4.循证药学在连续性肾脏替代治疗期间抗凝治疗决策中的应用汇编.docx

循证药学在连续性肾脏替代治疗期间抗凝治疗决策中的应用 唐 莲1*，姚慧娟2，卜书红2（1.南京医科大学附属苏州医院药学部，苏州 215002；2. 上海交通大学医学院附属新华医院药学部，上海 200092） *主管药师，硕士。研究方向：临床药学。电话：0512E-mail:tanglian716@ 摘 要 目的：探讨循证药学在连续性肾脏替代治疗（Continuous Renal Replacement Therapy, CRRT）期间抗凝药物治疗中协助实施最佳治疗方案的作用。方法：以一例患者行CRRT期间出现血小板减少时抗凝药物治疗决策为例，临床药师介入临床，通过循证药学方法结合临床数据，分析高出血风险及血小板减少患者行CRRT期间选用阿加曲班抗凝治疗的证据，并跟踪其疗效和安全性，对药物治疗过程进行综合评估。结果：分析检索到高出血风险及血小板减少患者行CRRT期间选用阿加曲班抗凝治疗的文献有1篇系统评价、1篇RCT研究、3篇列队研究以及相关指南4个。将其最佳证据应用到该例患者的临床实践中取得了较好效果，无出血和栓塞并发症发生，并且血小板和凝血指标改善。结论：循证药学在CRRT期间抗凝治疗决策中发挥了重要作用。 关键词 循证药学；临床药师；持续肾脏替代治疗；阿加曲班 Application of Evidence-based Pharmacy in Anticoagulant Treatment Strategies During Continuous Renal Replacement Therapy. TANG Lian(Dept. of Pharmacy，Suzhou Hospital Affiliated to Nanjing Medical University，Suzhou 215002，China) YAO Hui-juan, BU Shu-hong (Dept. of Pharmacy，Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China) ABSTRACT OBJECTIVE: To analyze the role of clinical evidence-based pharmacy in anticoagulant treatment strategies during continuous renal replacement therapy (CRRT). METHODS: Take a thrombocytopenia patient of anticoagulant treatment during CRRT for instance. Clinical pharmacists evaluated the quality of evidence data, analyzed the evidence of taken Argatroban anticoagulant therapy during CRRT for high risk blooding and thrombocytopenia patients, and monitored the efficacy and safety. RESULTS: One systematic review, one RCT, three cohort studies and four related guidelines were obtained. Based on the above evidences, good results were achieved in the clinical practice of this patient. No thrombotic or hemorrhagic complications occurred in this patient, platelet count and coagulation indicators also improved. CONCLUSIONS: Evidence- based pharmacy play an important role in anticoagulant treatment strategies during CRRT. KEYWORDS Evidence-based pharmacy; Clinical pharmacists; CRRT; Argatroban 连续性肾脏替代治疗( continuous renal replacement therapy，CRRT) 是目前重症医学科（I