1例小肠坏死患者的围术期营养支持与华法林相互作用的药学监护

One Case of Pharmaceutical Care of the Interaction Between Perioperative Nutritional Support and Warfarin on Patient with Small Bowel Necrosis

目的探讨营养支持治疗与华法林的药物相互作用。方法通过对1例突发小肠坏死的二尖瓣置换术患者的围术期营养支持治疗进行病例分析和药学监护,探讨营养支持治疗对华法林疗效的影响。结果营养配方的调整会影响INR值,而通过空肠造口给药,华法林的吸收也受到影响。在药师的药学监护下,通过对营养方案和华法林相互作用的分析和剂量调整,识别出可疑药物严重不良反应1例,避免了后续潜在的药物不良反应风险。结论营养支持治疗对华法林疗效的影响需要综合多方面因素考虑,临床药师的工作有助于帮助识别和减少药物不良反应,促进临床合理用药。

OBJECTIVE To explore the drug interaction between nutritional support and warfarin.METHODS Case analysis and pharmaceutical care of perioperative nutritional support were provided to a mitral valve replacement patient with sudden small bowel necrosis.The effect of nutritional support therapy on warfarin was explored.RESULTS INR value could be affected by the adjustment of the nutrition prescription.In addition,the absorption of warfarin was affected when administered via jejunostomy.Through the pharmaceutical care,one case of suspicious serious adverse drug reaction was identified by adjusting the nutrition prescription and the dose of warfarin,which avoiding the risk of subsequent potential adverse drug reaction.CONCLUSION The effects of nutritional support warfarin are affected by many factors.The work of clinical pharmacists helps to identify and reduce adverse drug reactions and improve the rationality of medication.