对1例肝硬化并肝性脑病患者的药学监护.pdfVIP

中国药物应用与监测 2010年4月第7卷第2期 Chinese Journal of Drug Application and Monitoring, Vol.7, No.2, April 2010 对1 例肝硬化并肝性脑病患者的药学监护 1 2 1 （1. 山东大学齐鲁医院药剂科，山东 济南 250012 ；2. 山东大学齐鲁医院消化内科，山东 济南 250012 ） 赵 亮 ，张晓静 ，周 文 [摘要] 1例54 a 男性患者，因肝硬化并肝性脑病、2 型糖尿病入院，给予降血氨、保肝、抑酸、抗感染等综合治疗。入院后4 d 患者出现肝昏迷现象，为及时降低血氨浓度、改善患者临床症状，临床药师建议增加门冬氨酸鸟氨酸给药剂量，并联合使用 精氨酸，之后患者症状好转；考虑到患者对青霉素过敏，对硫普罗宁致过敏反应进行判断和评估，并建议将硫普罗宁换为多 烯磷脂酰胆碱；并对双歧三联活菌与双八面体蒙脱石的相互作用给予监测，建议将两药间隔1 h服用；结合患者肝硬化病情 建议对奥美拉唑的给药剂量进行调整，以减少对肝功能损害。 [关键词] 临床药师；药学监护；肝硬化；肝性脑病 [ 中图分类号] R969.3 ；R575.2 [ 文献标识码] A [ 文章编号] 1672 – 8157(2010)02 – 0108 – 03 Pharmaceutical care on a patient with hepatic cirrhosis complicated with hepatic encephalopathy 1 2 1 ZHAO Liang , ZHANG Xiao-jing , ZHOU Wen (1. Department of Pharmacy, Qilu Hospital of Shandong University, Jinan 250012, China; 2. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, China) [ABSTRACT] A 54-year-old male patient with hepatic cirrhosis accompanied with hepatic encephalopathy and type 2 diabetes mellitus was hospitalized. The patient was treated with lowering ammonia, protective liver, inhibiting acid secretion, anti-infection. Four days after the patient ’s hospitalization, he developed coma hepaticum. To timely reduce the plasma concentration of ammonia and improve the patient ’s clinical symptom, clinical pharmacist suggested increasing the dose of L -ornithine-L -aspartate and combination treatment with arginine. The symptoms of the patient improved. Considering the patient’s allergic history of penicillin, clinical pharmacist recommended tiopronin should be replaced with polyene phosphatidylcholine for avoiding adverse reactions. The potential interaction between live combined bifidobacterium, lactobacillus and streptococcus thermophilus table and dioctahedral smectite was monitore