器质性心脏病合并室性心律失常患者的药学监护

Pharmaceutical Care for Patient with Structural Heart Disease and Ventricular Arrhythmias

目的:探讨临床药师在器质性心脏病合并室性心律失常患者药物治疗中的作用。方法:临床药师参与1例器质性心脏病合并室性心律失常患者的药物治疗,协助医师制订药物初始治疗方案;分析患者因注射盐酸胺碘酮注射液发生过敏性休克而口服盐酸胺碘酮片未发生过敏反应的原因,认为助溶剂致敏的可能性,建议医师给予患者盐酸胺碘酮片0.2 g,po,tid;将降压药左旋氨氯地平片更换为雷米普利片2.5 mg,po,qd,出现咳嗽后更换为氯沙坦片25 mg,po,qd。结果:医师采纳临床药师建议,患者心律失常控制良好,调整降压药后血压控制平稳,治疗过程中未出现严重药品不良反应,患者病情明显好转出院。结论:临床药师对患者进行药学监护,发挥专业特长,促进了临床合理用药,体现了药学监护在临床治疗中的价值。

OBJECTIVE：To explore the role of clinical pharmacists in the drug therapy for patient with structural heart disease and ventricular arrhythmias. METHODS：Clinical pharmacists participated in drug therapy for a patient with structural heart disease and ventricular arrhythmias,and assisted physicians to formulate preliminary drug therapy plan;analyzed the reasons that Amiodarone hydrochloride injection could induced allergic shock and oral administration of Amiodarone hydrochloride tablet could not induced allergic reaction. Considering the possibility of cosolvent-induced allergy,the physicians were suggested to prescribing Amiodarone hydrochloride tablets 0.2 g,po,tid for patient. It was suggested to replace Levamlodipine tablet with Ramipril tablet 2.5 mg,po,qd,and used Losartan tablet 25 mg,po,qd,instead if suffering from cough. RESULTS：Physicians adopted the suggestion of clinical pharmacists;arrhythmia controlled well,and blood pressure was stable after medication adjustment;no serious ADR occurred during treatment. The patient was recovered and discharged from the hospital. CONCLUSIONS：Clinical pharmacist should provide pharmaceutical care for the patient and play professional expertise to promote rational drug use in the clinic,which indicate the value of pharmaceutical care in clinical treatment.