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目的探讨临床药师在老年心房颤动患者中开展药学监护的内容和作用。方法临床药师监护老年心房颤动患者用药全过程,根据药物动力学知识,建议延长索他洛尔疗程至达稳态血药浓度;根据药物相互作用知识,建议调整他汀类药物种类和华法林剂量。结果在临床药师参与下,医生调整治疗方案,患者心房颤动转窦律、INR达标,好转出院。结论老年心房颤动患者药学监护的重点在于抗心律失常药物的选用、抗凝药剂量调整和避免药物相互作用等。
Objective To explore the content and the role of clinical pharmacists in developing pharmacy care in elderly patients with atrial fibrillation. Methods The clinical pharmacist supervised the whole process of the treatment of elderly patients with atrial fibrillation. Based on the knowledge of pharmacokinetics, it is suggested to prolong the course of sotalol treatment to reach steady state plasma drug concentration. Based on knowledge of drug interactions, it is suggested to adjust the statin class and warfarin dose . Results In the participation of clinical pharmacists, the doctor adjusted treatment options, patients with atrial fibrillation turn sinus rhythm, INR compliance, improved discharge. Conclusion The focus of pharmaco-intensive care for elderly patients with atrial fibrillation lies in the selection of antiarrhythmic drugs, the adjustment of anticoagulant dosage and the avoidance of drug interactions.