临床药师参与地高辛中毒合并华法林过度抗凝患者的治疗  

Clinical pharmacists participate in the treatment of patients with digoxin poisoning combined with warfarin over anticoagulation

作　　者：刘秀梅[1] 方圆[1] 毛新奇 石迎迎[1] 葛春丽[1] 陈楠[1] LIU Xiumei;FANG Yuan;MAO Xinqi;SHI Yingying;GE Chunli;CHEN Nan(Department of Pharmacy,the People’s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院药学部,郑州450000

出　　处：《上海医药》2021年第7期68-71,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：河南省医学科技攻关项目(LHGJ20191090);河南省医学科技攻关项目(2018020846);中国药学会全国医药经济信息网科技传播创新工程重点项目(CMEI2018KPYJ00411);2020年度郑州人民医院新冠肺炎专项课题(2020XG01005)。

摘　　要：目的:对地高辛中毒合并华法林过度抗凝患者进行干预,探讨临床药师在抗凝治疗中个体化药学服务的作用。方法:临床药师全程参与患者的抗凝药物治疗方案的制定、实施药学监护,对患者INR异常升高及地高辛中毒情况进行分析和干预,探讨了华法林过度抗凝以及地高辛中毒的原因。结果:患者疾病状态和药物均影响患者抗凝作用,老蔻丸和地高辛是升高该患者INR的主要影响因素。患者肾功能不全、心功能不全及合并用药等因素导致患者地高辛中毒。结论:临床药师通过分析患者用药情况,结合临床症状及时进行用药调整,可提高华法林的安全性和有效性。Objective:To explore the role of clinical pharmacists in individualized pharmaceutical care for patients with digoxin poisoning combined with warfarin over anticoagulation.Methods:The clinical pharmacist analyzed the impact factors of abnormal increase of INR and digoxin poisoning and performed intervention by participating in the formulation and implementation of pharmaceutical care of anticoagulant treatment plans for the patient.Results:The patient’s anticoagulant effect was affected by its disease state and the used drugs,in which Laokoo pills and digoxin were the main influencing factors for the increase of INR.Digoxin poisoning was caused by renal insufficiency,cardiac insufficiency and concomitant medication.Conclusion:Clinical pharmacist can improve the safety and effectiveness of warfarin by analyzing the medication status of the patient and making timely medication adjustments based on clinical symptoms.

关 键 词：华法林 国际标准化比值 相互作用 地高辛中毒 

分 类 号：R973.2[医药卫生—药品] R969.3[医药卫生—药学]