1例急性心衰患者的药学监护

1例72岁男性患者,以间断心慌、胸闷、气喘20余年,再发加重1 d入院。住院期间,临床药师对患者进行药学监护,主要包括:纠正长期应用呋塞米后的电解质紊乱、硝普钠的用药剂量及可能出现的不良反应监测、多巴胺的有效剂量和不良反应监测、华法林的抗凝强度以及肝肾功能等指标监测,并根据监护结果提出药物剂量调整的使用建议,同时对患者进行用药教育,提高用药依从性,保障用药安全、有效。

Pharmaceutical care on a patient with acute heart failure

One 72-year-old male patient with intermittent palpitation, chest tightness and asthma for more than 20 years was hospitalized because of aggravation of his symptoms for one day. Pharmaceutical cares were given to the patient by clinical pharmacists. Monitoring points of pharmaceutical care included the treatment of electrolyte imbalance after long-term use of furosemide, monitoring the dosage and side effect of sodium nitroprusside and dopamine, anticoagulation intensity of warfarin, hepatic and kidney function, etc. Clinical pharmacists gave recommendations on drug selection and dose titration according to the monitoring results, and provided medication education for the patient. With the efforts of clinical pharmacists, medication compliance of this patient was improved and safe and effective use of drugs was ensured.