1例急性肺栓塞合并肝功能不全患者的抗凝药学监护
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篇名: 1例急性肺栓塞合并肝功能不全患者的抗凝药学监护
TITLE:
摘要: 目的: 探讨临床药师在急性肺栓塞(APE)合并肝功能不全患者药物治疗中的作用。方法: 临床药师参与1例APE合并肝功能不全患者的药物治疗,根据患者情况,协助医师制订初始治疗方案,经验用药予华法林2.5 mg/d后国际标准化比值(INR)未达标,临床药师利用Gage 算法和国际华法林组织(IWPC)算法推算出华法林的给药剂量,建议给予患者华法林2 d 的初始剂量7 mg/d+维持剂量5 mg/d,并对患者进行用药宣教。结果:医师采纳临床药师建议,明显缩短了INR的达标时间,提高了患者使用华法林的依从性。结论: 临床药师参与华法林个体化剂量的制订和用药宣教,保证了患者用药的安全、有效。
ABSTRACT: OBJECTIVE: To explore the role of clinical pharmacists participating in the therapy for patients with acute pulmonary embolism (APE) complicated with hepatic insufficiency. METHODS: Clinical pharmacists participated in the therapy for a APE patient with hepatic insufficiency. According to patient’s condition, clinical pharmacists assisted physicians to formulate preliminary therapy plan, but INR was not up to the standard after given warfarin 2.5 mg/d empirically; clinical pharmacists calculated the dose of warfarin using Gage algorithm and IWPC algorithm. It was suggested to give initial dose of warfarin 7 mg/d for 2 days and maintenance dose of warfarin 5 mg/d, and the patient received medication education. RESULTS: Physicians adopted the suggestion of clinical pharmacists to shorten the time of reaching INR standard significantly and improve the compliance of patients with warfarin. CONCLUSIONS: Clinical pharmacists participate in the formulation of warfarin individualized dose and medication education to ensure the safety and effectiveness of drug use.
期刊: 2016年第27卷第2期
作者: 邢洁,张洁
AUTHORS: XING Jie,ZHANG Jie
关键字: 临床药师;急性肺栓塞;肝功能不全;华法林;个体化;药学监护
KEYWORDS: Clinical pharmacists; Acute pulmonary embolism; Hepatic insufficiency; Warfarin; Individualized treatment; Pharmaceutical care
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