颅内动脉瘤支架辅助介入栓塞术围术期抗栓治疗药学监护案例总结  

Pharmaceutical Care of Perioperative Antithrombotic Therapy in Cases with Intracranial Aneurysm Undergoing Stent-Assisted Interventional Embolization

作　　者：曾钰[1] 吴运燕 廖林 杨君 孙雪[5] 邱峰[1] ZENG Yu;WU Yunyan;LIAO Lin;YANG Jun;SUN Xue;QIU Feng(The First Affiliated Hospital of Chongqing Medical University,Chongqing,China 400016;People′s Hospital of Bishan District,Chongqing,China 402760;Chongqing People′s Hospital,Chongqing,China 401147;The First Affiliated Hospital of Army Medical University,Chongqing,China 400038;People′s Hospital of Tibet Autonomous Region,Lhasa,Tibet,China 850000)

机构地区：[1]重庆医科大学附属第一医院,重庆400016 [2]重庆市璧山区人民医院,重庆402760 [3]重庆市人民医院,重庆401147 [4]中国人民解放军陆军军医大学第一附属医院,重庆400038 [5]西藏自治区人民医院,西藏拉萨850000

出　　处：《中国药业》2023年第20期136-140,共5页China Pharmaceuticals

基　　金：重庆市临床药学重点专科建设项目[渝卫办发〔2023〕2号]。

摘　　要：目的探讨临床药师对颅内动脉瘤支架辅助介入栓塞术患者开展围术期抗栓治疗药学监护的介入点。方法回顾某院收治的3例行颅内动脉瘤支架辅助介入栓塞术患者围术期抗栓的治疗过程。抗凝专业临床药师结合专业知识、指南共识、特异性实验室检测指标等综合判断,对3例患者围术期抗栓治疗的用药时机评估、治疗方案制订及用药监护给出相应建议。结果医师采纳临床药师用药方案,干预后患者均好转出院。结论抗凝专业临床药师在神经外科如何高效开展药学服务仍处于探索阶段,特别是对颅内动脉瘤或蛛网膜下腔出血的高危患者缺乏有效的风险评估。根据颅内动脉瘤围术期患者特点,精准识别药物抗凝目标群体,提供科学的决策支持、正确的血栓及药物指标解读、优质的药品不良反应监护等,可作为临床药师高效参与临床治疗的介入点及优化工作模式的探索方向。Objective To investigate the intervention points of clinical pharmacists'participation in pharmaceutical care for perioperative antithrombotic therapy in patients with intracranial aneurysm undergoing stent-assisted interventional embolization.Methods The process of perioperative antithrombotic therapy in three cases with intracranial aneurysm underwent stent-assisted interventional embolization admitted to a hospital was retrospectively analyzed.Based on the professional knowledge,guidelines,consensuses and specific laboratory testing indicators,anticoagulation clinical pharmacists provided corresponding suggestions for the medication timing evaluation,treatment plan formulation and medication monitoring of perioperative antithrombotic therapy in the three patients.Results Physicians adopted the clinical pharmacists'medication plan,and all patients improved and discharged after intervention.Conclusion How anticoagulation clinical pharmacists efficiently provide pharmaceutical care in neurosurgery is still in the exploratory stage,especially lack of effective risk assessment for high-risk patients with intracranial aneurysm or subarachnoid hemorrhage.Based on the characteristics of patients with intracranial aneurysm during the perioperative period,accurate identification of target patients for drug anticoagulation,providing scientific decision-making support,correct interpretation of thrombosis and drug indicators and high-quality monitoring of adverse drug reactions can be as the intervention points for clinical pharmacists to efficiently participate in clinical treatment and an exploration direction of optimizing work mode.

关 键 词：围术期 抗栓治疗 颅内动脉瘤 支架辅助治疗 介入栓塞术 静脉血栓 药学监护 

分 类 号：R969.3[医药卫生—药理学] R973.2[医药卫生—药学]