Page 112 - 《中国药房》2021年5期

·药师与药学服务·

临床药师参与经母口服地高辛治疗胎儿心动过速的药物治疗管

理实践 Δ

1 #
梅洪梁 ，张海霞 ，张 玲 ，张晋萍 （1.南京大学医学院附属鼓楼医院药学部，南京 210008；2.江西省妇幼保
1＊
2
1
健院药剂科，南昌 330006）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）05-0614-05
DOI 10.6039/j.issn.1001-0408.2021.05.18

摘 要 目的：探讨临床药师在经母口服地高辛治疗胎儿心动过速治疗过程中的作用。方法：临床药师参与1例胎儿心动过速孕
妇的治疗全过程。根据患者妊娠31 周、入院时胎心率230次/min的情况，临床药师针对经母口服地高辛治疗胎儿心动过速的安
+6
全性和血药浓度测定等问题向医师提出相关建议。因患者血钾值偏低，建议应用地高辛前先补钾，并建议地高辛的初始剂量为每
12 h给药0.5 mg；在院7天时，患者地高辛血药浓度值升高明显，临床药师建议调整地高辛剂量至维持剂量（每12 h给药0.25 mg）；
在院11天时患者血钠值偏低，临床药师对其进行饮食指导；同时，临床药师向医、护、患交代地高辛不良反应的表现，对患者密切
观察并进行用药宣教。结果：医师对临床药师的建议均采纳。患者于治疗13天后出院，出院时胎心率降至180次/min，母体地高
辛血药浓度维持平稳，母胎均未发生药物不良反应。结论：妊娠期患者用药应兼顾母胎安全；临床药师协助医师制订用药策略、对
患者进行药学监护和宣教，保障了胎儿心动过速治疗用药的有效性和安全性。
关键词 宫内治疗；胎儿心动过速；地高辛；药学监护；临床药师

Participation of Clinical Pharmacists in the Management of Drug Therapy for Fetal Tachycardia Treated
by Oral Administration of Digoxin through Mother
MEI Hongliang ，ZHANG Haixia ，ZHANG Ling ，ZHANG Jinping（1. Dept. of Pharmacy，Nanjing Drum Tower
1
1
1
2
Hospital，the Affiliated Hospital of Nanjing University Medical School，Nanjing 210008，China；2. Dept. of
Pharmacy，Jiangxi Maternal and Child Health Hospital，Nanchang 330006，China）
ABSTRACT OBJECTIVE： To investigate the role of clinical pharmacists in the therapy of fetal tachycardia by oral
administration of digoxin through mother. METHODS：The clinical pharmacists participated in the whole process of drug therapy
for a pregnant woman with fetal tachycardia. According to 31 + 6 weeks of gestation，the fetal heart rate of 230 beats/min at
admission，clinical pharmacists provided the suggestion for the doctor about the safety and blood concentration determination of
digoxin in the treatment of fetal tachycardia by mother. The patient’s blood potassium value was lower than the normal range，and
it was suggested that potassium should be supplemented before digoxin was used，and the initial dose of digoxin was 0.5 mg per 12
h. On the 7th day in the hospital，the dosage of digoxin should be adjusted to maintaining dose（0.25 mg per 12 h）；on the 11th
day in the hospital，the patient’s blood sodium value was low，and the clinical pharmacists gave diet guidance. At the same time，
the clinical pharmacists explained the adverse reactions of digoxin to the doctors，nurses and patients，and closely observed and
educated the patients. RESULTS：Doctors adopted the suggestions of the clinical pharmacists. The fetal heart rate decreased to 180
beats/min from hospital after 13 days of treatment. The maternal digoxin concentration remained stable. No adverse drug reactions
occurred in the mother and infant. CONCLUSIONS：Maternal and child safety should be taken into account in the medication of
pregnant patients. The clinical pharmacists assisting doctors to formulate medication strategying，and carrying out pharmaceutical
care for patients，can ensure the effectiveness and safety of medication for fetal tachycardia.
KEYWORDS Intrauterine treatment；Fetal tachycardia；Digoxin；Pharmaceutical care；Clinical pharmacist

胎 儿 快 速 心 律 失 常 在 全 球 范 围 内 的 发 生 率 为
Δ 基金项目：国家自然科学基金资助项目（No.81903870）；中国药
学会科技开发中心科普项目[No.CMEI2020KPYJ（ZAMM）00106] 0.4％～0.6％，持续性心动过速可导致胎儿发生非免疫
＊主管药师，硕士。研究方向：妇产科临床药学与药理学。电话：
性水肿、心力衰竭、早产等并发症，甚至引起胎儿围产期
025-83106666-40130。E-mail：liulidemao@126.com
[1]
死亡 。及时的宫内治疗可纠正胎儿心动过速、改善妊
# 通信作者：主任药师，硕士。研究方向：医院药学。电话：025-
83106666-40130。E-mail：zjp16500@163.com 娠结局，其中药物治疗主要用于非足月、持续或间断心

·614 · China Pharmacy 2021 Vol. 32 No. 5 中国药房 2021年第32卷第5期