1例先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的药学监护  

Pharmaceutical care for a patient with atrial flutter,atrial fibrillation,placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease

作　　者：王庆 全淑燕 WANG Qing;QUAN Shuyan(Dept.of Pharmacy,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院药剂科,重庆400037

出　　处：《中国药房》2024年第8期1006-1010,共5页China Pharmacy

基　　金：重庆市临床药学重点专科建设项目(No.渝卫办发〔2023〕69号)。

摘　　要：目的为先天性心脏病术后心房扑动伴心房颤动(以下简称“房扑伴房颤”)合并前置胎盘出血及血小板减少先兆流产患者的安全用药提供参考。方法临床药师参与1例先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的诊治过程,针对其使用依诺肝素钠后出现的血小板下降,建议停用依诺肝素钠,复查血常规后改为磺达肝癸钠;针对患者心率快、血压低,建议选择美托洛尔并根据心率调整剂量,同时将呋塞米改为氢氯噻嗪;针对医师拟于剖宫产术前停用美托洛尔,改为索他洛尔,建议继续使用美托洛尔;针对患者可能出现的药物相互作用,建议密切监测血钾等指标,并进行用药教育。结果医师采纳临床药师建议。患者出血得到控制,住院期间各项指标均维持稳定,孕周延长,并顺利行剖宫产术。结论临床药师通过参与先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的治疗过程,以药物不良反应、药物相互作用及患者用药教育为切入点,为患者制定个体化用药方案,确保了用药的安全性和有效性。OBJECTIVE To provide a reference for the safe administration of patients with atrial flutter,atrial fibrillation,placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease.METHODS Clinical pharmacists participated in the diagnosis and treatment of a patient with atrial flutter,atrial fibrillation,placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease.Given the thrombocytopenia caused by enoxaparin sodium,pharmacists suggested to stop enoxaparin sodium and change it to fondaparinux sodium after a blood routine review.For the patient with fast heart rate and low blood pressure,pharmacists recommended to choose metoprolol and adjust the dosage according to the heart rate,and change furosemide to hydrochlorothiazide.Pharmacists recommended to continue using metoprolol regarding doctors’plan to replace metoprolol with sotalol before cesarean section.For possible drug interactions in the patient,pharmacists recommended to closely monitor blood potassium and other indicators,and provided drug education.RESULTS The doctors adopted the advice of clinical pharmacists.The patient’s bleeding was controlled,the indicators were kept stable during hospitalization,the gestational week was extended smoothly,and the cesarean section was successfully performed.CONCLUSIONS By participating in the treatment of the patient with atrial flutter,atrial fibrillation,placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease,clinical pharmacists formulate individualized medication plans for the patient based on adverse drug reactions,drug interactions and medication education,ensuring the safety and effectiveness of medication.

关 键 词：先天性心脏病术后 心房扑动 心房颤动 血小板减少 前置胎盘出血 先兆流产 临床药师 特殊人群 

分 类 号：R969.3[医药卫生—药理学] R714.21[医药卫生—药学]