1例沙库巴曲缬沙坦治疗恶性高血压合并肾功能损害伴心力衰竭药学监护

Pharmaceutical Care of Sacubitril Valsartan in the Treatment of a Patient with Malignant Hypertensive Renal Dysfunction and Heart Failure

目的探讨临床药师在恶性高血压合并肾功能损害伴心力衰竭患者治疗中的药学监护作用。方法临床药师参与1例恶性高血压合并肾功能损害伴心力衰竭患者的治疗,通过分析患者病情和查阅相关文献,提供循证证据,协助医师明确沙库巴曲缬沙坦应用于未透析状态下此类患者中的可行性及风险。建议从小剂量(每日2次,每次25 mg)开始,并对患者进行用药教育和随访。结果医师采纳建议,患者血肌酐水平和血压均下降,心力衰竭症状缓解,顺利出院。后期随访中,患者肾功能进一步改善,活动耐力明显增强,未行透析。结论未透析恶性高血压合并肾功能损害伴心力衰竭患者,尤其是估算肾小球滤过率(eGFR)<30 mL/(min/1.73 m^(2))者应慎用沙库巴曲缬沙坦。临床药师及时解决医师用药选择的问题,对患者进行用药监护,可确保用药安全、有效。

Objective To investigate the role of clinical pharmacists in the pharmaceutical care of the treatment of patients with malignant hypertensive renal dysfunction and heart failure.Methods The clinical pharmacists participated in the treatment of a patient with malignant hypertensive renal dysfunction and heart failure.They provided the evidence-based medicine by analyzing the patient′s condition and searching the relevant studies,and assisted the physicians to clarify the feasibility and risk of the application of sacubitril valsartan in the patient with malignant hypertensive renal dysfunction and heart failure and without dialysis.The clinical pharmacists suggested the medication of the patient should start from a small dose(25 mg each time,twice a day)of sacubitril valsartan,and then carried out the medication education and follow-up for patients.Results The physicians adopted the above suggestions,then the creatinine level,blood pressure of the patient decreased,his heart failure symptom relieved,and then he discharged successfully.In the later follow-up,the renal function of the patient continued to improve,the activity tolerance significantly enhanced,and he did not undergo the dialysis.Conclusion For patients with malignant hypertensive renal dysfunction and heart failure and without dialysis,especially those with estimated glomerular filtration rate(eGFR)<30 mL(min/1.73 m^(2)),it is recommended to use sacubitril valsartan with caution.The clinical pharmacists can ensure the safety and effectiveness of medication by solving the problems of medication selection timely for physicians and carrying out the pharmaceutical care for patients.