腹部手术后房颤患者应用胺碘酮的药学监护  

Pharmaceutical care on a patient using amiodarone for atrial fibrillation after abdominal surgery

作　　者：刘敬弢[1] 刘颖[1] 张艳华[1] LIU Jing-tao;LIU Ying;ZHANG Yan-hua(Key Laboratory of Carcinogenesis and Translational Research/Ministry of Education,Pharmacy Department,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所药剂科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国药物应用与监测》2021年第2期102-105,共4页Chinese Journal of Drug Application and Monitoring

基　　金：北京市自然科学基金面上项目(7182030)。

摘　　要：1例76岁女性患者,3年房颤病史,规律服用曲美他嗪、单硝酸异山梨酯和胰激肽原酶控制病情。半年前服用阿司匹林预防血栓,因十二指肠溃疡出血停药。近日以“无诱因黑便4个月余”入院,考虑胰腺导管内乳头状黏液肿瘤可能。入院后行胃空肠吻合术,术后相继出现房颤、心衰和凝血功能异常,医师给予静脉泵入盐酸胺碘酮注射液治疗。患者转氨酶进行性升高、凝血功能进一步下降。临床药师结合患者既往病史及目前病情,查阅相关文献,认为胺碘酮导致肝功能异常可能性大,故建议停药、加用抗凝治疗、提请外院会诊,开展全程化药学监护。医师采纳药师建议并结合院外会诊意见,调整药物治疗方案,给予患者利尿、强心、抗凝、降压等治疗。患者的肝功能和凝血功能逐渐恢复正常,术后3周平稳出院。A 76-year-old female patient with a 3-year history of atrial fibrillation was treated with trimetazidine,isosorbide mononitrate and pancreatic kininogenase.Aspirin was given to her for thrombosis prevention half a year ago and was stopped because of duodenal ulcer and bleeding.Recently,she was admitted to the hospital mainly because of black stool without inducement for more than 4 months and was diagnosed as probable pancreatic ductal papillary mucus tumor.After admission,she underwent gastrojejunostomy and developed atrial fibrillation,heart failure and abnormal coagulation function after operation.Intravenous infusion of amiodarone was given to her,which resulted in increased transaminase and worsening of coagulation function.Based on her past medical history,the current condition and literature,abnormal liver function induced by amiodarone was highly suspected by clinical pharmacist.And systematic treatment was suggested by clinical pharmacist including stopping amiodarone,giving anticoagulant drugs,applying for outside consultation,and carring out whole-course pharmaceutical care.Physicians adopted the advice of clinical pharmacist and consultation of outside experts.Diuresis,heart-strengthening,anticoagulation,antihypertention,and other treatment were given to her.And her liver function and coagulation function gradually returned to normal.She was discharged with stable condition 3 weeks after operation.

关 键 词：房颤 胺碘酮 肝功能损伤 凝血功能异常 药学监护 

分 类 号：R969.4[医药卫生—药理学]