基于1 例首乌藤致药物性肝损伤病例报告的临床药学服务模式研究

目的以1例首乌藤致药物性肝损伤(drug-induced liver injury，DILI)的病人为例，探讨临床药师为药源性疾病病人提供药学服务的切入点和服务模式。方法临床药师通过药学问诊，采用RUCAM因果关系评分法分析可疑药物首乌藤和肝损伤的相关性；病人住院期间，临床药师参与保肝治疗方案的优化与制定，监护用药疗效与不良反应，开展用药教育，保障病人治疗效果与用药安全性，开展分别针对医生与社会大众的药物科普宣教，避免和减少首乌类药源性疾病的发生。结果病人经过保肝治疗后，肝功能明显好转并出院，出院两周后门诊随访肝功能基本恢复正常。结论临床药师利用自己的专业特长，以药物重整、医嘱审核、合理用药指导、用药监护、用药教育以及科普宣传六项临床药学服务为切入点，全程参与1例首乌藤致DILI病人的药物治疗，探索了真正以“病人为中心”的临床药学服务模式，期望为今后临床药师在药源性疾病上的药学服务工作方向和重点提供依据。

Study on clinical pharmaceutical care model based on a case report of DILI caused by Caulis Polygoni Multiflori

Objective To discuss the entry point and service mode for clinical pharmacists in providing pharmaceutical care for pa?tients with drug-induced diseases based on a case analysis of DILI caused by Caulis Polygoni Multiflori.Methods The clinical phar?macist interrogated patients based on their past drug use, analyzed the correlation between the suspicious drug and liver injury by using the RUCAM causality score method; During the patient''s hospitalization, the clinical pharmacists participated in the optimization and formulation of liver-protecting treatment plan, monitored the efficacy and adverse reactions of medication and carried out medication ed?ucation to ensure the treatment effect and medication safety . They also carried out drug knowledge education for doctors and the public in order to a reduce and avoid the occurrence of such drug-induced diseases.Results After liver protection treatment, the patient''s liv?er function improved significantly and was discharged from hospital. At two weeks after discharge, the patient''s liver function basically returned to normal.Conclusions Clinical pharmacists make use of their professional expertise to participate in the whole-process clin?ical pharmaceutical care through the starting point of pharmaceutical care, such as medication reorganization, medical order review,medication guidance, medication monitoring, medication education and popular science publicity. The "patient-centered" mode of clini?cal pharmaceutical care was explored, which is expected to provide a basis for the direction and focus of clinical pharmacists'' pharma?ceutical care work on drug-induced diseases in the future.