临床药师对1例风湿性心脏病致脑栓塞患者的用药干预与监护  

Medication Intervention and Monitoring for a Patient with Cerebral Embolism Caused by Rheumatic Heart Disease by Clinical Pharmacists

作　　者：卢海儒[1] 李沛[2] 

机构地区：[1]青海省人民医院药学部临床药学室,西宁810007 [2]青海省人民医院神经内科,西宁810007

出　　处：《中国药房》2014年第2期188-190,共3页China Pharmacy

摘　　要：目的:提高风湿性心脏病致脑栓塞患者服用华法林和地高辛的依从性,增强医师和患者对华法林和地高辛进行相关指标监测的认识。方法:在审核医嘱过程中,发现1例风湿性心脏病致脑栓塞患者同时服用华法林和地高辛,考虑到两药需规律服药并进行相关指标监测,从了解患者服药和医师对相关指标进行监测情况开始进行用药干预和监护,对患者进行了用药教育,与医师进行了相关指标监测知识方面的沟通。结果:患者服药依从性提高,了解了相关指标监测的必要性;医师增加了对相关指标监测的次数,调整了药物剂量。结论:临床药师通过审核医嘱,对特殊药物的应用重点了解,对不合理使用情况与医师和患者进行沟通,促进了合理用药,提高了药物治疗水平。OBJECTIVE： To improve the compliance of patients with cerebral embolism caused by rheumatic heart disease taking warfarin and digoxin, and improve the awareness of physicians and patients to digoxin and warfarin-related data monitoring. METHODS： A patient with cerebral embolism caused by rheumatic heart disease taking digoxin and warfarin simultaneously was found during the process of reviewing the physician＇ s advice. Pharmacists interfered and monitored the medication, educated the patient as well as communicated with the physician about related monitoring index from monitoring medication index and considering about the regularity of two drugs use. RESULTS： The patients improved the compliance and understood the necessity of related index monitoring; the physician increased monitoring frequency and modulated drug dosage. CONCLUSIONS： Clinical pharmacist more focus on the application of special medicine, communicate with physicians and patients on drug abuse, promote rational drug use and enhance the treatment level by reviewing the prescription.

关 键 词：华法林 地高辛 白蛋白 用药监护 用药教育 

分 类 号：R972[医药卫生—药品] R969.2[医药卫生—药学]