妊娠剧烈呕吐合并Wernicke脑病1例的药学监护

Pharmaceutical care of one case of hyperemesis gravidarum complicated with Wernicke's encephalopathy

目的探讨临床药师对妊娠剧烈呕吐合并Wernicke脑病患者实施药学监护的过程、方法及其作用。方法结合1例妊娠剧烈呕吐合并Wernicke脑病患者应用维生素B_1进行药物治疗的过程,临床药师针对患者维生素B_1皮试强阳性的脱敏给药、给药剂量、给药疗程、不良反应等对患者进行监护和指导。同时该患者因妊娠剧烈呕吐,长时间不能进食,机体处于营养缺乏状态,对患者实施肠外营养并协助医生制订肠外营养处方。对患者肝、肾功能损害和血清电解质水平进行监测,根据患者疾病情况对其用药进行整合,并对治疗的全过程实施药学监护。结果临床药师结合患者的临床症状、实验室数据,围绕Wernicke脑病患者维生素B_1皮试强阳性的脱敏治疗和肠外营养治疗两方面提出建议,并协助医师制订治疗方案,使患者眼球震颤消失、共济失调和意识障碍均得到改善。结论临床药师在临床用药的安全性、合理性方面可以为临床医生提供帮助,是临床治疗团队中的重要成员。

Objective To investigate the process, methods and effect of pharmaceutical care by clinical pharmacists in the patients with hyperemesis gravidarum complicated with Wernicke＇s encephalopathy. Methods According to the process of pharmaceutical treatment of one patient with hyperemesis gravidarum complicated with Wernicke＇s encephalopathy who was treated with vitamin B_1, the patient with strong positive skin test of vitamin B_1 was given the care and guidance by clinical pharmacists on the basis of desensitization administration, dosage, course of administration and adverse reactions. At the same time, the patient was in nutritional deficiency due to hyperemesis gravidarum and long-time inability of eating. Parenteral nutrition was administered to the patient and the physician was assisted in formulating parenteral nutrition prescription. The damage of liver and kidney function of the patient and serum electrolyte levels were monitored. According to the patient＇s disease condition, the medication was integrated, and the entire process of treatment was given pharmaceutical care. Results Combined with the clinical symptoms and laboratory data of the patient, the clinical pharmacist raised suggestions and assisted the physician to formulate treatment plan on the basis of desensitization therapy and parenteral nutrition therapy for the patients with Wernicke＇s encephalopathy and strong positive skin test of vitamin B_1, which showed the results of disappeared nystagmus, and improved ataxia and disturbance of consciousness. Conclusion Clinical pharmacists can provide assistance for the physicians in the safety and rationality of clinical drug use, and they are important members of the clinical treatment team.