目的:探究欧洲医药保健网(Pharmaceuti-cal Care Network Europe，PCNE)分类系统用于评价肾移植受者他克莫司浓度波动药物相关问题(drug related problems，DRPs)的作用。方法:以门诊随访中出现他克莫司血药浓度波动、临床药师介入干预的肾移植受者为研究对象，利用PCNE(9。0)分类系统评价他克莫司的DRPs，并对存在DRPs的问题、原因、介入方案、介入方案的接受和状态进行分析。结果:本研究纳入2019年7月至2021年12月肾移植受者700例，发现1 014个他克莫司DRPs。DRPs的问题包括发生药物不良事件(P2。1，60。16％)和治疗效果不佳(P1。2，39。84％);原因主要包括剂量选择(C3，43％)、其他(C9，38。4％)和药物选择(C1，9。41％);临床药师从受者层面(I2，98。92％)和药物层面(I3，1。08％)积极介入;介入方案(A1。1+A1。3)的接受率达98。62％，完全执行(A1。1)率达72。09％;79。29％的DPRs被全部解决或部分解决(O1。1和O2。1)。结论:临床药师可将PC-NE用于评价他克莫司治疗药物监测(therapeutic drug monitoring，TDM)相关 DRPs，助力 TDM 药学服务模式标准化，规范TDM异常结果解读和干预工作，促进安全合理用药。
Study on the intervention and evaluation for the abnormal results of tacrolimus therapeutic drug monitoring
AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolim-us blood concentrations and clinical pharmacist in-tervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,inter-vention plans,acceptance and status were ana-lyzed.RESULTS:A total of 700 kidney transplant re-cipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16％)and poor treatment out-comes(P1.2,39.84％);The main reasons included dosage selection(C3,43％),others(C9,38.4％),and drug selection(C1,9.41％);Clinical pharmacists ac-tively intervened at the recipient level(I2,98.92％)and drug level(I3,1.08％);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62％,and the complete implementation rate(A1.1)reached 72.09％;79.29％of DPRs were fully or par-tially resolved(O1.1 and O2.1).CONCLUSION:Clini-cal pharmacists can use PCNE to evaluate tacrolim-us therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical ser-vice models,standardize TDM abnormal result in-terpretation and intervention workflows,and pro-mote safe and rational drug utilization.
kidney transplantationtacrolimustherapeutic drug monitoringoutcome interven-tionPharmaceutical Care Network Europe
万方数据
维普
