This thesis researches the main problems of the pharmaceutical service in the CRF treatment process in order to improve the treatment quality of CRF patients from the clinical doctor angle on the basis of the linkages of the medical administration fundamental theories and methodology and pharmaceutical services primary ideas. The thesis, firstly, demonstrates the vital problems of the Mаcаo pharmaceutical treatment on the basis of the analysis to the Macao CRF and dialysis clinical treatment situation; secondly, explores the core of the pharmaceutical tracing services and its functions in the following aspects, providing the pharmacy regarding services, improving the life quality, and rationally using the drug; thirdly, analyzes the essentiality and feasibility of applying the pharmaceutical care in Macao from the successful experiences study of the USA and EU in the following aspects, OTC regulation, market competitiveness, drug born disease, the extra increased medical cost, continued education to the doctor and pharmacist, and self-medication capability of the Macau citizens, and so on. Moreover, this thesis studies a few cases about the Macao CRF patients, and advances the suggestions to improve the Macao pharmaceutical care level, such as, developing the drug consulting and information services, implementing the consumer medication education services, establishing the ADR surveillance system, setting the consumer medication history regulation, and carrying out the practices about the health promotion services and drug knowledge education services. Finally, this thesis reaches the conclusion that the establishment and improvement of the Macau pharmaceutical tracing care system should pay attention to the following important steps, strengthening the application of the drug therapeutics and the pharmaceutical economics to the pharmaceutical care, and improving the role or status of the pharmacist, especially clinical pharmacist, with the aims to improve the therapy quality of CRF, to ensure the safety and efficiency of the clinical medication, and to rationally and economically use the drug. Key words: Chronic Renal Failure/ Dialysis/ Pharmaceutical Care

本文從臨床醫生的角度,根據醫療實踐的需要,為改善慢性腎功能衰竭(CRF)患者的治療質量,將醫藥管理的基本理論、方法與全程化藥學服務的基本理念有機結合,探討與提高在CRF 治療中開展藥學服務的關鍵問題。 通過分析澳門CRF、透析(Dialysis)的臨床專業治療現狀,提出目前澳門在藥物治療方面存在的主要問題: 闡述全程化藥學服務(Pharmaceutical Care)的實質,及其在提供藥學相關服務,提高生命質量和合理用藥等方面的功能;並借鑒歐美國家、臨近地區藥學服務實施成功的經驗,對澳門藥學服務在非處方藥品管理、市場競爭力、藥源性疾病、醫藥費用過度增長、醫生和藥師繼續教育問題及本澳市民自我藥療能力較低等現實問題進行了深入分析,探討了在澳門開展藥學服務應用研究的必要性和可行性。 從強化藥學服務和完善透析技術的層面,對澳門 CRF 患者藥學服務應用研究的多個典型案例進行了剖析,針對在澳門開展藥學服務應用研究的關鍵問題,提出了規範化藥物咨詢與信息服務、消費者用藥教育服務的實施、藥物不良監測的服務、消費各用藥檔案(藥歷)建立與管理服務的措施、健康促進服務的措施和藥物知識普及教育服務的措施等六項適合澳門的具體實施技術方案。 澳門全程化藥學服務的建設與完善,需要切實加強藥物治療學在藥學服務中的應用,加強藥物經濟學在藥學服務中的應用,加強藥師尤其是臨床藥師隊伍建設,從而較好的改善 CRF 治療質量,同時提高臨床用藥的安全性和有效性,達到合理、經濟用藥,提高公眾的醫療服務水平及生活質量。 【關鍵詞】 慢性腎功能衰竭 透析治療 藥學服務