临床药师参与一例血栓性血小板减少性紫癜患者的个体化治疗

Clinical pharmacists participated in individualized treatment of a patient with thrombotic thrombocytopenic purpura

关键词:  血栓性血小板减少性紫癜  万古霉素  抗凝  肾功能不全  血浆置换

Key words:  thrombotic thrombocytopenic purpura  vancomycin  anti-coagulation  renal insufficiency  plasmapheresis

摘要:

目的 探讨临床药师为患者提供个体化药学服务的方式，为血栓性血小板减少性紫癜（thrombotic thrombocytopenic purpura,TTP）患者实施药学服务提供参考和思路。方法 临床药师参与1例TTP伴感染及血栓患者的治疗过程，从抗感染方案和抗凝方案的制定、血浆置换时药物剂量的调整策略等方面为患者提供个体化的药学服务，并进行全程的药学监护。结果 医师采纳了临床药师的用药建议，治疗后患者血小板恢复正常，感染及肾功能好转，国际标准化比值(international normalized ratio,INR)达标，患者顺利出院。结论 临床药师在临床诊疗过程中提供药学专业服务，有利于提高TTP患者药物治疗的有效性、安全性及合理性。

Abstract:

OBJECTIVE To provide reference and thought for implementing pharmaceu -tical care for patients with thrombotic thrombocytopenic purpura. METHODS Clinical pharmacists participated in the treatment of a patient with thrombotic thrombocytopenic purpura accompanied by infection and thrombosis, and provided individualized pharmaceutical care for the patient from the aspects of formulation and adjustment of antiinfection and anticoagulation programs, and the influence of plasma exchange on drugs. RESULTS The doctor adopted the medication suggestions of the clinical pharmacist. After the treatment, the patient""s platelets returned to normal, infection and renal function improved, international normalized ratio (INR) reached the standard, and the patient was discharged successfully. CONCLUSION Providing pharmaceutical professional services by clinical pharmacists during the clinical diagnosis and treatment process is beneficial for improving the effectiveness, safety, and rationality of drug treatment for patients with thrombotic thrombocytopenic purpura.