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临床药师基于临床药学路径参与慢性心力衰竭治疗的效果评价
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| 篇名： | 临床药师基于临床药学路径参与慢性心力衰竭治疗的效果评价 |
| TITLE： | Evaluation of the effect of clinical pharmacists participating in the treatment of chronic heart failure based on the clinical pharmacy pathway |
| 摘要： | 目的 评价临床药师基于临床药学路径（CPP）参与慢性心力衰竭（CHF）治疗的效果。方法选择2024年8月24日－2025年3月14日内蒙古科技大学包头医学院第一附属医院收治的226例CHF患者，按随机数字表法分为观察组和对照组，每组113例。所有患者均接受常规治疗，观察组患者在此基础上接受CPP管理（含住院期间药学监护、个体化出院用药方案制定、出院后药学随访）。比较两组患者入院时、出院时和出院3、6个月时的心功能指标、出院6个月时的治疗药物使用情况、经济指标以及出院6个月时的再入院率与死亡率；比较观察组患者入院时、出院时和出院3、6个月时的8条目Morisky用药依从性量表（MMAS-8）评分、躯体化症状自评量表（SSS）评分和患者健康问卷抑郁症状群量表（PHQ-9）评分。结果出院6个月后，共有24例患者脱落，最终观察组104例、对照组98例患者完成研究。与入院时比较，两组患者出院时和出院3、6个月时的美国纽约心脏协会（NYHA）心功能分级、左室射血分数、氨基末端脑利钠肽前体均显著改善，且在出院3、6个月时均显著优于出院时；同时，观察组出院时和出院3、6个月时的上述指标（出院时的NYHA心功能分级、氨基末端脑利钠肽前体和出院3个月时的NYHA心功能分级除外）均显著优于对照组（P＜0.05）。观察组患者的血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂使用率、β受体阻滞剂使用靶剂量的患者占比、钠-葡萄糖耦联转运体2抑制剂使用率及使用靶剂量的患者占比均显著高于对照组（P＜0.05），药占比、再入院率均显著低于对照组（P＜0.05）。与入院时比较，观察组患者出院时和出院3、6个月时的MMAS-8评分均显著升高，SSS评分、PHQ-9评分均显著降低（P＜0.05），且上述评分均随出院时间延长而逐渐降低（P＜0.05）。结论临床药师通过CPP可显著改善患者的心功能、用药依从性、躯体化症状和抑郁状态，提高血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂、钠-葡萄糖耦联转运体2抑制剂使用率及β受体阻滞剂、钠-葡萄糖耦联转运体2抑制剂使用靶剂量的患者占比，降低再入院率。 |
| ABSTRACT： | OBJECTIVE To evaluate the effect of clinical pharmacists participating in the treatment of chronic heart failure （CHF） based on the clinical pharmacy pathway （CPP）. METHODS Totally 226 CHF patients recruited from August 24th， 2024 to March 14th， 2025， were divided into an observation group and a control group based on the random number table method， with 113 cases in each group. All patients were treated with conventional therapy. The observation group was additionally given CPP management （including pharmaceutical care during hospitalization， the formulation of individualized discharge medication regimens， and pharmaceutical follow-up after discharge）. The cardiac function parameters at admission， at discharge， at 3 and 6 months after discharge， drug use at 6 months after discharge， economic indicators， as well as the readmission rate and mortality rate at 6 months after discharge were compared between the two groups. Morisky Medication Adherence Scale-8 Items （MMAS-8）， Somatic Self-rating Scale （SSS） and Patient Health Questionnaire-9 （PHQ-9） scores were compared at admission， at discharge and at 3 and 6 months after discharge. RESULTS Six months after discharge， 24 patients dropped out. Eventually， 104 patients in the observation group and 98 patients in the control group completed the study. Compared with at admission， New York Heart Association （NYHA） cardiac functional classification， left ventricular ejection fraction （LVEF） and N -terminal pro-B-type natriuretic peptide （NT-proBNP） of both groups of patients at discharge as well as at 3 and 6 months after discharge were significantly improved； moreover， the improvements at 3 and 6 months after discharge were significantly better than those at discharge. Meanwhile， the above indexes （except for NYHA cardiac functional classification at discharge， NT-proBNP and NYHA cardiac functional classification at 3 months after discharge） of the observation group at discharge， at 3 and 6 months after discharge were significantly better than the control group （ P ＜0.05）. The utilization rates of angiotensin converting enzyme inhibitor （ACEI）/angiotensin Ⅱ receptor blocker （ARB）/angiotensin receptor neprilysin inhibitor （ARNI）， the proportion of β-blockers reaching the target dose， the utilization rate of sodium-glucose linked transporter 2 inhibitor （SGLT2i）， and the proportion of SGLT2i reaching the target dose in the observation group were significantly higher than the control group （ P ＜0.05）， and the proportion of drugs and readmission rate were significantly lower than the control group （ P ＜0.05）. Compared with at admission， MMAS-8 scores of the patients in the observation group at discharge， at 3 and 6 months after discharge were significantly increased， while SSS and PHQ-9 scores were significantly lowered （ P ＜0.05）. And all the above scores gradually decreas ed with the extension of discharge time （ P ＜0.05）. CONCLUSIONS Clinical pharmacists can utilize CPP to significantly improve patients’ cardiac function， medication adherence， somatic symptoms and depression. Additionally， they can significantly improve the utilization rates of ACEI/ARB/ARNI and SGLT2i， as well as the proportion of target doses of β-blockers and SGLT2i， while simultaneously reducing readmission rates. |
| 期刊： | 2026年第37卷第06期 |
| 作者： | 侯冠华；王宝珍；唐雨晨；程杰；董媛；董志强 |
| AUTHORS： | HOU Guanhua，WANG Baozhen，TANG Yuchen，CHENG Jie，DONG Yuan，DONG Zhiqiang |
| 关键字： | 慢性心力衰竭；临床药学路径；临床药师；个体化用药 |
| KEYWORDS： | chronic heart failure； clinical pharmacy pathway； clinical pharmacist； individualized medication |
| 阅读数： | 2 次 |
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