原

【Abstract】 OBJECTIVE To identify the drug-related problems(DRPs) in hospitalized heart failure patients and evaluate the effects of interventions by clinical pharmacistin a multidisciplinary cooperative team.METHODS Include the patients with chronic heart failure admitted to a ward in the heart center of a 3 A hospital.Review the patients′ medical records, and monitor the patients′ condition, to identify and record the DRPs.In the early stage of the study, clinical pharmacist only identified the DRPs(non-intervention group).In the later stage of the study, intervention suggestions were proposed based on the DRPs(intervention group).In addition, the effects of interventions were analyzed.RESULTS 54 cases were included.32 patients in the non-intervention group, while 22 patients in the intervention group.A total of 167 DRPs were identified, with an average of 3.09 DRPs per patient, among which, 98 were in the non-intervention group, 69 in the intervention group before intervention and 43 after intervention.DRPs decreased by 37.68%,with an average decrease of 1.18 per case.We evaluated the intervention effects.For indication and safety, the effects were significant(P=0.001,0.024).For effectiveness, the effects were not significant(P=0.170).The most obvious directions of intervention effects were: insufficient drug treatment, adverse events, and overdose.CONCLUSION Clinical pharmacists can well recognize the DRPs existing in treatment of hospitalized heart failure patients.Through the intervention of pharmacists, DRPs of inadequate drug treatment, adverse events, and overdose can be effectively solved.更多还原