中国临床药学杂志

目的 构建临床药师主导的脊柱外科患者围术期静脉血栓栓塞症（VTE）预防的全程化药学服务模式，并评价其临床应用的可行性及实践效果。方法 选取2024年7月至2025年6月我院脊柱外科围术期药物预防VTE的248例患者为研究对象。其中2024年7—12月120例患者为对照组，仅接受常规医护诊疗；2025年1—6月128例患者为干预组，在常规医护诊疗基础上实施临床药师主导的全程化药学服务。比较2组患者VTE预防的有效性和安全性，抗凝药物的合理性和经济性，以及患者的满意度。结果 与对照组比较，干预组抗凝药物的给药剂量与给药频次合理性均显著提升（90%vs 78%,78%vs 61%,P<0.05），抗凝治疗后凝血酶原时间和活化部分凝血活酶时间显著延长（11.67 s vs 11.42 s ,26.64 s vs 25.27 s,P<0.05）, VTE发生率明显降低（1.56%vs7.00%,P<0.05），出血事件发生率也明显下降（6.25%vs 14.17%,P<0.05）。干预组患者的次均药品费用和次均抗凝药物费用均较对照组显著降低，患者满意度也较对照组显著提升（P<0.05）。结论 在脊柱外科围术期VTE预防中实施全程化药学服务模式，能有效降低VTE及出血事件的发生，提升围术期抗凝治疗的有效性、安全性、合理性及经济性，提高患者满意度。

AIM To establish a full-process pharmaceutical care model for the prevention of venous thromboembolism(VTE) in perioperative patients undergoing spinal surgery, and to evaluate its clinical feasibility and practical effect. METHODS A total of 248 patients who received drug prevention of VTE in the perioperative period in the spinal surgery department of our hospital from July 2024 to June 2025 were selected as the research subjects. Among them, 120 patients from July to December 2024 were assigned to the control group, and 128 patients admitted from January to June 2025 were assigned to the intervention group(receiving standard care plus full-process pharmaceutical care provided by clinical pharmacists). The effectiveness and safety of VTE prevention, the rationality and economy of anticoagulant drugs, and patient satisfaction were compared between 2 groups. RESULTS the intervention group showed significant improvements in the rationality of anticoagulant dosage and frequency, Compared with the control group,(90% vs 78%, 78% vs 61%, P < 0.05). Prothrombin time and activated partial thromboplastin time were longer in the intervention group than in the control group(11.67 s vs 11.42 s, 26.64 s vs 25.27 s P < 0.05). The incidence of VTE was significantly lower in the intervention group than in the control group(1.56% vs 7.00%, P < 0.05), as was the incidence of bleeding events(6.25% vs 14.17%, P < 0.05). The average medication cost and anticoagulant cost were significantly reduced, and patient satisfaction was significantly higher in the intervention group(P < 0.05). CONCLUSION The implementation of a full-process pharmaceutical care model for perioperative VTE prevention in spinal surgery can effectively reduce the risk of VTE and bleeding events, improve the effectiveness, safety, rationality, and economy of perioperative anticoagulant therapy, and enhance patient satisfaction.