急性冠状动脉综合征患者药品不良反应的药学监护与分析

Pharmaceutical Care and Analysis of Adverse Drug Reactions in Patients with Acute Coronary Syndrome

目的:分析临床药师对急性冠状动脉综合征(acute coronary syndrome,ACS)患者药品不良反应(adverse drug reactions,ADRs)的药学监护情况,探讨临床药师在ADRs药学监护中发挥的作用。方法:选取2021年9月—2022年2月某医院心内科ACS患者108例,由临床药师进行ADRs药学监护,记录ADRs的类型、发生时间、临床表现/实验室检查结果、处置措施、转归情况、涉及药品等信息,并对ADRs的关联性和预后进行评价。结果:83例患者报告了ADRs,占比76.85%;累计报告150例次ADRs,涉及17种ADRs类型;全部药品不良反应均为一般ADR,其中1例为新的ADR,无严重ADR。全部ADRs涉及25种药物,其中22种药物的ADRs发生率为“常见”。发生频次最高的ADRs为出血事件,均为1型或2型出血,第二位为肝功能异常,均为轻度肝损伤;第三位为胃肠系统不适,50%与阿司匹林相关。根据ADRs情况采取不同的处置措施后,痊愈和好转比例为90.00%。结论:ACS患者的ADRs发生率较高,均为一般ADR,多数为常见ADR且预后良好。临床药师的全程药学监护可保证ACS患者用药依从性和药物治疗安全性。

Objective:To analyze the clinical pharmacists’pharmaceutical care of adverse drug reactions(ADRs)in patients with acute coronary syndrome(ACS),and discuss the role of clinical pharmacists in the pharmaceutical care of ADRs.Methods:A total of 108 ACS patients in the Department of Cardiology of a hospital from September 2021 to February 2022 were enrolled.ADRs pharmaceutical care were conducted throughout the therapy including the type,occurrence time,clinical manifestations/laboratory examination results,disposal measures,outcomes,drugs involved and other information of ADRs by clinical pharmacists,and the association and prognosis of ADRs were evaluated.Results:ADRs were reported in 83 patients,accounting for 76.85%;150 ADRs were reported,involving 17 types of ADRs;All ADRs were general ADR,one of which was a new ADR and no serious ADR.All ADRs involved 25 drugs,of which 22 drugs had a common incidence of ADRs.The ADRs most frequently were bleeding events,all of which were type 1 or type 2 bleeding.The second were abnormal liver function,which were mild liver injury.The third were gastrointestinal system discomfort,which was 50%associated with aspirin.After taking different treatment measures according to ADRs,the rate of recovery and improvement was 90.00%.Conclusion:The patients with ACS have a high incidence of ADRs,all of which are general ADR,most of which are common ADR with good prognosis.The whole course pharmaceutical care of clinical pharmacists can ensure the drug compliance and drug therary safety in ACS patients.