1例肺栓塞诱发心力衰竭患者静注胺碘酮致急性肝损伤的药学监护

Pharmaceutical care of acute liver injury caused by intravenous amiodarone in a patient with pulmonary embolism-induced heart failure

本文报道临床药师参与1例肺栓塞诱发心力衰竭患者静脉注射胺碘酮致急性肝损伤的药物治疗过程。该患者因急性心力衰竭合并肺栓塞及体循环瘀血,继而出现急性肝损伤,病情加重且有肝硬化风险,同时因静脉注射胺碘酮存在导致药源性肝损伤的风险因素,干扰临床制定治疗方案。临床医师强化抗心力衰竭、抗凝、降低肺动脉压等治疗,解除心源性肝损伤病理因素,临床药师建议停用胺碘酮排除药物性肝损伤因素,临床医师采纳了建议,最终患者病情稳定,肝功能好转。分析该患者肝损伤原因并协助临床调整用药是药学监护的重要内容,本文可为同类型急性肝损伤病例的诊疗提供参考。

This article reports the pharmacotherapy process of a clinical pharmacist participating in the treatment of a patient with acute liver injury caused by intravenous injection of amiodarone and pulmonary embolism-induced heart failure.The patient had heart failure complicated with pulmonary embolism and systemic congestion and then developed into acute liver injury,which was aggravated and had the risk of cirrhosis.At the same time,the patient developed drug-induced liver injury due to intravenous injection of amiodarone,which interfered with the clinical formulation of treatment plans.The clinician strengthened treatments of anti-heart failure,anticoagulation,reduction of pulmonary artery pressure and others to relieve the pathological factors of cardiogenic liver injury.The clinical pharmacist suggested stopping amiodarone to exclude the factors of drug-induced liver injury,the clinician adopted the suggestion,and finally the patient's condition was stable and the liver function improved.The analysis of this patient’s liver injury and assisting the clinical adjustment of medication are important contents of pharmaceutical monitoring.This article can provide a reference for the diagnosis and treatment of similar cases of acute liver injury.