临床药师参与1例伴药物性甲状腺功能减退症房颤患者药学监护实践

Clinical Pharmacists′Practice in Pharmaceutical Care of Atrial Fibrillation Complicated with Drug-Induced Hypothyroidism:A Case Report

目的促进特殊心律失常患者的合理用药。方法回顾性分析医院收治的1例伴药物性甲状腺功能减退症(简称甲减)心房颤动患者的用药经过。患者曾因阵发性心房颤动予胺碘酮、普罗帕酮转律及行射频消融术,且术后规律使用美托洛尔、胺碘酮及华法林,心悸等症状仍反复发作。入院后予胺碘酮纠正心律失常等对症治疗,但根据实验室检查结果新诊断亚临床甲减,停用胺碘酮,改为普罗帕酮,后行射频消融术及多次调整用药方案,效果欠佳。临床药师结合病情并查阅文献,建议联用普罗帕酮及小剂量索他洛尔。结果临床医师采纳建议,患者的临床症状、不良反应等均明显改善,心房颤动未再发作。结论临床药师参与用药方案的制订和调整,为心房颤动伴药物性甲减等特殊心律失常患者的药物治疗提供了更多选择,促进了合理用药。

Objective To promote the rational drug use of patients with special arrhythmias.Methods The treatment process of a patient with atrial fibrillation and drug-induced hypothyroidism admitted to the hospital was analyzed retrospectively.The patient was given previously amiodarone,propafenone for cardioversion and radiofrequency ablation due to paroxysmal atrial fibrillation,and treated with metoprolol,amiodarone and warfarin regularly after surgery,while symptoms such as palpitations still recurred.After admission,she was given the symptomatic treatment such as amiodarone for cardioversion.However,the subclinical hypothyroidism was diagnosed newly in this patient based on the laboratory examinations,so amiodarone was discontinued and replaced with propafenone,followed by radiofrequency ablation and medication regimen adjustments,while the treatment efficacy was unsatisfactory.Clinical pharmacists suggested the combination of propafenone and low-dose sotalol based on the patient′s condition and literature.Results Clinical physicians adopted the above suggestions,and then the patient′s clinical symptoms and adverse reactions improved obviously,and atrial fibrillation did not recur.Conclusion Clinical pharmacists′participation in the formulation and adjustment of medication regimens provides options of drug treatment for patients with special arrhythmias such as atrial fibrillation complicated with drug-induced hypothyroidism,and promotes rational drug use.