临床药师参与1例妊娠伴高脂血症急性胰腺炎患者治疗的药学实践

Pharmaceutical Practice of Clinical Pharmacist for A Patient with Hyperlipidemic Acute Pancreatitis During Pregnancy

关键词:  高脂血症急性胰腺炎  妊娠  药学实践  临床药师

Key words:  hyperlipidemic acute pancreatitis  pregnancy  pharmaceutical practice  clinical pharmacist

摘要:

目的 探讨临床药师在妊娠伴高脂血症急性胰腺炎患者治疗方案制定及用药监护中的作用。方法 临床药师就宁夏医科大学总医院收治的1例高脂血症急性胰腺炎妊娠病例，结合患者病情变化，从药物选择时机、安全性及有效性方面协助医师制订降脂、抗感染及镇痛治疗方案，并开展药学监护。结果 根据患者血脂水平，先后使用非诺贝特及阿托伐他汀钙降脂治疗以及低分子肝素辅助治疗；评估患者腹痛情况，建议给予盐酸哌替啶镇痛治疗；在患者感染控制不佳的情况下，建议抗菌药物由哌拉西林他唑巴坦升级为美罗培南，感染好转后降阶梯为头孢他啶联合甲硝唑，并于感染控制后及时停药。医师采纳临床药师上述建议。治疗后患者体温、血象正常，腹痛好转，血脂下降明显，行剖宫产术，病情平稳转入专科治疗。结论 妊娠患者在药物治疗前，临床药师应根据疾病严重程度，评估药物使用必要性，协助医师制定治疗方案并进行药学监护，确保用药安全有效。

Abstract:

OBJECTIVE To explore the role of clinical pharmacist in the formulation of therapy plan and pharmaceutical care for a patient with hyperlipidemic acute pancreatitis during pregnancy. METHODS According to the change of a patient's condition, clinical pharmacist provided pharmaceutical care throughout the therapy of the pregnant patient with hyperlipidemic acute pancreatitis in General Hospital of Ningxia Medical University, assisted physician to optimize medication plan, including the lipid lowering agents, anti-infection regimens and analgesic drugs in terms of the timing, safety and effectiveness of drug selection, and to carry out pharmaceutical monitoring. RESULTS According to the blood lipids level, fenofibrate and atorvastatin calcium were used to lower lipids, coorperated with low-molecular-weight heparin. Clinical pharmacist suggested the use of pethidine hydrochloride to control the abdominal pain. The antibiotics was upgraded from piperacillin/tazobactam to meropenem when the infection was aggravated, de-escalated to ceftazidime and metronidazole after infection improved, and stopped in time when infection well controlled. The physician adopted the recommendations. The laboratory indicators turned to normal, abdominal pain improved, blood lipids decreased significantly, the cesarean section was successfully performed, and transferred to gastroenterology department. CONCLUSION When it comes to pregnant patient, clinical pharmacists should evaluate the necessity of medication in accordance with the severity of the disease, then exert specialty advantages in assist physicians to formulate therapy plan, provide pharmaceutical care to guarantee the safety and effectiveness of medication.