抗血小板药物治疗的药学监护_张石革.pdf

中国执业药师· 专家论坛 抗血小板药物治疗的药学监护 张石革 （北京大学第四临床医学院，北京积水潭医院药剂科，北京 100035） 【摘要】 目的：抗血小板药物围绕血栓形成机制，对血小板聚集各个环节形成抑制而成为对抗血栓的一线 用药，受到临床医师和患者的青睐，本文总结抗血小板药的临床应用评价和监护要点。方法：采用国内、外 文献综述方法。结果与结论：在大量的临床研究中，抗血小板药显示了良好效果，各种临床结果已被多项 循证医学系统研究所证实，但其用药风险和不良反应较大，使得药学监护和抗凝药合理安全应用尤显重要。 【关键词】 抗血小板药；环氧合酶抑制剂；血栓；药学监护；合理用药 Pharmaceutical Care during Antiplatelet Therapies Zhang Shige （Pharmacy Department of the Fourth Clinical Medical College of Beijing University ，Beijing Jishuitan Hospital ，Bejing 100035 ，China） ABSTRACT Objective: To summarize the evaluation of clinical application of antiplatelet drugs and the critical points of pharmaceutical care so as to provide reference for improving the clinical pharmaceutical care. Methods: To collect medical data by literature review both at home and abroad. Results and Conclusion: Antiplatelet drugs were proved good in efficacy by indication-based medical studies and the results of clinical trials were confirmed by clinical systematic researches using multiple evidence-based methodology. As there were potential risks in use of antiplatelet drugs and relatively more adverse drug reactions ，the pharmaceutical care and rational use of anticoagulant drugs were becoming more important. KEY WORDS Antiplatelet Drug ；Cyclooxygenase Inhibitor ；Thrombosis ；Pharmaceutical Care ；Rational Drug Use 血小板(Platelet ，PLT) 是骨髓中成熟细胞巨核细胞胞 功能、活化和聚集而发挥作用，用于防治血栓性疾病。作 浆脱落的结构，每日产生的数量相当于每升血液中增加 用类别主要包括： 9 35 ×10 个，其寿命为7 ～ 14 d。血小板计数明显减少，可 1.1 环氧酶抑制剂（Cyclooxygenase inhibitor ） 致出血；但血小板计数过度增多、激活和聚集性增加，形 阿司匹林可抑制血小板环氧酶，阻止血小板合成的前 态和功能方面改变，可致血栓性和动脉粥样硬化等疾病。 列腺素（PGI）及血栓素的释放，从而具有强烈的抗血小板 在动脉壁不平滑（损伤、管腔狭窄、闭塞、痉挛）、动脉粥样 聚集作用。用于血小板增多、血液呈高凝状态或血栓