药师参与1例2型糖尿病伴严重肾功能不全患者的治疗方案的优化.pdfVIP

Vo I. 14,No.5 临床药物治疗杂志 第14 卷第5 期 Clinical Medication Journal Sep ,2016 2016 年9 月 ·药物与临床· 药师参与 1 例 2 型糖尿病伴严重肾功能不全患者的治疗方案的优化 李博宇，崔向丽，刘丽宏* (首都医科大学附属北京朝阳医院药事部，北京 100020 ) [摘要]目的:总结临床药师参与优化i1f1j2型糖尿病伴严重肾功能不全患者的降糖方案的经验和体会，体现药 师在临床合理用药中的价值c 方法:临床药师结合患者临床具体情况，对患者的治疗方案进行分析，并着重从降糖药 物的药代动力学、药效动力学和药物经济学 3 方面考虑，对患者的降糖方案进行优化。结果:优化后的基础+餐时且夷 岛素(甘精且夷岛素+门冬膜岛素)降糖方案克服了患者血糖控制不佳的问题，个体化的给药剂量下患者未发生低血糖 不良反应，患者血糖控制满意后出院。结论:临床药师参与临床治疗方案的优化，从药学角度提出专业建议，可提高 医疗质量和患者满意度。 [关键词] 2 型糖尿病;肾功能不会;降糖方案;合理用药 [中图分类号] R969.3 [文献标志码] A [文章编号] 1672-3384(2016)05-0065-004 doi: 10.3969/j.issn.1672-3384.2016.05.016 Participation of pharmacist in optimization of therapeutic regimen for a patient with type 2 diabetes mellitus and sever chronic renal dysfunction LI Bo-沪J， CUI Xiang-li , LIU Li-hong ( Department ofPharmacy. Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China ) [ Abstract ] Objective: To summarize the experience of participating the optimization of the therapeutic regimen for a patient with type 2 diabetes mellitus and sever chronic renal dysfunction and to embody the important role of the pharmacist in therapeutic regimen management. Methods: The pharmacist analyzed the patients therapeutic regimen combining with clinical situation and provided professional advice to optimize the anti-diabetic therapeutic regimen from the perspective of pharmacokinetics ,pharmacodyna mics and pharmacoeconomics. Result: The optimized regimen of basal insulin in combination with short-acting insulin (insulin glargine in combinatio