对脑梗死伴甲状腺功能减退症患者调节血脂药治疗的药学监护

Pharmaceutical Care for Patients with Cerebral Infarction Complicated with Hypothyroidism in Lipid-lowering Drug Treatment

目的:探讨临床药师参与脑梗死伴甲状腺功能减退症患者调节血脂药治疗的药学实践。方法:临床药师参与了1例脑梗死伴甲状腺功能减退症患者的诊疗过程,针对患者肌酸激酶升高的情况,分析其可能的原因,对调节血脂药治疗方案提出建议。结果:药师认为该患者肌酸激酶升高的原因与他汀类药物的不良反应和(或)患者甲状腺功能减退有关,建议医师停用阿托伐他汀钙,换用其他调节血脂药如胆酸螯合剂或烟酸,以降低总胆固醇、低密度脂蛋白胆固醇,待患者甲状腺功能恢复且肌酸激酶降至正常值范围后再继续使用他汀类药物。结论:通过对该患者肌酸激酶升高的原因进行分析,临床药师及时建议医师对调节血脂药治疗方案进行了调整,避免了不良反应的发生。

OBJECTIVE： To probe into the pharmaceutical care for patients with cerebral infarction complicated with hypothyroidism in lipid-lowering drug treatment by clinical pharmacists. METHODS： Through participating in the treatment process,the clinical pharmacists analyzed the possible causes of the elevated creatine kinase,and put forward recommendations for lipid-lowering drug treatment programs. RESULTS： The clinical pharmacists believed that the elevated creatine kinase was concerned with statins and / or hypothyroidism,and suggested the clinicians to stop using atorvastatin calcium and changed by other lipid-lowering drugs such as bile acid sequestrants or nicotinic acid,so as to reduce the total cholesterol and low density lipoprotein cholesterin; in addition,statin-related drugs can be used till the thyroid function and creatine kinase values back to normal. CONCLUSIONS： Through analyzing the causes of the patient＇s elevated creatine kinase,the clinical pharmacists recommend the clinicians to adjust lipid-lowering therapy to avoid the occurrence of adverse drug reactions.