慢性心力衰竭患者口服药物的不良反应及药学监护要点分析  

Analysis of Adverse Drug Reactions and Key Points of Pharmaceutical Care in Patients with Chronic Heart Failure

作　　者：张晓燕[1] 孙世龙 张慧芝[1] 王娟[1] 张宏颖[3] ZHANG Xiao-yan;SUN Shi-long;ZHANG Hui-zhi;WANG Juan;ZHANG Hong-ying(Department of Pharmacy,Zhengzhou Second Hospital,Zhengzhou 450006,China;Department of Neurology,Zhengzhou Second Hospital,Zhengzhou 450006,China;Department of Cardiovascular,Zhengzhou Second Hospital,Zhengzhou 450006,China)

机构地区：[1]郑州市第二人民医院药务科,河南郑州450006 [2]郑州市第二人民医院神经内科,河南郑州450006 [3]郑州市第二人民医院心内科,河南郑州450006

出　　处：《河南医学研究》2020年第22期4055-4058,共4页Henan Medical Research

基　　金：郑州市常州四药临床药学科研基金(NO.CZSYJJ16004)。

摘　　要：目的分析慢性心力衰竭患者住院期间口服药物不良反应(ADR)和药学监护要点。方法选取2018年1月至2019年12月于郑州市第二人民医院心内科住院的慢性心力衰竭患者。临床药师参与心内科慢性心力衰竭患者住院期间的日常查房工作。对患者开展住院期间全程药学监护和用药宣教。分析慢性心力衰竭患者的伴随疾病情况、治疗药物使用率、ADR发生情况及药学监护要点。结果共纳入420例患者,其中60岁以上患者393例(93.57%),63.57%的患者伴有3项及以上其他疾病。在慢性心力衰竭的药物治疗中,利尿剂、醛固酮受体拮抗剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、洋地黄苷类的使用率分别为89.29%(375/420)、87.14%(366/420)、27.14%(114/420)、33.57%(141/420)、55.71%(234/420)、55.71%(234/420)。利尿剂的ADR发生率为10.40%,多为电解质紊乱(13例);ACEI的ADR发生率为12.28%,多为干咳(10例);洋地黄苷类的ADR多不典型,如胃纳不佳或恶心、呕吐(6例)、头晕无力(4例)。结论老年慢性心力衰竭患者多重用药的情况比较普遍。慢性心力衰竭患者住院期间发生ADR的种类较多。对此类长期多重用药的患者进行药学监护的要点也较多。临床药师有必要开展药学监护,识别潜在的用药风险或错误,减少药源性危害。Objective To analyze the adverse drug reactions(ADR)and key points of pharmaceutical care in patients with chronic heart failure during hospitalization.Methods The patients with chronic heart failure hospitalized in the Department of Cardiovascular of Zhengzhou Second Hospital from January 2018 to December 2019 were selected.Clinical pharmacists participated in routine clinical ward rounds of patients with chronic heart failure during hospitalization in the Department of Cardiovascular.The pharmaceutical care and medication education for patients with chronic heart failure during hospitalization were provided.To analyze the accompanying diseases,usage rate of therapeutic drugs,occurrence of ADR and key points of pharmaceutical care for patients with chronic heart failure.Results A total of 420 patients were enrolled,while 393 patients(93.57%)were over 60 years old,and 63.57%of them were accompanied by 3 or more other diseases.In the drug therapy of chronic heart failure,the usage rates of diuretics,aldosterone receptor antagonists,angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor blocker(ARB),βreceptor blockers and digitalis glycosides were 89.29%(375/420),87.14%(366/420),27.14%(114/420),33.57%(141/420),55.71%(234/420),55.71%(234/420),respectively.The ADR incidence of diuretics was 10.40%,mostly electrolyte disturbance(13 cases).The ADR incidence of ACEI was 12.28%,mostly dry cough(10 cases).The ADR of digitalis glycosides were mostly atypical,such as poor gastric reception or nausea,vomiting(6 cases),dizziness and weakness(4 cases).Conclusion Polypharmacy is common in elderly patients with chronic heart failure.There are many kinds of ADR in patients with chronic heart failure during hospitalization.There are also many important points for pharmaceutical care for patients with long-term polypharmacy.It is necessary for clinical pharmacists to carry out pharmaceutical care,identify potential drug risks or errors,and reduce drug-induced hazards.

关 键 词：慢性心力衰竭 药学监护 多重用药 药物不良反应 临床药师 

分 类 号：R541.6[医药卫生—心血管疾病]