药师指导对吸入装置操作正确率的影响及操作错误因素分析

来源:用户上传      作者:张捷青 金知萍 张静 李晓宇 吕迁洲 叶晓芬

　　摘 要 目的：l现患者在吸入剂使用中存在的问题及其影响因素，并分析药师指导患者使用吸入装置的效果。方法：临床药师对2018年3月―2019年3月在本院就诊于吸入药物指导门诊的245例患者现场演示吸入装置步骤进行评估打分，采用χ2检验和二元logistic回归分析患者使用吸入剂时的错误操作步骤及其影响因素。结果：患者经药师指导后首次使用吸入装置与自学后操作装置错误率差异有统计学意义（17.70% vs 58.33%，P<0.001）。操作步骤错误率排在前3位的分别为吸入后未漱口（14.29%）、呼气动作错误未呼气/对着吸嘴呼气（11.43%）、吸入DPI未用力深吸气/ MDI吸气和按压不同步（8.16%）。使用干粉吸入装置操作错误的影响因素为使用装置数量和是否经药师指导使用装置（P<0.05）。结论：临床药师面对面指导患者使用吸入剂对于减少患者操作错误是有效的，但需根据患者使用的装置数量、年龄等情况，进行针对性的指导和健康教育，以提高吸入药物的治疗效果。
　　关键词 吸入装置 哮喘 慢性阻塞性肺病 用药教育 影响因素
　　中图分类号：R974.3； R197.1 文献标志码：C 文章编号：1006-1533（2022）09-0063-04
　　引用本文 张捷青， 金知萍， 张静， 等. 药师指导对吸入装置操作正确率的影响及操作错误因素分析[J]. 上海医药， 2022， 43（9）： 63-66.
　　Effect of pharmacist guidance on operation accuracy of inhalation device and analysis of operation error factors
　　ZHANG Jieqing1， JIN Zhiping1， ZHANG Jing2， LI Xiaoyu1， LYU Qianzhou 1， YE Xiaofen1（1. Department of Pharmacy； 2. Department of Respiratory and Critical Care Medicine， Zhongshan Hospital of Fudan University， Shanghai 200032， China）
　　ABSTRACT Objective： To find out the problems and influencing factors in the use of inhalants in patients and analyze the effect of pharmacists’ guidance on the use of inhalation devices in patients. Methods： The clinical pharmacist evaluated and scored the operation steps of inhalation device by 245 patients with on-site demonstration who visited the clinic of inhalation drug guidance in our hospital from March 2018 to March 2019. The wrong operation steps of the use of inhalants in the patients and their influencing factors were analyzed by Chi-square test and binary logistic regression. Results： There was a significant difference in the error rate between the first use of inhalation device under the guidance of pharmacists and the operation of inhalation device after self-study （17.70% vs 58.33%， P<0.001）. The top 3 procedure error rates were not gargling after inhalation（14.29%）， not exhaling or exhaling against the suction nozzle （11.43%）， no force deep inspirations when using DPI or inhaling and not synchronizing compressions when using MDI （8.16%）. The influencing factors of operating errors in the use of dry powder inhalation devices were the number of devices used and whether patients were using the device under the guidance of pharmacists （P<0.05）. Conclusion： Face-to-face instruction of clinical pharmacists to the use of inhalants is effective in reducing patient manipulation errors. However， targeted guidance and health education should be carried out according to the number of devices used and age of patients to improve the therapeutic effect of inhalants.

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