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加速康复外科模式下临床药师参与骨科术后阿片类药物使用管理的前瞻性队列研究
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| 篇名： | 加速康复外科模式下临床药师参与骨科术后阿片类药物使用管理的前瞻性队列研究 |
| TITLE： | Prospective cohort study on clinical pharmacist involvement in the management of opioid use after orthopedic surgery under the enhanced recovery after surgery model |
| 摘要： | 目的 为改善术后患者疼痛管理成效、加速患者康复、确保阿片类药物使用安全提供参考。方法采用前瞻性队列研究方法，将2021年11月－2023年11月在保定市第一中心医院（下称“我院”）骨科接受择期髋膝关节置换术的患者按随机数字表法分为对照组和观察组，每组178例。对照组患者接受由医护人员按照我院骨科围手术期疼痛治疗临床路径实施的术后疼痛管理，观察组患者在加速康复外科模式下，接受由含临床药师参与的多学科协作团队提供的术后疼痛管理。比较两组患者术后阿片类药物相关问题（DRPs）的发生及解决情况，并利用欧洲医药保健网分类系统9.1版对两组患者存在的DRPs进行分类分析；比较两组患者术后疼痛评分、睡眠质量评分、住院时间及不良反应发生情况。结果两组患者共存在阿片类药物DRPs162个，其中观察组58个（涉及52例患者）、对照组104个（涉及91例患者），差异有统计学意义（P＜0.05）；两组DRPs涉及问题均以治疗有效性为主。观察组临床药师对发现的58个阿片类药物DRPs进行了88次干预，总体干预成功率为84.5%。观察组患者术后1～7d的疼痛评分和睡眠质量评分、髋关节置换术住院时间及平均住院时间、阿片类药物总不良反应发生率均显著低于或短于对照组（P＜0.05）；且两组患者疼痛评分和睡眠质量评分的主时间效应、时间及组别交互作用均显著（P＜0.05），即对照组相关评分减少更多，观察组相关评分改善更为迅速。结论临床药师全程参与骨科术后疼痛治疗及阿片类药物管理，可及时识别并干预DRPs，提高术后镇痛效果，减少不良反应，缩短住院时间，加速患者术后康复。 |
| ABSTRACT： | OBJECTIVE To provide a reference for improving postoperative pain management outcomes， accelerating patient recovery， and ensuring the safe use of opioids. METHODS A prospective cohort study was conducted， in which patients undergoing elective hip or knee replacement in the Department of Orthopedics at Baoding No.1 Central Hospital （hereinafter referred to as “our hospital”） from November 2021 to November 2023 were randomly divided into control group and observation group using a random number table， with 178 cases in each group. Patients in the control group received postoperative pain management implemented by medical staff according to the clinical pathway for perioperative pain treatment. Patients in the observation group， under the enhanced recovery after surgery model， received postoperative pain management through a multidisciplinary collaborative team including clinical pharmacists. The occurrence and resolution of opioid-related drug-related problems （DRPs） were compared between the two groups， and the DRPs were classified and analyzed using the Pharmaceutical Care Network Europe Classification System （V9.1）. Postoperative pain scores， sleep quality scores， length of hospital stay， and incidence of adverse reactions were compared between the two groups. RESULTS A total of 162 opioid-related DRPs were identified in 2 groups， with 58 in the observation group （identified 52 patients） and 104 in the control group （identified 91 patients）， showing a statistically significant difference （P＜0.05）. The primary issue involved in the DRPs for both groups was therapeutic effectiveness. Clinical pharmacists in the observation group conducted 88 interventions for the identified 58 opioid-related DRPs， achieving an overall intervention success rate of 84.5%. The pain scores and sleep quality scores from postoperative day 1 to 7， the length of hospitalization for hip replacement， the average hospitalization duration， and the total incidence of opioid-related adverse reactions were all significantly lower or shorter in the observation group compared to the control group （P＜0.05）. Furthermore， the main time effect， time-group interaction effect for pain scores and sleep quality scores were statistically significant in both groups （P＜0.05）， indicating that the control group exhibited greater reductions in these scores and observation group exhibited more rapid improvements. CONCLUSIONS The full involvement of clinical pharmacists in postoperative pain management and opioid medication administration in the orthopedics department enables timely identification and intervention of DRPs， enhance postoperative analgesia efficacy， decrease adverse drug reactions， shorten hospital stays， and accelerate patient recovery. |
| 期刊： | 2025年第36卷第12期 |
| 作者： | 杨玉敏；李秀敏；王璐 |
| AUTHORS： | YANG Yumin，LI Xiumin，WANG Lu |
| 关键字： | 阿片类药物；髋膝关节置换术；加速康复外科；药物相关问题；临床药师 |
| KEYWORDS： | opioid； hip or knee arthroplasty； enhanced recovery after surgery； drug-related problems； clinical pharmacist |
| 阅读数： | 3 次 |
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