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目的了解抗凝药师在药师主导的基因个体化治疗等会诊中发挥的作用。方法收集北京大学第一医院2013年6月至2015年12月我院抗凝药师参与584例会诊病例,对基本临床情况、会诊目的、会诊建议及采纳情况等主要指标进行统计分析。结果 584例会诊病例中华法林基因会诊272例(46.58%)、氯吡格雷基因会诊130例(22.26%)、华法林患者教育会诊173例(29.62%)和其他会诊9例,共涉及13个科室。华法林基因会诊目的包括预测剂量(101例)、调整剂量(177例)、用药教育(33例)及其他(7例);氯吡格雷基因会诊目的包括使用前预测抗血小板疗效(20例)、使用后明确抗血小板疗效(110例)及其他(4例)。药师会诊建议包括剂量建议(408例)、药物相互作用(138例)、合并疾病影响(88例)、药物不良反应监测(112例)、用药教育(205例)、换药(92例)等;所有会诊意见采纳率为86.64%(506例/584例)。在药师会诊前,华法林治疗患者国际标准化比值达标率为35.06%、氯吡格雷治疗患者血小板功能抑制达标率为30.77%;会诊后,出院时两者达标率分别增加至44.11%和48.70%。结论我院药师主导的基因个体化治疗等会诊效果显著,提示药师结合药物知识开展药学服务的必要性。
Objective To understand the role of anticoagulant pharmacists in consultation with pharmacist-led individualized individuals. Methods The first affiliated hospital of Peking University from June 2013 to December 2015 in our hospital anticoagulant pharmacists participated in 584 cases of consultation, the basic clinical situation, consultation purposes, consultation recommendations and the adoption of such major indicators of statistical analysis. Results A total of 272 cases (46.58%) were consulted of 584 cases of warfarin gene, 130 cases (22.26%) were diagnosed as clopidogrel gene, 173 cases (29.62%) were consulted by warfarin clinics and 9 cases were other consultations involving 13 A department. Predict the dosage of warfarin gene (101 cases), adjusted dose (177 cases), medication education (33 cases) and others (7 cases); Clopidogrel counseling purposes include prediction of antiplatelet efficacy before use (20 cases ), Clear anti-platelet effect (110 cases) and others (4 cases) after use. Advice from the pharmacists included dose recommendations (408 cases), drug interactions (138 cases), combined disease effects (88 cases), adverse drug reactions monitoring (112 cases), medication education (205 cases), dressing change ; Adoption rate of all consultations was 86.64% (506 cases / 584 cases). Pharmacists consultation before warfarin treatment of patients with international standardization rate was 35.06%, clopidogrel treatment of patients with platelet function suppression compliance rate was 30.77%; after consultation, the discharge rate of the two were increased to 44.11% and 48.70% . Conclusions The individualized treatment of genes led by pharmacists in our hospital has significant consultation results, suggesting the necessity of pharmacy services by pharmacists combined with drug knowledge.