药剂师在使用普萘洛尔治疗婴幼儿血管瘤患者中的作用
The Role of the Pharmacist in the Treatment of Patients with Infantile Hemangioma Using Propranolol.
作者信息
Castaneda Saul, Melendez-Lopez Samuel, Garcia Esbeydy, De la Cruz Hermelinda, Sanchez-Palacio Jose
机构信息
Department of Pharmacy, Children's Hospital of the Californias, Tijuana, Baja California, Mexico.
Faculty of Chemical Sciences and Engineering, Autonomous University of Baja California, Tijuana, Mexico.
出版信息
Adv Ther. 2016 Oct;33(10):1831-1839. doi: 10.1007/s12325-016-0391-9. Epub 2016 Jul 26.
INTRODUCTION
Infantile hemangiomas (IH) are the most common benign vascular tumors of childhood, with an incidence of 5-10% during the first year of age. Propranolol is considered the first-line treatment for this condition. Potentially there is a high probability of negative results to therapy, because in many countries there are no treatment protocols or propranolol formulations appropriate for the pediatric population. The objective of the present study was to evaluate the impact of pharmacist interventions such as detecting, analyzing, and solving problems presented during treatment with propranolol in patients with IH.
METHODS
An open observational prospective study was performed over 25 months in a group of pediatric patients diagnosed with infantile hemangioma treated with propranolol. Pharmacist participation consisted of development of an extemporaneous formulation and counseling the child's parents. At each visit to the pharmacy service, family members were interviewed, detecting and classifying problems related to treatment.
RESULTS
Sixty-three children with IH were treated during the period under review. Patient ages ranged from 3 to 11 months old; 64% were female and 36% were male. Forty-nine problems in 30 patients were detected, principally inadequate dose (18.4%), non-adherence to treatment (16.3%), side effects (14.3%), and wrong administration (14.3%). Of the problems detected, 81.6% were resolved. Interventions by the pharmacist in 27 patients were intensive counseling on adherence to therapy (20%), detection of adverse effects (11.4%), and adjustment of the dose (22.9%). In 95.2% of patients a good response to treatment was obtained compared with 77.2% reported in European studies without pharmacist intervention.
CONCLUSION
It seems that pharmacist participation increases adherence to treatment and reduces the likelihood of adverse effects, allowing for safe and effective therapy in patients with IH.
引言
婴儿血管瘤（IH）是儿童期最常见的良性血管肿瘤，在一岁以内的发病率为5%-10%。普萘洛尔被认为是这种疾病的一线治疗药物。治疗结果可能有很大概率不理想，因为在许多国家没有适合儿科人群的治疗方案或普萘洛尔制剂。本研究的目的是评估药师干预的影响，例如检测、分析和解决IH患者使用普萘洛尔治疗期间出现的问题。
方法
对一组诊断为婴儿血管瘤并接受普萘洛尔治疗的儿科患者进行了为期25个月的开放性观察性前瞻性研究。药师的参与包括配制临时制剂并为患儿家长提供咨询。每次患者到药房就诊时，都会对其家庭成员进行访谈，检测并分类与治疗相关的问题。
结果
在研究期间，63名患有IH的儿童接受了治疗。患者年龄在3至11个月之间；64%为女性，36%为男性。在30名患者中检测到49个问题，主要是剂量不足（18.4%）、不遵医嘱治疗（16.3%）、副作用（14.3%）和用药错误（14.3%）。在检测到的问题中，81.6%得到了解决。药师对27名患者的干预措施包括强化治疗依从性咨询（20%）、检测不良反应（11.4%）和调整剂量（22.9%）。与欧洲无药师干预研究中报告的77.2%相比，95.2%的患者治疗反应良好。
结论
药师的参与似乎提高了治疗依从性，降低了不良反应的可能性，使IH患者能够接受安全有效的治疗。
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