醫院藥師介入腦中風門診病人 危險因子改善之研究

Study of Improvements in Risk Factors of Stroke Outpatients by Hospital Pharmacist Intervention

邱春吉(Chun-Chi Chiu)

指導教授 ： 張谷州 ； 吳信昇

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2004年)

摘要

研究背景：腦中風在全世界是造成死亡率與罹病率增加的最主要因素之一，在許多工業國家它是第三常見的死亡原因，而在國內根據行政院衛生署的統計它是第二常見的死亡原因。高血壓、糖尿病和高血脂是引起腦中風之重要且確立的可治療危險因子與預測因子。雖然許多研究顯示治療這些重要的危險因子可減少腦中風病人的罹病率與死亡率，而在治療上也有詳盡的建議準則當參考，但目前仍有許多腦中風門診病人的上述危險因子未能有效控制，適當的藥事照護對於這些危險因子還有明顯的改善空間。\r
研究目的：測定藥師介入神經科門診腦中風病患藥事照護，評估改善腦中風危險因子的成效。
研究方法：本研究為一項前瞻性、等量分層隨機取樣之臨床試驗，經隨機取樣160位病患分配為實驗組80人和對照組80人，實驗組接受藥師積極介入之藥事照護研究計畫，對照組則如醫院一般程序。主要指標是(1)兩組內與兩組間收縮壓、舒張壓、糖化血色素、空腹血糖、飯後血糖、總膽固醇、三酸甘油酯、低密度脂蛋白膽固醇和高密度脂蛋白膽固醇等，相較於基準點之變化差異；(2)高血壓、糖尿病和高血脂相較於基準點之足夠治療比例，以及評估研究後改善的比例。次要指標是兩組內與兩組間麩酸草醋酸丙酮轉胺酶、麩酸丙酮酸轉胺酶、血尿素氮和肌酸酐等，相較於基準點之變化差異。
研究結果：實驗組在收縮壓、舒張壓、總膽固醇和低密度脂蛋白膽固醇有明顯意義的改善；對照組在這些可治療的危險因子則無改善。實驗組符合高血壓控制情形的人數比例改善了37 % ( p=0.000)，符合高血脂控制情形的人數比例改善了29 % ( p=0.002)；對照組符合高血壓、糖尿病和高血脂等控制情形的人數比例並未有明顯意義改善。麩酸草醋酸丙酮轉胺酶、麩酸丙酮酸轉胺酶、血尿素氮等，無論在實驗組或對照組研究前後皆無變化差異。
結論：我們的研究顯示，醫院藥師提供藥事照護，對於腦中風門診病人的血壓與血脂等危險因子之改善有顯著的統計意義。因此，藥師介入初級門診醫療照護體系，對腦中風門診病人的危險因子之改善有明顯助益。

關鍵字

藥師介入 ； 藥事照護 ； 可治療危險因子 ； 腦中風

並列摘要

Background : Stroke is one of the leading factors of morbidity and mortality worldwide. It represents the third most common cause of death in many industrialized countries and the second most common cause of mortality in Taiwan. Hypertension, diabetes mellitus and hyperlipidemia are important and established modifiable risk factors and predictors for stroke. Although many studies had demonstrated treatment of these important risk factors can reduce morbidity and mortality of stroke patients. But still had many stroke patients inadequate management of these risk factors despite explicit management recommendations. There are marked room for improvement in the management of these risk factors.
Objective : To determine the efficacy of pharmacist intervention in the management of modifiable risk factors in the neurologic clinic in Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Methods : This was a prospective and equal allocation stratified random sampling clinical trial. One-hundred sixty patients were randomly assigned to experimental (n=80) or control (n=80) group. The experimental group received pharmacist intervention while the control group did as routine. Primary endpoints were (1) the differences of within groups and between groups of systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, low-density lipoprotein and high-density lipoprotein levels from baseline to the end of study. (2) the proportion of adequate management or assessed improvement of hypertension, diabetes, hyperlipidemia from baseline to the end of study. Secondary endpoints were the differences of within groups and between groups of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, blood urea nitrogen and creatinine levels from baseline to the end of study.
Results : In the experimental group had significant improvement in systolic blood pressure, diastolic blood pressure, total cholesterol and low-density lipoprotein. In the control group did not improved in these modifiable risk factors. Hypertension adequate management improved 37 % (p = 0.000) and hyperlipidemia adequate management improved 29 % (p = 0.002) in the experimental group. There was no significant improvement in hypertension, hyperlipidemia and diabetes adequate management in the control group. Glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, blood urea nitrogen were no difference in the experimental and control group.
Conclusion : Our study was indicated that pharmacist-managed modifiable risk factors program integrated into a primary care medical clinic can effectively improve blood pressure and lipid control in stroke outpatients.

並列關鍵字

pharmacist intervention ； stroke ； mordifiable risk factors

參考文獻

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