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临床药师参与1例PCI术后合并急性心力衰竭患者的药学监护
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| 篇名： | 临床药师参与1例PCI术后合并急性心力衰竭患者的药学监护 |
| TITLE： | Pharmaceutical care of a critical patient with acute heart failure after PCI by clinical pharmacists |
| 摘要： | 目的 探讨临床药师在经皮冠状动脉介入（PCI）术后合并急性心力衰竭患者治疗过程中发挥的作用，为此类患者的药物治疗和监护提供参考。方法临床药师参与1例PCI术后合并急性心力衰竭患者的治疗过程，结合国内外文献，协助医师共同制定个体化用药方案：建议给予注射用亚胺培南西司他丁钠抗感染，根据肾功能调整药物剂量，并及时进行降阶梯治疗；选用左乙拉西坦片预防癫痫；对可能由阿托伐他汀钙片引起的横纹肌溶解进行鉴别诊断及对症处理；同时进行全程的药学监护。结果医师采纳了临床药师的建议。该患者的急性心力衰竭症状得到控制，肺部感染情况好转，不良反应症状缓解，顺利转出重症监护病房。结论对于重症患者，给予亚胺培南西司他丁抗感染治疗时，临床药师应根据患者肾功能调整剂量并警惕其可能的神经毒性；在阿托伐他汀钙片治疗过程中，临床药师应综合分析患者是否存在发生横纹肌溶解的风险；对已发生的不良反应，应及时对症处理，以保障患者用药的安全性和有效性。 |
| ABSTRACT： | OBJECTIVE To explore the role of clinical pharmacists in the treatment of critical patients with acute heart failure after percutaneous coronary intervention （PCI）， and to provide reference for drug treatment and monitoring of such patients. METHODS Clinical pharmacists participated in the treatment of a critical patient with acute heart failure after PCI， and assisted physicians to jointly develop individualized medication plans based on domestic and foreign literature： it was suggested to give imipenem and cilastatin for anti-infective therapy， adjust drug dose according to renal function， and timely descend step therapy； Levetiracetam tablets were selected to prevent epilepsy； the differential diagnosis and treatment of rhabdomyolysis possibly caused by Atorvastatin calcium tablets were performed； the whole process of pharmaceutical care was conducted. RESULTS Physicians adopted the suggestions of clinical pharmacists. The acute heart failure of the patient was controlled， the pulmonary infection was improved， the adverse reaction symptoms were relieved， and the patient was successfully transferred out of the ICU. CONCLUSIONS For severe patients， when giving imipenem and cilastatin for anti-infection treatment，the clinical pharmacist should adjust the dose according to the patient’s renal function and be alert to the possible neurotoxicity. During the treatment with Atorvastatin calcium tablets，the clinical pharmacist should comprehensively analyze the risk of rhabdomyolysis. For the adverse reactions that have occurred， clinical pharmacist should promptly address symptomatic issues to ensure the safety and effectiveness of medication for patients. |
| 期刊： | 2023年第34卷第18期 |
| 作者： | 黎林丽；张培莲；张佳丽 |
| AUTHORS： | LI Linli，ZHANG Peilian，ZHANG Jiali |
| 关键字： | 临床药师；经皮冠状动脉介入术；急性心力衰竭；药学监护 |
| KEYWORDS： | clinical pharmacist； percutaneous coronary intervention； acute heart failure； pharmaceutical care |
| 阅读数： | 69 次 |
| 本月下载数： | 10 次 |
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