对1例复杂永久性心脏起搏器植入术患者的药学监护

Pharmaceutical care on a patient with undergoing complicated permanent cardiac pacemaker implantation

1例71岁男性患者,因反复头晕17年,伴活动后气短2年,加重6 d入院。10个月前因急性心肌梗死行PCI术治疗,入院后查动态心电图回报:窦性停搏最长达4.3 s,阵发性房性心动过速、室性心动过速。诊断:心律失常,慢-快综合征。行永久性心脏起搏器植入术治疗,术后因阵发房速给予静脉胺碘酮,用药第3天,患者出现恶心、呕吐,查体见皮肤黄染,肝功能异常(ALT 2954 IU·L-1,AST 156 IU·L-1),停用胺碘酮,其他药物继续使用,行保肝治疗,15 d后,肝功恢复正常(ALT 37IU·L-1,AST 27 IU·L-1)。临床药师在患者PCI术后用药依从性,起搏器植入术围手术期预防用抗菌药物的选择,静脉胺碘酮不良反应的判断和处理等方面提供药学监护。经对症治疗,患者病情好转出院。

One 71-year-old male patient with repeated dizziness for 17 years, shortness of breath after exertion for 2 years and worse for 6 days was hospitalized. Ten months ago, the patient underwent percutaneous coronary intervention operation because of acute myocardial infarction. After admission, the dynamic electrocardiogram performance of patient showed the results as follows： sinus arrest up to 4.3 s, paroxysmal atrial tachycardia, ventricular heartbeat tachycardia. The patient was diagnosed as arrhythmia, slow fast syndrome. The patient was intravenously given amiodarone because of paroxysmal atrial tachycardia after permanent cardiac pacemaker implantation. Three days later, the patient developed nausea, vomiting, yellowish skin and abnormal of liver function with ALT of 2954 IU·L^-1, AST of 156 IU·L^-1. Amiodarone was withdrawn and protective liver therapy was given. After 15 days, the liver function returned to normal with ALT of 37 IU·L^-1 and AST of 27 IU·L^-1. Clinical pharmacists provided pharmaceutical cares on medication guidance for the patient after PCI, prophylactic antibiotics usage selection during pacemaker implantation, judgment and treatment of amiodarone-related ADRs. The patient discharged with improved condition after symptomatic treatment.