1例慢性肾功能衰竭伴上消化道出血患者的药学监护

1例52岁男性患者，以慢性肾功能衰竭入院。入院后查血生化、血象等指标，监测血压，结果显示患者血压、贫血控制不佳，水电解质和酸碱平衡紊乱，结合实验室检查结果给予降压、抗肾性贫血、纠正水电解质和酸碱平衡紊乱等治疗。入院第6天，患者出现严重上消化道出血并发症，给予抑酸、生长抑素治疗。在临床治疗过程中，临床药师针对该例肾病患者的具体情况，选用适宜的降压药物、抗肾性贫血药物、利尿药物，计算用药剂量，尤其是对合并严重消化道出血并发症时，针对抑酸药物、生长抑素指导用药方法，同时实施治疗药物监测。出院后1个月随访，患者血压、血红蛋白、水电解质和酸碱度等指标恢复正常。

Pharmaceutical care for a patient with chronic renal failure and upper gastrointestinal bleeding

One 52-year-old male patient was hospitalized for chronic renal failure. The blood pressure and anemia of the patient were not in a well-controlled manner and fluid and electrolyte imbalance and acid-base imbalance were diagnosed on the basis of laboratory tests for blood biochemical examination, anemia detection, blood pressure monitoring etc. The patient was treated with antihypertensive therapy, anti-renal anemia treatment, corrections of water-electrolyte and acid-base imbalance, nutritional therapy. Severe upper gastrointestinal bleeding complications occurred six days after admission, and acid suppression and somatostatin treatment were given. Pharmaceutical care focused on selection and dosage adjustment of antihypertensive drugs, anti-renal anemia drugs and diuretic drugs and the directions of the medication method in patients with severe gastrointestinal bleeding, and implementation of therapeutic drug monitoring, decreasing potential medication risk during clinical course of treatment for patients with nephropathy. Indicators of blood pressure, hemoglobin, water-electrolyte and pH etc returned to normal in the first month after discharged from hospital.