甲状腺功能亢进合并胆汁瘀积性肝损伤患者的治疗与药学监护

Medical treatment and pharmaceutical care of the patient with hyperthyroidism coupled with cholestatic liver injury

目的探讨如何为甲状腺功能亢进合并胆汁瘀积性肝损伤患者提供药物治疗与药学监护。方法临床药师参与1例甲状腺功能亢进和甲巯咪唑共同导致的胆汁瘀积性肝损患者的治疗全过程,重点监护激素和保肝药物治疗的合理性,与医师良好沟通,及时给出药物治疗调整建议,使得药物性不良反应所造成的影响降到最低。同时对患者进行用药教育,保障患者用药安全有效。结果患者总胆红素由574μmol/L降至113μmol/L,病情得到缓解,用药依从性提高。结论医务人员与患者需警惕硫代酰胺类药物会引起胆汁瘀积加重的可能,临床药师应该加强对患者肝功能和激素应用的重点监护。

Objective To explore methods for the provision of medical treatment and pharmaceutical care of the patients with hyperthyroidism coupled with cholestatic liver injury. Methods The clinical pharmacist was involved in the whole treatment course of one patient with hyperthyroidism and cholestatic liver injury. The pharmacist focused on the monitoring of the use of steroids and hepatoprotective drug,established good communication with the physician,and suggestions were made as to the adjustment of therapeutic drugs,so that adverse drug reactions could be minimized. At the same time,medication education was given to the patient,so as to ensure the safety and efficacy of medication. Results Total bilirubin of the patient was decreased from 574 μmol / L to 113 μmol / L and the state of the illness was alleviated,and as a consequence,the compliance in drug use was raised too. Conclusion The medical personnel should be highly aware of the probability that cholestasis could be worsened by the medication of thionamide,and clinical pharmacists should pay great attention to the monitoring of the liver function and the medication of steroids.