1例血小板减少症并发脑梗死患者的药学监护

Pharmaceutical care on a patient with thrombocytopenia combined with cerebral infarction

1例62岁女性患者,因左侧肢体麻木、无力2 d入院,诊断为脑梗死。因患者合并血小板减少症,暂予降血压、改善循环治疗。患者所用药物中,马来酸桂哌齐特及酒石酸美托洛尔说明书中标注有血小板减少的不良反应,临床药师建议更换同类药物,避免加重血小板减少症状、增加出血风险。患者所用静脉液体中,注射用七叶皂苷钠及前列地尔注射液发生静脉炎的不良反应报告较多,临床药师每日询问患者输液时及输液后有无血管输注部位肿胀、疼痛等反应,及时发现了患者静脉炎的不良反应并建议停药处理。经过治疗,患者肢体麻木、无力情况改善,好转出院。治疗过程中未出现活动性出血,血常规检查与既往相比未出现明显变化。

One 62-year-old female who was hospitalized as left limb numbness and weakness for 2 days,was diagnosed as cerebral infarction.For combining with thrombocytopenia,the patient was temporarily treated with reducing blood pressure and improving circulation.Among the drugs administered to the patient,drug instructions of cinepazide maleate injection and metoprolol tartrate tablets have indicated adverse reactions of thrombocytopenia.Clinical pharmacists suggested using similar drugs instead to avoid aggravating the symptoms of thrombocytopenia or increasing the risk of bleeding.For the intravenous drugs,adverse reaction of phlebitis induced by sodium aescinate for injection and alprostadil for injection has been reported,and clinical pharmacists enquired the patient whether there was swelling or pain in vascular infusion site everyday.Phlebitis had been observed timely and the drugs were withdrawn.The limb numbness and weakness of the patient had been improved after the treatment and the patient was discharged.There was no sign about active bleeding during treatment,and blood examination showed no significant change compared with previous results.