1例不稳定型心绞痛患者的药学监护.pdfVIP

中国药物应用与监测2011年6月第8卷第3期 Chinese Journal of Drug Application and Monitoring, Vol.8, No.3, June 2011 1例不稳定型心绞痛患者的药学监护 赵维娟，王金萍，刘　静，许景峰（北京军区总医院药理科，北京 100700 ） [摘要] 1例78 岁女性患者，因不稳定型心绞痛入院治疗，入院时合并有高血压病和2 型糖尿病。给予扩张冠状动脉、抗血 小板、降压等治疗，并于入院第3 天行经皮冠状动脉介入治疗，术后患者情况稳定。针对患者心绞痛发病时舌下含服硝酸甘 油症状不能缓解，高血压药物控制血压效果不佳，行乙醛脱氢酶（ALDH ）和高血压药物相关基因检测，作为选用和调整药物 依据。患者ALDH 为WM （GA ）型（低活性），其含服硝酸甘油效果差，不能作为急性心绞痛的治疗药，必要时含服速效救心 β 丸；高血压药物相关基因检测显示，患者对 受体阻滞剂的代谢酶活性低，对ACE 抑制剂（ACEI ）和AT 1受体阻断药（ARBs ） 敏感，可根据具体情况加以选择。经合理优化治疗方案，患者血压及血糖控制稳定，病情好转出院。 [关键词] 不稳定型心绞痛；药物相关基因检测；临床药师；药学监护 [ 中图分类号] R972 [文献标识码] A [文章编号] 1672 – 8157(2011)03 – 0164 – 03 Pharmaceutical care on a patient with instable angina ZHAO Wei-juan, WANG Jin-ping, LIU Jing, XU Jing-feng ( General Hospital of Beijing Military Command, Beijing 100700, China) [ABSTRACT] One 78-year-old woman with instable angina, hypertension and type II diabetes was hospitalized for acute coronary syndrome and received the therapy of distending the coronary artery, anti-platelet, lowering hypertension, etc. Three days later, the patient was treated with the therapy of PCI, and then the situation was stable. Considering the oral nitroglycerin having no effect on the patient, and the hypertension didn ’t control very well, the hypertension related gene （HRG ）was detected. The results showed that the gene type of ALDH was WM （GA ）（low activity ）. Therefore, the pharmacist advised that nitroglycerin should be withdrawn in acute angina pectoris situation because of low sensitivity. Suxiaojiuxinwan could be administrated against angina pectoris attacks. Basing on the low activity of βreceptor blocker ’s metabolic enzyme ，ACE inhibitor （ACEI ）and AT 1 acceptor blockers (ARBs) could be chosen. The blood pressure and blood glucose were stable and the state was improved markedly according to the rational optimization based on the gene test. [KEY WORDS]