刘秀梅 华之卉 毛新奇 陈楠 都丽萍

摘 要 目的：探讨临床药师对老年心力衰竭合并房颤及肾功能不全患者地高辛中毒治疗方案中的作用及药学监护切入点。方法：临床药师通过参与老年心力衰竭合并房颤及肾功能不全患者地高辛中毒的治疗，从地高辛中毒的鉴别、地高辛血药浓度监测、临床药物治疗方案调整等环节提供药学建议。调整药物治疗方案后，患者地高辛中毒表现逐渐好转，入院第19天患者病情稳定出院。结果：临床药师在老年心力衰竭地高辛中毒的治疗过程中，通过分析患者用药情况，结合临床症状，及时进行用药调整，积极开展个体化药学监护。结论：临床药师参与地高辛中毒患者的治疗过程，提高了患者用药的安全性和有效性。

关键词 心力衰竭 地高辛中毒 药学监护

中图分类号：R972.1； R969.3 文献标志码：C 文章编号：1006-1533（2021）09-0049-03

*基金项目：河南省医学科技攻关项目（LHGJ20191090）；河南省中医药科学研究专项课题（2018ZY3017）；河南省医学科技攻关项目（2018020846）

Pharmaceutical care of digoxin poisoning in an elderly patient with heart failure complicated with atrial fibrillation and renal insufficiency by clinical pharmacists*

LIU Xiumei1，2**， HUA Zhihui1，2， MAO Xinqi1，2， CHEN Nan1，2， DU Liping3***[1. Department of Pharmacy， the Peoples Hospital of Henan University of Chinese Medicine （the Peoples Hospital of Zhengzhou）， Zhengzhou 450003， China； 2. the Fifth Clinical Medical College of Henan University of Chinese Medicine ， Zhengzhou 450003， China； 3. Department of Pharmacy， Peking Union Medical College Hospital， Chinese Academy of Medical Sciences& Peking Union Medical College， Beijing 100730， China]

ABSTRACT Objective： To explore the role of clinical pharmacists in the treatment of digoxin poisoning in an elderly patient with heart failure complicated with atrial fibrillation and renal insufficiency and the entry point of pharmaceutical monitoring. Methods： The clinical pharmacists provided pharmaceutical advice from the aspects of the identification of digoxin poisoning， the monitoring of digoxin blood concentration and the adjustment of clinical drug treatment plan by participating in the treatment of digoxin poisoning in the elderly patient. After adjusting the drug treatment plan， the digoxin poisoning of the patient was gradually improved， and she was discharged due to stable condition on the 19th day of admission. Results： The clinical pharmacists timely adjusted medication and actively carried out individual pharmaceutical monitoring by the analysis of the patients medication and combining with clinical symptoms in the treatment process of the elderly patient. Conclusion： The safety and effectiveness of the drug use can be improved by clinical pharmacist participating in the treatment process of digoxin poisoning patient.

KEy WORDS heart failure； digoxin poisoning； pharmaceutical care

心力衰竭是由于任何心臟结构或功能异常导致心室充盈或射血能力受损的一组复杂临床综合征，其主要临床表现为呼吸困难、乏力（活动耐量受限）、液体潴留（肺淤血和外周水肿）等。心力衰竭为各种心脏疾病的严重和终末阶段，发病率高，是当今最主要的心血管病之一[1]。地高辛是强心苷的一种，是临床常用的抗心力衰竭药物，但由于它的治疗量和中毒量之间范围较小，个体差异大，极易出现中毒反应。研究表明，地高辛中毒反应集中于老年心肾功能不全患者中[2]。……