1例慢性心力衰竭、慢性肾功能不全合并痛风患者下肢持续疼痛治疗分析

Treatment Analysis of One Case of Chronic Heart Failure,Chronic Renal Insufficiency and Gout Patients with Sustained Pain in Lower Limbs

1例80岁男性患者,因"反复心悸、气促10余年,反复手足肿痛8年"入院。入院诊断为"二尖瓣狭窄(中度)合并关闭不全(重度)、心功能Ⅳ级、胸腔感染、肺部感染、慢性肾功能不全(CKD 3期)、痛风性关节炎"等多种慢性疾病。入院后给予利尿、抗凝、降尿酸治疗。患者左下肢疼痛反复发作且逐渐加重,单次应用激素虽能较快缓解疼痛未诱发心衰,但维持时间较短,为避免长时间应用激素或NSAID诱发心衰发作和能够让患者较好的预防痛风发作,在既往患者秋水仙碱服用后易出现腹泻情况下,临床药师建议尝试给予口服小剂量秋水仙碱0. 25 mg qd,观察是否能够耐受;并分析痛风反复发作的原因是患者共存心衰、肾功能不全多种慢性疾病,后者限制了急性痛风治疗药物的种类选择和应用的安全性和有效性,并据此对患者及家属进行用药教育,保障患者用药安全、有效。

One 80-year-old male patient was admitted to the hospital because of repeated palpitation and shortness of breath for more than 10 years and repeated swelling and pain in his hands and feet for 8 years. After the admission,the diagnosis was mitral stenosis（ moderate） with insufficiency（ severe）,grade Ⅳ heart function,chest infection,pulmonary infection,chronic renal insufficiency（ CKD3）,gouty arthritis and the other chronic diseases. Diuresis,anticoagulation and uric acid lowering treatment were given after the admission. The pain in the left lower extremity of the patient recurred and gradually worsened. The single application of hormones relieved the pain quickly without heart failure,while the effective duration was short. Therefore,in order to avoid long-term application of hormones or NSAIDs with heart failure risk and prevent gout attack better,and according to colchicine past used in the patient with diarrhea,clinical pharmacists suggested to try lower dose of colchicine 0. 25 mg qd,and observed the tolerance of the patient. Clinical pharmacists thought the reasons for the repeated gout attacks were related with such chronic diseases as heart failure and renal insufficiency etc,which limited the safety and effectiveness of the selection and application of acute gout treatment drugs. Based on the above analysis,clinical pharmacists carried out drug education for the patient and his family members to ensure the safety and effectiveness of medication.