中国药物警戒 ›› 2025, Vol. 22 ›› Issue (7): 805-808.
DOI: 10.19803/j.1672-8629.20240898

• 安全与合理用药 • 上一篇    下一篇

1例心力衰竭合并尿毒症老年综合征患者的药学实践

李莹1,2, 黄立双3, 张静静4, 朱愿超2,*, 沈姞5, 杨珺1   

  1. 1国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院药剂科,北京 100021;
    2北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,北京市药物临床风险与个体化应用评价重点实验室（北京医院）,北京 100730;
    3唐山市工人医院药学部,河北 唐山 063000;
    4潍坊市人民医院临床药学科,山东 潍坊 261041;
    5北京医院老年医学科,国家老年医学中心,中国医学科学院老年医学研究院,北京 100730
  • 收稿日期:2024-11-25 出版日期:2025-07-15 发布日期:2025-07-17
  • 通讯作者: *朱愿超,女,硕士,副主任药师,临床药学。E-mail: yc4155@163.com
  • 作者简介:李莹,女,硕士,主管药师,临床药学。
  • 基金资助:
    国家重点研发计划（2021YFE0111800）

Pharmaceutical Care to a Geriatric Syndrome Patient with Heart Failure Combined with Uremia

LI Ying1,2, HUANG Lishuang3, ZHANG Jingjing4, ZHU Yuanchao2,*, SHEN Ji5, YANG Jun1   

  1. 1Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
    2Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application, Beijing Hospital, Beijing 100730, China;
    3Department of Pharmacy, Tangshan Workers’ Hospital, Tangshan Hebei 063000, China;
    4Department of Pharmacy, Weifang People’s Hospital, Weifang Shandong 261041, China;
    5Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2024-11-25 Online:2025-07-15 Published:2025-07-17

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摘要： 目的 以心力衰竭合并尿毒症老年综合征患者药学服务实践为例,探讨临床药师在老年治疗团队中发挥的作用。方法 临床药师全程参与老年综合征患者的诊疗过程,关注老年患者药动学-药效学改变,根据老年综合评估结果,提出个体化药物治疗建议,加强药学监护。结果 根据患者个体化情况进行了药物重整,减少了不良反应发生,优化了老年综合征患者治疗方案,并对患者进行用药教育,提高了用药依从性。结论 临床药师加入诊疗团队可以充分发挥专业特长,结合药学特性和患者情况提出个体化给药建议,并实施药学监护,对患者的药物治疗进行监测和分析,可及时发现不良反应、避免药物相互作用等,在提高老年患者用药安全性和依从性方面发挥重要作用。

关键词: 心力衰竭, 尿毒症, 血液透析滤过, 老年综合评估

Abstract: Objective To explore the role of clinical pharmacists in the geriatric treatment team based on pharmaceutical services to a geriatric syndrome patient with heart failure combined with uremia. Methods A clinical pharmacist participated in the whole process of diagnosis and treatment of this patient. This pharmacist observed pharmacokinetic-pharmacodynamic changes in this patient, recommended an individualized medication plan according to the Results of comprehensive assessment, and improved pharmaceutical care. Results Adjustment of medication based on the patient’s condition reduced adverse reactions and optimized the treatment regimen for a patient with geriatric syndromes. Giving tips about medication improved the patient’s compliance. Conclusion Clinical pharmacists can give full play to their expertise by recommending individualized medications, detecting adverse reactions quickly, preventing drug interactions and analyzing the process of medication. They can play an important role in ensuring the safety of medication and improving the compliance of elderly patients.

Key words: Heart Failure, Uremia, Hemodiafiltration, Comprehensive Geriatric Assessment

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