1例冠心病合并消化道出血患者的抗血小板用药监护

Pharmaceutical Care of Antiplatelet Drugs in 1 Patient with Coronary Heart Disease Complicated with Hemorrhage of Digestive Tract

目的促进临床合理用药,提高药学服务水平。方法 1例80岁高龄男性患者,因胸闷、胸痛不适加重合并消化道出血而入院,给予抗血小板、保护胃黏膜、稳定斑块、控制心室率、改善心室重构、利尿、活血通络等治疗。期间临床药师对患者进行药学监护,主要包括抗栓治疗药物的调整、消化道出血及胃黏膜保护药物的合理应用,监测药品不良反应及患者的肝、肾功能等相关指标。结果与结论根据监护结果及时有效地调整给药方案,并强化用药教育,可以提高药物疗效和安全性。

Objective To promote rational drug use in clinic and improve the level of pharmaceutical care.Methods One 80-year-old male patient was admitted to hospital because of aggravation of chest tightness and chest discomfort complicated with hemorrhage of digestive tract.The patient was treated with antiplatelet,protecting gastric mucosa,stabilizing plaques,controlling heart rate,improving ventricular remodeling,diuresis,activating blood circulation and dredging collaterals.During the treatment,the clinical pharmacist carried out pharmaceutical care for the patient,including the adjustment of antithrombotic drugs,rational drug use for treating hemorrhage of digestive tract and protecting gastric mucosa,monitoring adverse drug reactions and indexes of liver and renal function.Results and Conclusion According to the results of monitoring,timely and effective adjustment of medication regimen and intensive medication education can improve the efficacy and safety of drugs.