经颈静脉肝内门体分流术后患者抗栓治疗的药学监护实践  

Pharmaceutical care of patients with antithrombotic therapy after transjugular intrahepatic portal shunt

作　　者：刘秀梅 郭倩倩[1] 方圆 陈楠 齐琦 LIU Xiumei;GUO Qianqian;FANG Yuan;CHEN Nan;QI Qi(Department of Pharmacy,The Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450003,Henan,China;School of Medicine,Jinan University,Guangzhou 510632,Guangdong,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)药学部,河南郑州450003 [2]暨南大学基础医学院,广东广州510632

出　　处：《中国临床药理学与治疗学》2023年第5期556-560,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家自然科学基金面上项目(81973341);河南省医学科技攻关项目(LHGJ20191090,LHGJ2018020846,LHGJ20200682,LHGJ20200689)。

摘　　要：目的:探讨临床药师在经颈静脉肝内门体分流术后患者抗栓药物治疗中的作用。方法:临床药师参与服用多种抗栓药物反复口腔出血的经颈静脉肝内门体分流术后患者的治疗,协助医师诊断及调整抗栓治疗方案,并对患者进行全程药学监护及线上管理。结果:药师通过详细询问患者既往史和现病史,合并用药情况,分析该患者反复口腔出血与服用抗栓药物相关性较小,建议口腔科会诊,患者诊断为慢性牙龈炎。口服华法林抗凝,出院后药师对其进行线上管理,实现患者国际标准化比值(international normalised ratios,INR)稳定。后在随访过程中患者出现INR异常升高,通过问询用药史,考虑患者INR升高与同服阿莫西林胶囊相关。停用阿莫西林胶囊,逐渐调整华法林剂量至原来水平,对症治疗后好转。结论:药师参与临床药物治疗,协助医师诊疗,对患者实施全程的用药服务,保障患者的用药安全性和有效性。AIM:To explore the role of clinical pharmacist in the treatment of patients with tran-sjugular intrahepatic portosystemic shunt.METH-ODS:Clinical pharmacist participated in the treat-ment of a patient with repeated oral bleeding after transjugular intrahepatic portal shunt followed treatment with multiple antithrombotic drugs,which assisted the physician to diagnose and adjust the antithrombotic treatment plan as well as pro-vided the patient with whole-process pharmaceuti-cal care and online management.RESULTS:Based on the inquiry about the patient's past and current medical history and medication consumption,the pharmacist considered that there was weak correla-tion between oral hemorrhage and antithrombotic drugs and advised for dentist inspection.Thereaf-ter,the patient was diagnosed with chronic gingivi-tis.The dosage of warfarin was adjusted,and the pharmacists managed it online after discharge to achieve stable INR of the patient.In the later on-line follow-up,an abnormal increase of INR was en-countered,By asking about the history of medica-tion,it was considered that the increase in INR was related to taking amoxicillin capsules.Therefore,the pharmacist suggested to stop amoxicillin cap-sule and to gradually adjust the dose of warfarin to the original level to improve the treatment.CON-CLUSION:The involvement of clinical pharmacists in clinical treatment facilitates comprehensive phar-maceutical care of patients,which plays a positive role in the efficacy and safety of medication thera-py.

关 键 词：经颈静脉肝内门体分流术 华法林 线上管理 药学监护 

分 类 号：R657.31[医药卫生—外科学]