葡萄糖-6-磷酸脱氢酶缺乏症患者阿司匹林治疗的药学监护  

Pharmaceutical care of aspirin therapy in a patient with glucose-6-phosphate dehydrogenases deficiency

作　　者：张晓丽[1,3] 周忠江 郑萍[1] Zhang Xiaoli;Zhou Zhongjiang;Zheng Ping(Department of Pharmacy,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Cardiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Pharmacy,Chaoshan Hospital,the First Affiliated Hospital of Jinan University,Guangdong Province,Chaozhou 515700,China)

机构地区：[1]南方医科大学南方医院药学部,广州510515 [2]南方医科大学南方医院心内科,广州510515 [3]暨南大学附属第一医院潮汕医院药剂科,潮州515700

出　　处：《药物不良反应杂志》2021年第3期145-147,共3页Adverse Drug Reactions Journal

摘　　要：1例63岁男性葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症患者罹患2型糖尿病3年,长期服用格列美脲(2 mg、1次/d)治疗,未发生明显不良反应。因急性下壁心肌梗死先后行经皮冠状动脉介入术(PCI)和药物洗脱支架(DES)植入术。术后给予口服阿司匹林肠溶片(100 mg、1次/d)和替格瑞洛(90 mg、2次/d)双联抗血小板治疗。临床药师参与查房,了解到患者有G6PD缺乏症病史,随即查阅G6PD缺乏症患者不安全药物清单,发现格列美脲和阿司匹林均为可诱发G6PD缺乏症患者溶血的高风险药物,认为两药联用可能增加患者溶血的风险,建议停用格列美脲,保留PCI和DES术后应常规服用的阿司匹林。该建议被临床医师采纳,降血糖药改用盐酸二甲双胍。患者术后恢复顺利,随访3个月,未发生溶血反应。A 63⁃year⁃old male patient with glucose⁃6⁃phosphate dehydrogenase(G6PD)deficiency and type 2 diabetes mellitus received long⁃term use of glimepiride(2 mg once daily)and no adverse reactions occurred.He underwent percutaneous coronary intervention(PCI)followed by drug⁃eluting stent(DES)implantation because of acute inferior myocardial infarction.After the operation,dual antiplatelet therapy with oral aspirin enteric⁃coated tablets(100 mg once daily)and ticagrelor(90 mg twice daily)was given.Clinical pharmacists participated in the ward round and learned that the patient had a history of G6PD deficiency.After consulting the list of unsafe drugs for G6PD deficiency patients,the pharmacists found that glimepiride and aspirin were high⁃risk drugs that could induce hemolysis in G6PD deficiency patients.It was believed that the combination of the 2 drugs might increase the patient′s risk of hemolysis.They recommended that glimepiride should be discontinued and routine aspirin after PCI and DES should be continued.The physician adopted the pharmacists′advice and the hypoglycemic agent was replaced by metformin hydrochloride.The patient recovered soon after surgery.At a 3⁃month follow⁃up,no hemolytic reaction occurred in the patient.

关 键 词：葡糖磷酸脱氢酶缺乏 糖尿病 经皮冠状动脉介入术 阿司匹林 磺酰脲化合物 

分 类 号：R969[医药卫生—药理学]