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目的系统的评价药师参与的抗凝服务对华法林治疗管理的作用。方法计算机检索OVID、SCI、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文期刊数据库(VIP)数据库,万方数据库(WANFANG),纳入药师参与的抗凝服务对华法林治疗管理作用的随机对照试验,检索时间从建库至2014年1月。系统筛选文献、提取资料及评价质量后,采用Rev Man5.0软件进行Meta分析。结果共纳入9个随机对照试验,1 630例患者。Meta分析结果显示,试验组与对照组结局指标:精确的国际标准化比值(international normalized ratio,INR)治疗目标范围时间比、宽松的国际标准化比值治疗目标范围(目标INR±0.2)时间比、全因死亡率、主要出血事件发生率、血栓栓塞事件发生率差异均无统计学意义,效应量依次为MD=1.24,95%CI(-2.83,5.30),P=0.55;MD=2.86,95%CI(-1.52,7.25),P=0.20;RR=0.87,95%CI(0.40,1.91),P=0.73;RR=0.65,95%CI(0.32,1.34),P=0.24;RR=0.85,95%CI(0.40,1.78),P=0.66。而患者满意度指标显示患者对试验组的满意度高于对照组(P≤0.001)。结论基于当前证据,除能增加患者满意度外,药师参与的抗凝服务对华法林治疗管理的其他作用仍有待进一步的研究支持。
Objective To evaluate the role of pharmacists in anticoagulation in the management of warfarin. Methods Computer-based searches of OVID, SCI, CBM, CNKI, VIP database, Wanfang database (WANFANG) Therapeutic management role of the randomized controlled trial, search time from the database to January 2014. Systematic screening of literature, data extraction and evaluation of quality, the use of Rev Man5.0 Meta-analysis software. Results A total of 9 randomized controlled trials were included, with 1 630 patients. Meta-analysis showed that the outcomes of the trial group and the control group were as follows: accurate international normalized ratio (INR) treatment target range time, relaxed international normalized ratio treatment target range (target INR ± 0.2) time ratio, There was no significant difference in the incidence of death, major bleeding and thromboembolic events between the two groups. The effect rates were MD = 1.24, 95% CI (-2.83, 5.30), P = 0.55, MD = 2.86, 95% CI (-1.52,7.25), P = 0.20; RR = 0.87,95% CI (0.40,1.91), P = 0.73; RR = 0.65,95% CI (0.32,1.34), P = 0.24; RR = 0.85,95 % CI (0.40, 1.78), P = 0.66. The patient satisfaction index showed that patients were more satisfied with the test group than the control group (P≤0.001). Conclusions Based on current evidence, in addition to increasing patient satisfaction, the additional role of pharmacists in anticoagulation in the management of warfarin remains to be further supported.