摘要
目的探讨基于冰山理论的询问-倾听-帮助-再询问(ALHA)药学干预联合药物重整在急性心肌梗死(AMI)患者中的应用及效果。方法采用前瞻性随机对照研究,选取2021年1月至2022年6月南通大学附属南通第三医院江苏省南通市第三人民医院心血管内科与老年医学科接受治疗的AMI患者112例。根据随机数字表法将其分为对照组与观察组,各56例。对照组接受常规临床药学干预,观察组接受基于冰山理论的ALHA药学干预联合药物重整,两组均干预6个月,比较两组心理状态、用药依从性、药物不良反应(ADR)、心血管不良事件(MACE)发生情况、患者的自我管理能力及生活质量。结果干预6个月后,两组汉密尔顿焦虑量表与汉密尔顿抑郁量表评分均低于干预前,且观察组低于对照组(P<0.05)。整体分析发现:两组用药依从性组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05)。组内比较:两组各时间点依从性评分比较,差异有统计学意义(P<0.05);组间比较:观察组各时间点依从性评分均高于对照组(P<0.05)。观察组出现肝功能异常、消化道出血与头晕头痛的ADR的总发生率低于对照组(P<0.05),观察组出现心肌梗死、心绞痛与心律失常等MACE的总发生率低于对照组(P<0.05)。干预6个月后,两组行为管理、状态管理、疾病认知管理、急救技能管理评分均高于干预前,且观察组高于对照组(P<0.05)。干预6个月后,两组情感功能、生理功能、社会功能及躯体健康评分均高于干预前,且观察组高于对照组(P<0.05)。结论在为AMI患者构建药学服务模式时,基于冰山理论的ALHA药学干预联合药物重整能更好地改善AMI患者的心理状态,有效提高患者的用药依从性,降低ADR与MACE发生率,并提升自我管理能力与生活质量。
Objective To explore the application and effectiveness of ask-listen-help-ask again(ALHA)pharmaceutical intervention combined with drug restructuring based on iceberg theory in patients with acute myocardial infarction(AMI).Methods A prospective randomized controlled study was conducted,selecting 112 patients with AMI who received treatment in the Departments of Cardiovascular and Geriatric Nantong Third Hospital Affiliated to Nantong University Nantong Third People’s Hospital from January 2021 to June 2022.According to the random number table method,they were divided into control group and observation group,with 56 patients in each group.The control group received routine clinical pharmaceutical intervention,while the observation group received ALHA pharmaceutical intervention based on iceberg theory combined with drug restructuring,six months of intervention between two groups.The psychological status,medication compliance,adverse drug reactions(ADR),incidence of cardiovascular adverse events(MACE),self-management ability,and quality of life of the two groups of patients were compared.Results After six months of intervention,Hamilton anxiety scale and Hamilton depression scale scores in the two groups were lower than those before the intervention,and the observation group was lower than the control group(P<0.05).The overall analysis found that there were statistically significant differences in medication compliance between the two groups,time points and interactions(P<0.05).Comparison within the group:there were statistically significant difference in compliance scores between the two groups at each time point(P<0.05);comparison between groups:the compliance scores of the observation group at each time point were higher than those of the control group(P<0.05).The total incidence of ADR including abnormal liver function,gastrointestinal bleeding and dizziness,and headache in the observation group was lower than that in the control group(P<0.05).The total incidence of MACE such as myocardial infarction,angina pectoris,and arrhythmia in the observation group was lower than that in the control group(P<0.05).After six months of intervention,the scores of behavior management,state management,disease cognition management,and emergency skills management of the two groups were higher than those before the intervention,the observation group was higher than the control group(P<0.05).After six months of intervention,the scores of emotional function,physiological function,social function,and physical health of the two groups were higher than those before the intervention,and the observation group was higher than the control group(P<0.05).Conclusion When constructing a pharmaceutical service model for AMI patients,the combination of ALHA pharmaceutical intervention based on iceberg theory and drug restructuring can better improve the psychological state of AMI patients,effectively improve medication compliance,reduce the incidence of adverse drug reactions and cardiovascular events,and enhance their self-management ability and quality of life.
作者
陈智娴
乔进
陈霞
CHEN Zhixian;QIAO Jin;CHEN Xia(Department of Pharmacy,Nantong Health College of Jiangsu Province,Jiangsu Province,Nantong226010,China;Department of Pharmacy,Nantong Third Hospital Affiliated to Nantong University Nantong Third People’s Hospital,Jiangsu Province,Nantong226006,China)
出处
《中国医药导报》
CAS
2024年第32期126-131,共6页
China Medical Herald
基金
江苏省333高层次人才培养工程资助项目[(2022)3-16-815号]
江苏省南通市青年医学重点人才项目[WR2017011]。
关键词
急性心肌梗死
临床药师
冰山理论
药物重整
用药依从性
自我管理能力
Acute myocardial infarction
Clinical pharmacist
Iceberg theory
Drug restructuring
Medication compliance
Self management ability
