中国药物应用与监测
中國藥物應用與鑑測
중국약물응용여감측
CHINESE JOURNAL OF DRUG APPLICATION AND MONITORING
2015年
1期
33-35
,共3页
房颤%脑梗死%临床药师%药学监护
房顫%腦梗死%臨床藥師%藥學鑑護
방전%뇌경사%림상약사%약학감호
Atrial fibrillation%Cerebral infarction%Clinical pharmacist%Pharmaceutical care
1例83岁男性患者，因左侧肢体乏力1月余，加重伴运动迟缓3 d入院，诊断为脑梗死、阵发性房颤、慢性阻塞性肺疾病。入院先后给予华法林抗凝，哌拉西林他唑巴坦抗感染，阿司匹林抗血小板，阿托伐他汀钙调血脂，胺碘酮复律等治疗。治疗期间，结合患者的病情及相关检查，临床药师对患者华法林初始剂量的选择及后期剂量的调整给予建议，并推荐哌拉西林他唑巴坦抗感染，重点监测胺碘酮的不良反应以及与其他药物之间的相互作用。对患者进行用药教育，治疗18 d后，患者病情稳定出院。
1例83歲男性患者，因左側肢體乏力1月餘，加重伴運動遲緩3 d入院，診斷為腦梗死、陣髮性房顫、慢性阻塞性肺疾病。入院先後給予華法林抗凝，哌拉西林他唑巴坦抗感染，阿司匹林抗血小闆，阿託伐他汀鈣調血脂，胺碘酮複律等治療。治療期間，結閤患者的病情及相關檢查，臨床藥師對患者華法林初始劑量的選擇及後期劑量的調整給予建議，併推薦哌拉西林他唑巴坦抗感染，重點鑑測胺碘酮的不良反應以及與其他藥物之間的相互作用。對患者進行用藥教育，治療18 d後，患者病情穩定齣院。
1례83세남성환자，인좌측지체핍력1월여，가중반운동지완3 d입원，진단위뇌경사、진발성방전、만성조새성폐질병。입원선후급여화법림항응，고랍서림타서파탄항감염，아사필림항혈소판，아탁벌타정개조혈지，알전동복률등치료。치료기간，결합환자적병정급상관검사，림상약사대환자화법림초시제량적선택급후기제량적조정급여건의，병추천고랍서림타서파탄항감염，중점감측알전동적불량반응이급여기타약물지간적상호작용。대환자진행용약교육，치료18 d후，환자병정은정출원。
One 83-year-old male patient was hospitalized due to the weakness of left limbs for one month, followed by aggravation of bradykinesia for three days. Clinical diagnosis was cerebral infarction, paroxysmal atrial fibrillation, chronic obstructive pulmonary diseases. After hospitalization, the patient received the anticoagulant therapy with warfarin, anti-infection therapy with piperacillin and tazobactam, antiplatelet therapy with aspirin, lipid-regulating therapy with atorvastatin, pharmacological cardioversion with amiodarone. During the treatment, clinical pharmacist gave suggestions about the initial dose and dose adjusting of warfarin in the later treatment, recommended piperacillin and tazobactam for anti-infection, monitored the drug interaction between amiodarone and other drugs, provided medication education to the patient. The patient was in a stable condition and discharged on the 18th day.
