1例男性青年难治性高血压的药学监护分析

Pharmaceutical care on a young male patient with resistant hypertension

临床药师通过参与临床药物治疗,进行药学监护,协助临床医生进行1例男性青年难治性高血压的治疗。药师参与患者初始治疗方案选择,并根据相应指南和共识参与治疗药物调整并开展安全性、有效性、依从性药学监护及患者用药教育,参与患者在院期间多种药物的调整,血压由入院165/98 mmHg降至出院143/84 mmHg(1mmHg=0.133 kPa),心率入院80次/分至出院63次/分,尿酸由入院594μmol·L^(-1)降至出院510μmol·L^(-1),血肌酐入院224μmol·L^(-1)至出院216μmol·L^(-1),血钾在院期间无较大波动。患者未出现因血压改变导致头晕跌倒等恶性事件,并开始记录血压日志,治疗依从性良好。临床药师与医师在沟通中学习心内科医师治疗难治性高血压的经验知识,加深对难治性高血压诊治的认识,关注细节、对比联系,这也是临床药师开展药学监护工作的出发点。

To explore the method of pharmaceutical care on a young male patient with resistant hypertension. The clinical pharmacist participated in developing the drug therapy plan, monitoring the patient＇s progress in achieving the specific outcomes. The pharmacist also assured that the patient has a thorough understanding of the disease and the therapy/medications prescribed in this plan. The key monitoring points included initial regimen selection, medication adjustment, efficiency, safety and compliance monitoring, and patient education. With the treatment, the blood pressure of the patient decreased gradually from 165/98 mm Hg to 143/84 mm Hg, heart rate from 63/min to 80/min, serum uric acid from 594 μmol·L^（-1） to 510 μmol·L^（-1）, serum creatinine from 224 μmol·L^（-1） to 216 μmol·L^（-1）, serum potassium almost stable. No serious adverse drug reactions occurred and patient compliance was improved. Involvement of clinical pharmacist in clinical therapeutic team and taking pharmaceutical care will improve the efficacy of clinical pharmacotherapy.