1例多种危险因素并存的肺栓塞患者的药学监护

Pharmaceutical care of a multiple risk factors coexisting in patient with pulmonary embolism

目的:通过对1例肺栓塞患者实施的药学监护过程,探讨临床药师在临床治疗中发挥的作用。方法:通过对患者进行入院前的用药情况调查、住院期间用药医嘱全程关注(尤其是抗凝治疗),为患者建立药历,协助医师为患者制订有效的个体化用药方案,患者出院后继续对其进行电话随访,了解患者INR稳定情况及病情,以评价药物治疗效果。结果:通过药师在整个过程中细致的药学监护及医嘱干预,避免了不良反应事件的发生,提高了患者治疗的依从性及药物治疗效果。结论:临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者的用药安全有效。

OBJECTIVE To explore the role of clinical pharmacist in the clinical drug treatment through the implementing pharmaceutical care process in a patient with pulmonary embolism. METHODS By the surveys on drug use before admission and full attention to the prescription medication during hospitalization （especially anticoagulant therapy）, the patient＇s medica- tion history was established to assist physicians to develop effective individualized regimen. In order to understand the situation and the patient＇s INR stable condition and the effects of drug treatment, the telephone follow-up was continued after patient discharge, and then we could evaluate the effects of drug treatment. RESULTS The meticulous pharmaceutical care and medi- cation intervention by pharmacist in the whole process avoid the occurrence of adverse events and improve the effects of drug treatment. CONCLUSION The clinical pharmacist actively carries out pharmaceutical care, collaborates clinicians to optimize dosing regimens, which are conducive to patients with safe and effective medication.