Page 103 - 《中国药房》2023年18期

·药师与药学服务·

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
Δ

1， 3
1 #
黎林丽 1， 2＊ ，张培莲 ，张佳丽 （1.浙江大学医学院附属第二医院药剂科，杭州 310052；2.河北医科大学第三
医院临床药学部，石家庄 050051；3.晋江市中医院医疗服务部，福建 泉州 362211）

中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2023）18-2269-05
DOI 10.6039/j.issn.1001-0408.2023.18.17

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。
关键词 临床药师；经皮冠状动脉介入术；急性心力衰竭；药学监护

Pharmaceutical care of a critical patient with acute heart failure after PCI by clinical pharmacists
LI Linli ，ZHANG Peilian ，ZHANG Jiali（1. Dept. of Pharmacy， the Second Affiliated Hospital of Zhejiang
1， 2
1， 3
1
University School of Medicine， Hangzhou 310052， China；2. Dept. of Clinical Pharmacy， the Third Hospital of
Hebei Medical University， Shijiazhuang 050051， China；3. Medical Services Department， Jinjiang Municipal
Hospital of Traditional Chinese Medicine， Fujian Quanzhou 362211， China）

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.
KEYWORDS clinical pharmacist； percutaneous coronary intervention； acute heart failure； pharmaceutical care

经皮冠状动脉介入（percutaneous coronary interven‐
[1]
Δ 基金项目 浙江省医药卫生科技计划项目（No.2019KY406） tion，PCI）治疗是冠心病治疗的重要手段 。急性心力衰
＊第一作者 主管药师，博士。研究方向：临床药学。E-mail： 竭（acute heart failure，AHF）是PCI术后常见的不良事件
lily1914@126.com
和危重急症，已成为65岁以上PCI术后患者住院的主要
# 通信作者 主管药师，硕士。研究方向：用药安全性、医院药学。
电话：0571-89713418。E-mail：zjlsally@zju.edu.cn 原因 [2―3] 。有研究显示，心力衰竭患者在 3～6 个月内反

中国药房 2023年第34卷第18期 China Pharmacy 2023 Vol. 34 No. 18 · 2269 ·