心房颤动合并地高辛中毒老年患者的药学监护

摘 要 目的：探讨临床药师在房颤伴地高辛中毒患者治疗方案中的作用及药学监护的切入点。方法: 临床药师参与1例房颤伴地高辛中毒患者的治疗，结合患者个体特点，对地高辛进行血药浓度监测，根据患者基础疾病、肾功能、联合用药等方面分析地高辛中毒的原因，并对患者进行有益的药学监护。结果: 临床药师的建议被医生采纳，及时停用地高辛，纠正了药物中毒。结论: 临床药师从药学学科的特点出发，找到临床监护的切入点，协助医生制定安全有效的治疗方案。

Pharmaceutical Care for Elderly Patients with Atrial Fibrillation Complicated with Digoxin Poisoning

ABSTRACT Objective: To explore the role of clinical pharmacists in the treatment of artial fibrillation complicated with digoxin poisoning and the entry points of pharmaceutical care. Methods: Clinical pharmacists participated in the therapy for a patient with atrial fibrillation and digoxin poisoning, monitored the blood concentration of digoxin combined with the characteristics of the patient, analyzed the causes of digoxin poisoning in terms of the underlying diseases, renal function and combined medication, and performed beneficial pharmaceutical care. Results: The suggestions of clinical pharmacists were adopted by doctors, digoxin was withdrawn timely and the drug poisoning was corrected. Conclusion: From the perspective of pharmacy, clinical pharmacists find the entry points of clinical care and help doctors develop safe and effective treatment programs.