临床药师参与高血压管理对血压控制的Meta分析

Meta-analysis of Clinical Pharmacist Interventions on Blood Pressure Control

关键词:  高血压  临床药师  meta分析

Key words:  hypertension  clinical pharmacist  meta-analysis

摘要:

目的 评价临床药师参与高血压管理对血压控制的影响。方法 计算机检索PubMed、Embase、Cochrane图书馆、中国期刊全文数据库、维普和万方等数据库，全面收集符合纳入标准的随机对照试验（RCT），检索时限为从建库至2015年9月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的偏倚风险，采用RevMan 5.3软件进行meta分析。结果 纳入8项RCT研究，共计2 056例高血压患者。与传统治疗相比，有临床药师参与的高血压管理收缩压[MD=-5.15 mmHg，95%CI（-6.54，-3.76），P<0.000 01]和舒张压[MD=-3.01 mmHg，95%CI（-4.51，-1.51），P<0.000 1]的平均降幅显著增大，血压控制率显著提高[RR=1.45，95%CI（1.32，1.60），P<0.000 01]。结论 临床药师参与高血压管理有助于提高治疗效果，医师和药师合作是一种较好的高血压管理模式。

Abstract:

OBJECTIVE To evaluate the impact of clinical pharmacist interventions on blood pressure control in patients with hypertension. METHODS PubMed, Embase, The Cochrane Library, CNKI, VIP and Wanfang Data databases were searched from inception to Sep 2015 for randomized controlled trials (RCTs) investigating the impact of pharmacist interventions on blood pressure control in patients with hypertension. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 8 RCTs involving 2 056 patients were included. Compared with usual care, clinical pharmacist interventions showed greater reduction in systolic[MD=-5.15 mmHg, 95%CI(-6.54, -3.76), P<0.000 01] and diastolic blood pressure[MD=-3.01 mmHg, 95%CI (-4.51, -1.51), P<0.000 1]. Additionally, pharmacist interventions improved the control rate of blood pressure[RR=1.45, 95%CI(1.32, 1.60), P<0.000 01]. CONCLUSION Pharmacist interventions are useful for improving clinical management of hypertension. Cooperation between physician and clinical pharmacist can be a successful strategy for managing hypertension.