临床药师参与1例慢性肾衰竭患者药物治疗的实践与分析  

Practice and Analysis of Clinical Pharmacists Participating in the Treatment for A Patient with Chronic Renal Failure

作　　者：王靖[1] 宁重博 张翠娥 王彬[3] 张凤云[1] 马晓霞[1] 

机构地区：[1]牡丹江医学院第二附属医院肾内科,黑龙江牡丹江157015 [2]大连伊诺生物有限公司,辽宁大连116000 [3]牡丹江医学院第二附属医院药剂科,黑龙江牡丹江157015

出　　处：《中国药房》2016年第26期3729-3732,共4页China Pharmacy

摘　　要：目的:探讨临床药师在慢性肾衰竭患者药物治疗中的作用。方法:临床药师参与1例慢性肾功能衰竭尿毒症期患者的药物治疗过程,协助医师从纠正贫血、控制血压、改善心功能和调整离子紊乱等方面对药物治疗方案进行优化和完善,先后建议增加非洛地平缓释片、酒石酸美托洛尔片和参芎葡萄糖注射液的给药频次,加用盐酸贝那普利片和单硝酸异山梨酯缓释片;调整重组人促红素的剂量和铁剂的剂型,增加骨化三醇胶丸和碳酸钙片的剂量,减少5%葡萄糖注射液+注射用左卡尼汀的给药频次,加用维生素B12片;治疗过程中密切观察药物治疗效果和药品不良反应,并对患者进行用药教育。结果:医师采纳临床药师建议,患者病情好转,28 d后带药出院。结论:临床药师参与慢性肾衰竭患者的个体化治疗,可协助医师优化用药方案,有助于提高临床药物治疗的有效性与安全性。OBJECTIVE：To investigate the role of clinical pharmacists in the treatment for patients with chronic renal failure.METHODS：Clinical pharmacists participated in the treatment process for a patient with chronic renal failure during uremia period;assisted physicians to optimize and improve therapy plan from correcting anemia,controlling blood pressure,improving heart function and regulating ion disorder,etc.;suggested adding dosing frequence of Felodipine sustained-release tablet,Metoprolol tartrate tablet and Shenqiong glucose injection,and giving Benazepril hydrochloride tablet and Isosorbide 5- mononitrate sustained- release tablet. They also suggested adjusting the dosage of rh EPO and the dosage form of ferralia,increasing the dosage of Calcitriol capsule and Calcium carbonate tablet,decreasing dosing frequence of 5% Glucose injection and Levocarnitine for injection,and giving Vitamine B12 tablet. Therapeutic efficacy and ADR should be observed closely during treatment,and medication education should be performed for the patient. RESULTS：Physicians adopted the suggestions of clinical pharmacists. The patient was improved and discharged from hospital with drugs 28 days later. CONCLUSIONS：Clinical pharmacists participate in the individualized treatment for patients with chronic renal failure and assist physicians to optimize therapy plan,which promote the clinical effectiveness and safety of drug treatment.

关 键 词：临床药师 药学监护 慢性肾衰竭 

分 类 号：R969.3[医药卫生—药理学]