骨科围术期血糖全程管理药师规范化服务及实践

目的:总结武汉市第一医院围术期血糖全程管理规范化服务工作经验，并以骨科为例分享实践经验及成效，为同行提供参考。方法:选取2021年1月至2022年3月，在骨科行2～4级手术的2型糖尿病患者，最终纳入74例，随机分为药师全程管理组(n=37)与非药师全程管理组(n=37),分别统计2组患者基线资料，比较血糖管理指标(术前1 d、术后第3 d、出院前1 d的血糖水平及达标率)、安全性指标(低血糖发生率、其他不良反应发生率、降糖药物不合理使用率)、经济学指标(住院期间降糖药物治疗总费用及日均降糖药物治疗费用、出院时日均降糖费用)和管理效率指标(住院天数及住院期间的降糖方案调整次数、调血糖会诊次数)。结果:2组基线差异均无统计学意义。结果显示药师组患者平均住院天数更短，内分泌科会诊次数更少，降糖药物医嘱调整频率更高，降糖药物不合理使用率更低，可见药师参与血糖管理可减轻外科医生负担，提高管理效率。结论:内分泌药师参与围术期血糖全程管理成效不劣于内分泌专科医生，我院围术期血糖管理药学服务模式值得推广使用。

Standardized service and practice of the full-course perioperative blood glucose management by pharmacists in orthopedics department

OBJECTIVE To summarize the experience of standardized perioperative blood glucose management service in our hospital(Wuhan First Hospital),and to share the practical experience and results with orthopedics as an example,so as to provide reference for peers.METHODS A total of 74 patients with type 2 diabetes who underwent grade 2~4 surgery in orthopedics department from January 2021 to March 2022 were selected and randomly divided into pharmacist full-course management group(n=37)and non-pharmacist full-course management group(n=37).Baseline data of patients in the two groups were statistically analyzed.Blood glucose management indicators were compared(1 day before operation,3 days after operation,and 1 day before discharge-D blood glucose level and success rate),security index(hypoglycemia incidence,the incidence of adverse reactions,other glucose-lowering drugs unreasonable utilization rate)and economic indicators(hospitalization glucose-lowering medications total cost and average daily oral glucose-lowering drugs cost,the average daily discharge hypoglycemic cost)and management efficiency indicators(hospitalization days and hospitalization number of hypoglycemic scheme adjustment,regulation of blood sugar during consultation Number).RUSULTS There was no significant difference between the two groups at baseline.The results showed that the average hospital stay of patients in the pharmacist group was shorter,the consultation frequency of endocrinology department was less,the frequency of medical order adjustment of hypoglycemic drugs was higher,and the unreasonable utilization rate of hypoglycemic drugs was lower.It could be seen that the participation of pharmacists in blood glucose management can reduce the burden of surgeons and improve the management efficiency.CONCLUSION The effect of endocrine pharmacists participating in perioperative blood glucose management is not inferior to that of endocrinologists.The pharmaceutical care model of perioperative blood glucose management in our hospital is worthy of promotion and use.