岳晓红 薛莹 司方莹

中圖分类号 R977.7;R969.3 文献标志码 A 文章编号 1001-0408（2021）08-1003-06

DOI 10.6039/j.issn.1001-0408.2021.08.18

摘 要 目的：研究维持性血液透析患者磷结合剂用药依从性的影响因素及药师干预效果，以提高患者的用药依从性，改善疾病控制的效果。方法：选取2019年6-12月在我院血液净化中心进行维持性血液透析患者，采用调查问卷对其一般资料、磷结合剂用药依从性、疾病与用药知识掌握水平、社会支持度、自我效能等进行评估。采用t检验、χ2检验和多元Logistic回归等方法分析各影响因素与用药依从性之间的关系。将患者随机分为药学干预组和非干预组，针对危险因素为药学干预组提供3个月的药学服务，然后比较两组患者的血磷水平、用药依从性等指标。结果：共有298例患者有效完成调查问卷（有效回收率为96.1%）。其中，163例患者（54.7%）依从性良好、135例患者（45.3%）依从性差。单因素分析结果表明，磷结合剂用药依从性与患者年龄、透析龄、甲状旁腺激素水平、每日服药总数量、每日磷结合剂服药数量、疾病与药物知识掌握水平、社会支持度、自我效能显著相关（P<0.05）;多元Logistic回归结果显示，每日服药总数量、每日磷结合剂服药数量、药物与疾病知识掌握水平、社会支持度、自我效能是影响患者磷结合剂用药依从性的独立危险因素（P<0.05或P<0.01）。药学干预组用药依从性、疾病控制情况、疾病和药物相关知识掌握水平、社会支持度和自我效能均较非干预组显著改善或提高，血磷水平较非干预组显著降低（P<0.05）。结论：每日服药总数量、每日磷结合剂服药数量、药物与疾病知识掌握水平、社会支持、自我效能是影响磷结合剂用药依从性的独立危险因素。维持性血液透析患者磷结合剂用药依从性偏低;药师对上述危险因素采取个体化、有针对性的干预措施能有效提高患者的用药依从性，改善疾病预后。

关键词 维持性血液透析;磷结合剂;用药依从性;高磷血症;药学干预

Study on Influential Factors for Medication Compliance of Phosphate Binder in Patients with Maintenance Hemodialysis and Pharmaceutical Intervention

YUE Xiaohong1，XUE Ying2，SI Fangying2（1. Blood Purification Center， the First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China; 2. Dept. of Pharmacy， the First Affiliated of Zhengzhou University， Zhengzhou 450052， China）

ABSTRACT   OBJECTIVE： To study influential factors for medication compliance of phosphate binder in patients with maintenance hemodialysis and the effects of pharmacist intervention， and to improve medication compliance and the effects of disease control. METHODS： The patients with maintenance hemodialysis who were treated in the blood purification center of our hospital from Jun. to Dec.， 2019 were selected for questionnaire survey. The questionnaires involved general information， medication compliance of phosphate binder， disease and medicine related knowledge， social support， self-efficacy. The t-test， χ2 test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared between 2 groups. RESULTS： Totally 298 patients completed the survey （effective recovery rate of 96.1%）. Among them， 163 patients （54.7%） had good adherence to phosphate binder， while 135 patients （45.3%） had poor compliance. Results of single factor analysis showed that medication compliance of phosphate binder was closely associated with age， dialysis duration， parathyroid hormone levels， total daily dose， daily dose of phosphate binder， disease and medicine related knowledge scores， social support， self-efficacy （P<0.05）. Results of multivariate Logistic regression analysis showed that total daily dose， daily dose of phosphate binder， disease and medicine related knowledge scores， social support and self-efficacy were the influential factors for medication compliance （P<0.05 or P<0.01）. Medication compliance， disease control status， disease and medicine related knowledge score， social support and self-efficacy in pharmaceutical intervention group were significant improved， blood phosphorus level was significant lower， compared with non-intervention group（P<0.05）. CONCLUSIONS： Independent risk factors influencing medication compliance of phosphate binder include total daily dose， daily dose of phosphate binder， disease and medicine related knowledge scores， social support and self-efficacy. The patients with maintenance hemodialysis have poor compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk factors， which can effectively improve the medication compliance and disease prognosis of patients.

KEYWORDS   Maintenance hemodialysis; Phosphate binder; Medication compliance; Hyperphosphatemia;Pharmaceutical intervention

在我国，血液透析患者高磷血症的发生率为57.4%[1]。长期高磷血症不仅是慢性肾脏病疾病进展的独立危险因素，也是慢性肾脏病患者发生全因死亡和心血管死亡的独立危险因素[2]。高磷血症不仅会促进继发性甲状旁腺功能亢进、矿物质和骨代谢异常，还会导致心脏瓣膜钙化、血管和软组织等出现转移性钙化[3-5]。……