Abstract: Objective　To explore the rational medication management mode of clinical pharmacists participating in the clinical pathway of femoral neck fracture under the background of enhanced recovery after surgery (ERAS). Methods　Patients with femoral neck fracture admitted to Department of Orthopedics, The Affiliated Suzhou Hospital of Nanjing Medical University from January 2020 to December 2021 were prospectively collected. With the patients with femoral neck fracture as a pilot, a total of 110 cases for whom clinical pharmacists did not participate in the clinical pathway were set as a control group, and 122 cases for whom clinical pharmacists participated in the clinical pathway were set as an observation group. Clinical pharmacists implemented comprehensive intervention through the establishment of clinical pathway medication list, medication list review, perioperative medication optimization, and other whole-process pharmaceutical management. t test and χ² test were used. Results　There were 49 males and 73 females in the observation group, with an age of (71.02±11.13) years old; there were 40 males and 70 females in the control group, with an age of (69.41±18.01) years old. The drug cost [open reduction and internal fixation (2 903.49±381.36) yuan, closed reduction and internal fixation (2 980.70±298.76) yuan, hip replacement (6 568.81±923.11) yuan, and femoral head replacement (5 319.50±744.38) yuan] and the proportion of drug consumption of the observation group [open reduction and internal fixation (6.61%), closed reduction and internal fixation (16.90%), hip replacement (10.20%), and femoral head replacement (12.48%)] were significantly lower than those of the control group, with statistically significant differences (all P<0.05). The number of antibiotic use, the intensity of antibiotic use, the incidence of incision infection, the incidence of venous thromboembolism (VTE), the number of opioids used, and the rate of opioids in the observation group were lower than those in the control group, with statistically significant differences (all P<0.05). Conclusions　Through clinical pharmacists' participation in the implementation of clinical pathway, patients can receive targeted drug treatment, and the improvement of service efficiency indexes can be realized through the whole-process closed-loop pharmaceutical guidance, which provides references for rational drug use and intervention entry point in clinical practice.

Key words: Clinical pharmacists, Clinical pathway, Femoral neck fracture

摘要： 目的　探索加速康复外科（enhanced recovery after surgery，ERAS）背景下临床药师参与股骨颈骨折临床路径合理用药管理模式。方法　前瞻性收集南京医科大学附属苏州医院关节外科2020年1月至2021年12月期间收治的股骨颈骨折病例作为研究对象，以股骨颈骨折病例作为试点，临床药师未参与临床路径的110例病例设为对照组，临床药师参与临床路径的122例病例设为观察组。临床药师通过建立临床路径用药清单、用药目录审核、优化围术期用药等全程化药学管理实施综合干预。采用t检验、χ²检验。结果　观察组男49例，女73例，年龄（71.02±11.13）岁；对照组男40例，女70例，年龄（69.41±18.01）岁。观察组药品费用［切开复位内固定（2 903.49±381.36）元、闭合复位内固定（2 980.70±298.76）元、髋关节置换（6 568.81±923.11）元、股骨头置换（5 319.50±744.38）元］及药品使用金额占比［切开复位内固定（6.61%）、闭合复位内固定（16.90%）、髋关节置换（10.20%）、股骨头置换（12.48%）］均显著低于对照组，差异均有统计学意义（均P<0.05）。观察组使用抗菌药物品种数、抗菌药物使用强度、切口感染发生率、静脉血栓栓塞症发生率、使用阿片类药物品种数、阿片类药物使用率均低于对照组，差异均有统计学意义（均P<0.05）。结论　临床药师参与临床路径的实施，让患者接受具有针对性的药物治疗，以全流程闭环的药学指导来实现服务效率指标的提升，为临床合理用药和干预切入点提供了参考。

关键词: 临床药师, 临床路径, 股骨颈骨折