中国的糖尿病患者数居世界首位.复杂糖尿病患者的血糖控制难度大,血糖达标率低,这是导致他们病残和病死的主要原因.针对复杂糖尿病患者血糖管理的三大难点,即不充分的循证用药证据、不完善的真实世界数据和不规范的患者管理方式,我们以循证药学评价为前提,以真实世界研究为基础,构建并应用标准化、同质化的药物治疗管理体系,以提高复杂糖尿病患者的血糖达标率.应用该创新管理体系,我们已累计管理复杂糖尿病住院患者500余例,使他们的血糖达标率提高了35.0％,患者满意度提高了33.7％.

国际糖尿病联盟(International Diabetes Federa-tion,IDF)最新报告显示,2019年全球约4.63亿20～79岁成人患糖尿病,其年龄标化患病率高达8.3％,预计2030年和2045年上升为9.2％和9.6％[1].最新全国流行病学调查结果显示,我国大陆地区糖尿病总体患病率为12.8％,糖尿病前期患病率为35.2％.胰岛素是治疗糖尿病的重要药物,在我国的使用非常广泛[2].

目的:评价萘替芬酮康唑乳膏治疗足癣患者的成本与效果.方法:使用决策树模型评价萘替芬酮康唑乳膏与硝酸咪康唑乳膏、联苯苄唑乳膏以及酮康唑乳膏的成本与效果,得到患者1年的治疗费用和无治疗时间.临床参数来自萘替芬酮康唑乳膏的Meta分析研究.与治疗相关的成本和效果数据来自中国招标采购数据和上海当地医院.对分析结果进行单因素敏感性分析.结果:与其他3种外用抗真菌药物相比,萘替芬酮康唑乳膏最多可以增加0.1个无治疗月,同时卫生成本减少144.11元,萘替芬酮康唑乳膏为绝对优势方案.萘替芬酮康唑乳膏治疗有效率和足癣复发率是对分析结果影响较大的参数.结论:从中国卫生体系角度出发,足癣患者使用萘替芬酮康唑乳膏治疗更具有成本-效果.

目的:考察按病种分类进行用药医嘱点评新模式的应用效果.方法:从我院各科室中共选择16个常见病种,每个病种分别随机抽取2016年1月1日-12月31日医院信息系统中的各10份、总计160例患者的电子病历,对各患者住院期间的10720条用药医嘱从合理性方面进行回顾性点评,对不合理用药医嘱中用法用量不适宜、辅助用药占比、适应证不适宜等相关指标进行统计和分析,建立按病种分类进行用药医嘱点评的新模式;收集点评新模式实施及进行相关干预后(2017年4-5月)相同病种的9862条用药医嘱,点评其不合理率,评价新模式的应用效果.结果:在2016年的样本中,共点评出751条不合理用药医嘱,以用法用量不适宜情况最多(414条,55.12％),其中尤以在脑出血病种中最多(69条,16.67％),此病种下以单次给药用量过大最多(31条,44.92％);辅助用药占病种药品总费用比排序前3位的病种依次为肾肿瘤手术(39.43％)、急性脑梗死(非手术)(37.03％)和椎间盘突出手术(35.26％);适应证不适宜用药有70条(9.32％).应用按病种分类的点评模式及进行相关干预后,医嘱不合理率由点评前的7.00％(751/10720)下降至点评后的2.95％(291/9862),降幅为57.86％.结论:应用按病种分类的点评模式管理用药医嘱不合理率取得了一定的成效,该模式有助于促进临床合理用药.

Objeetive To investigate the correlation between blood glucose control of elderly patients with type 2 diabetes mellitus and their partner sickness status in Shanghai Pujiang Community and to provide reference for the scientific management of diabetes.Methods A cross-sectional epidemiological investigation was conducted on elderly patients in the community from January to March 2017,215 patients with type 2 diabetes were randomly selected,and the patients were divided into the solitary group,the partner positive group and the partner negative group according to their living conditions and whether their partners had diabetes or not.The data of personal background information,medical history and medication,self-management behavior,physical examination and blood biochemical indicators was collected.The target rate of glycosylated hemoglobin (HbA1c) was set as ＜7.0％.The single factor variance analysis,t-test and chi-square test were used for statistical analysis.Results There were no significant differences in blood pressure,blood lipids and body mass index among the three groups (P ＞ 0.05),while the patients in the partner positive group had better control of HbA1c (P ＜ 0.05).Compared with the solitary group,the patients in the partner positive group had more related knowledge of diabetes (P ＜ 0.05),more exercise (P ＜ 0.05),and better sleep quality (P ＜ 0.05).Conclusion Blood glucose control in diabetic patients is affected by their partners' disease,which may be related to the level of selfmanagement behavior.To strengthen the management of chronic diseases in the community,it is necessary to pay attention to the self-management education of solitary patients and diabetic knowledge education of the patients and their partners.