药师参与肝癌肝切除患者围术期人血白蛋白合理使用管理的工作模式探讨

目的：通过药师参与人血白蛋白在肝胆外科合理性使用管理，规范肝癌肝切除患者围术期白蛋白的使用，建立药师参与临床合理用药管理工作模式。方法：查阅文献和指南，制定《肝癌肝切除患者围术期人血白蛋白使用规范》（以下简称《规范》）。将2014年1月至2015年5月收治入院的肝癌肝切除患者随机分为试验组（药师干预）和对照组（非药师干预）。试验组44例是在临床药师干预下，按照《规范》予以补充白蛋白；对照组46例按临床经验和医生习惯予以补充白蛋白。观察肝切除术后不同白蛋白补充方案的术前、术后1天以及术后8天的血白蛋白水平、术后住院时间、白蛋白费用、住院费用、住院药费、术后并发症。结果：两组患者年龄、性别、肝硬化比例，术前、术后1天以及术后8天血白蛋白水平、术后住院时间、术后并发症等比较差异均无统计学意义（均P>0.05）；药师干预组在住院期间白蛋白费用、住院费用、住院药费上均明显低于非药师干预组，差异均有统计学意义（均P<0.05）。结论：通过临床药师干预大大减少了行肝癌肝切除术患者住院期间白蛋白费用，患者围术期血白蛋白水平与非干预组相当，且没有增加术后住院时间以及并发症的发生率。由临床药师参与的白蛋白使用措施规范，对于节约医疗资源、临床合理用药、保障患者用药安全方面发挥了关键性作用。

Discussion on the Working Mode of Pharmacists Participating in the Man-agement of Clinical Rational Use of Albumin

Objective: To explore the rationality of perioperative albumin application in the Department of Hepatobiliary Surgery. To standardize the use of albumin in patients undergoing liver resection for liver cancer. To ensure the effectiveness and safety of clinical albumin administration. To establish a clinical al-bumin management mode which pharmacists participate in, and to promote the management mode to other surgical operations. Methods: Through consulting literature and guidelines, a standard was developed for perioperative use of albumin in patients undergoing liver resection for liver cancer (hereinafter referred to as the "standard"). Patients of liver cancer underwent hepatectomy between January 2014 and May 2015 in Nanjing Drum Tower Hospital were recruited for the study: 44 patients injected human albumin under the "standard" and 46 patients under clinical experience. We investigated the levels of serum albumin preopera-tively and in day 1 and 8 after operation, the days of postoperative hospitalization, the cost of albumin us-age, the cost of hospitalization, the cost of medicine and postoperative complications. Results: There were no significant differences between the two groups (P>0.05) in age, sex, the ratio of cirrhosis, the levels of serum albumin before or in day 1 or day 8 after operation, the days of postoperative hospitalization or postoperative complications. However, the costs of albumin usage, hospitalization and medicine of the exper-imental group were significantly lower than those of the control group (P<0.05). Conclusions: Under the intervention of pharmacists, the cost of albumin infusion in patients undergoing hepatectomy with liver can-cer can be reduced, with similar perioperative albumin level, postoperative hospitalization and incidence of complications. The standard of the use of albumin with clinical pharmacists participating has played a key role in saving medical resources, standardizing clinical rational drug use and guarding the patient's medica-tion safety.