药剂师主导的干预方案在选择性心血管手术后预防术后狂妄症的影响
Yuki Asai1, Tatsuki Yanagawa1, Masaaki Takahashi1
1Pharmacy, National Hospital Organization Mie Chuo Medical Center, Hisaimyojin, Tsu, Mie, Japan.
PloS one
|October 12, 2023
概括
使用基于协议的药物管理 (PBPM) 的药剂师主导的干预措施显著降低了心血管手术患者的术后狂妄症 (PD) 率. 这种方法确定了多药作为一个关键的风险因素,导致减少了二二的使用和改善了患者的治疗结果.
科学领域:
- 药理学和制药科学 药理学和制药科学
- 心血管外科心血管外科
- 神经科学和神经病学 神经科学和神经病学
背景情况:
- 手术后妄 (PD) 是心血管手术后的常见并发症,目前药剂师干预的成功程度有限.
- 识别与药物治疗相关的风险因素对于制定有效的预防PD策略至关重要.
研究的目的:
- 在接受选择性心血管手术的患者中识别PD的药物治疗风险因素.
- 评估使用基于协议的药物管理 (PBPM) 的药剂师主导干预措施在降低PD率方面的有效性.
主要方法:
- 对142名接受选择性门置换或膜整形手术的成年患者进行了回顾性队列研究.
- 多变量逻辑回归分析以确定PD风险因素,重点是药物治疗.
- 实施PBPM协议,在高风险患者中停止使用二类药物,并用ramelteon/suvorexant替代 (多药,频繁剂量,二类药物使用/失眠).
主要成果:
- 总体的PD率为25%. 多药性是一个显著的风险因素 (调整后OR为3.3,p=0.016).
- 患病率显著下降,从PBPM前组的33%降至PBPM后组的13% (p=0.014).
- PBPM导致二二胺使用量减少 (p=0.026) 和使用拉梅尔和素受体对抗剂增加 (p<0.001).
结论:
- 基于协议的药物管理,针对二二胺的减少和替代性催眠使用,有效地降低了心血管手术患者的PD率.
- 对多种药物的术前评估对于识别患有PD高风险的患者至关重要.
- 这种由药剂师主导的干预是心血管外科手术中PD风险评估和管理的简单且潜在有用的策略.
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