CAJ | 학술논문

临床药师通过参与1例心瓣膜置换术后患者的药物治疗实践，对影响华法林抗凝作用的药物因素进行分析，根据患者凝血酶原时间（PT）和国际标准化比值（INR）提供用药建议，与临床医师共同制定个体化治疗方案，使得患者相关症状得到缓解，取得了满意的治疗效果，从而探讨临床药师参与抗凝和抗感染药物治疗的工作模式与方法；临床药师全程参与治疗过程，对患者整个用药过程进行监护，发现、解决、预防潜在的或实际存在的联合用药问题，以保障患者用药安全和有效。
림상약사통과삼여1례심판막치환술후환자적약물치료실천，대영향화법림항응작용적약물인소진행분석，근거환자응혈매원시간（PT）화국제표준화비치（INR）제공용약건의，여림상의사공동제정개체화치료방안，사득환자상관증상득도완해，취득료만의적치료효과，종이탐토림상약사삼여항응화항감염약물치료적공작모식여방법；림상약사전정삼여치료과정，대환자정개용약과정진행감호，발현、해결、예방잠재적혹실제존재적연합용약문제，이보장환자용약안전화유효。
By participating in the treatment for a patient having undergone heart valve replacement, clinical pharmacists analyzed the drug factors affecting the anticoagulant efficacy of warfarin, made proper suggestions according to the prothrombin time and international normalized ratio, and assisted physicians in making individualized treatment plan. As a result, the related symptoms of the patient were remitted and satisfying therapeutic effects were achieved. This case was used to discuss the mode and method of clinical pharmacists participating in clinical drug treatment of anticoagulation and anti-infection. Clinical pharma_cists should provide pharmaceutical care in the whole course, find or prevent real or potential problems in combined medications and guarantee the safety and effectiveness of drug use.