PCI术后亚急性支架内血栓形成患者的个体化抗血小板治疗分析及药学监护

发布时间：2018-01-30 14:25

本文关键词： 心肌梗死糖尿病亚急性支架内血栓形成 CYPC基因多态性抗血小板药学监护　出处：《中国药房》2017年32期 　论文类型：期刊论文

【摘要】：目的:探讨临床药师在经皮冠状动脉介入治疗(PCI)术后亚急性支架内血栓形成患者个体化抗血小板治疗中的作用。方法:临床药师参与1例心肌梗死合并糖尿病患者的治疗过程,该患者于PCI术后第4天发生亚急性支架内血栓形成,临床药师通过综合分析其病变复杂程度、支架内血栓发生时间、植入支架数量、合并疾病等因素,建议行氯吡格雷相关基因[细胞色素P_(450)(CYP)2C19]检测;根据其检测结果(CYP2C19*1/*2),建议在原双联抗血小板治疗的基础上加用西洛他唑片50 mg,po,bid,同时加用前列地尔注射液10μg,ivgtt,qd改善微循环,并行疗效评价、不良反应监测等药学监护以及用药注意事项、饮食调整等用药教育。结果:医师采纳临床药师建议,患者病情好转出院。出院后,仍坚持使用阿司匹林+氯吡格雷+西洛他唑三联抗血小板治疗,患者病情稳定。结论:药物代谢酶是引起抗血小板药物效应和毒性个体差异的重要原因,其基因多态性与患者的临床转归和终点事件密切相关。临床药师应发挥自身专业所长,协助医师查阅和解读相关信息,在综合考虑患者病情、合并疾病、基因型等因素后,制订和调整个体化抗血小板治疗方案,保证患者用药的安全、有效。
[Abstract]:Objective: to investigate the clinical pharmacists undergoing percutaneous coronary intervention (PCI). The role of individual antiplatelet therapy in patients with subacute stent thrombosis methods: clinical pharmacists participated in the treatment of 1 patient with myocardial infarction and diabetes mellitus. The patient developed subacute stent thrombosis on the 4th day after PCI. The clinical pharmacists analyzed the complexity of the lesion, the time of stent thrombosis, the number of stents implanted, and the associated diseases. Recommended clopidogrel related genes. [Cytochrome PX 450C 19 was detected. According to the results of CYP2C19 / 1 / 2, it is recommended to add cilostazol tablets to 50 mg / d bid on the basis of prothrombotic anti-platelet therapy. At the same time, alprostadil injection 10 渭 g / g iv GTT QD was used to improve microcirculation, evaluate curative effect, monitor adverse reaction and other pharmacological monitoring as well as matters needing attention. Results: according to the advice of the clinical pharmacist, the patients were discharged from hospital. After discharge, they still used clopidoglycotazol triple antiplatelet therapy. Conclusion: drug metabolizing enzyme is an important reason for the difference of antiplatelet drug effect and individual toxicity. Its gene polymorphism is closely related to the clinical outcome and terminal events. Clinical pharmacists should give full play to their own professional expertise, assist doctors to consult and interpret relevant information, in the comprehensive consideration of the patient's condition, combined with the disease. After genotypes and other factors, individual antiplatelet therapy was formulated and adjusted to ensure the safety and effectiveness of drug use.
【作者单位】：西南医科大学附属医院药学部;
【基金】：泸州市科技计划项目[No.2013-S-48(19/30)]
【分类号】：R542.22
【正文快照】： [21]金锐,王宇光,薛春苗,等.中成药处方点评的标准与尺度探索(八):疗程与用药时长问题[J].中国医院药学杂志,2015,35(22):1979-1985.[22]Barlam TF,Cosgrove SE,Abbo LM,et al.Implementingan antibiotic stewardship program:guidelines by the infec-tious diseases society

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