任金妹+沈毅+謝寧+薛曉紅
摘 要 目的:對(duì)1例腦栓塞患者治療過(guò)程中出現(xiàn)肌酶升高及肝損傷的原因進(jìn)行討論,提高臨床藥師運(yùn)用專(zhuān)業(yè)知識(shí)對(duì)臨床發(fā)生不良反應(yīng)的判斷和分析能力。方法:查閱文獻(xiàn),對(duì)該病例中發(fā)生肌酶升高和肝損傷不良反應(yīng)的藥物相關(guān)因素進(jìn)行分析。結(jié)果:阿托伐他汀鈣片可能是肌酶升高和肝損傷原因。結(jié)論:臨床藥師需要利用專(zhuān)業(yè)知識(shí)對(duì)藥物不良反應(yīng)進(jìn)行分析和監(jiān)護(hù),提高患者用藥安全性。
關(guān)鍵詞 肌酶濃度升高 肝損傷 不良反應(yīng)
中圖分類(lèi)號(hào):R743.33 文獻(xiàn)標(biāo)識(shí)碼:C 文章編號(hào):1006-1533(2017)17-0069-03
Analysis of a stroke patient with rise of muscle enzyme concentrations and liver injury
REN Jinmei*, SHEN Yi, XIE Ning, XUE Xiaohong**
(Qingpu Branch of Zhongshan Hospital affiliated to Fudan University, Shanghai 201700, China)
ABSTRACT Objective: To improve the judgment and analytic ability of clinical pharmacists for adverse drug reactions(ADR) by analysis of the reasons of muscle enzyme concentration rise and liver injury of a case of stroke patient. Methods: The ADR occurred duo to enzyme concentration rise and liver injury related to drugs were judged and analyzed by reviewing the relative literatures. Results: atorvastatin might induce muscle enzyme concentration rise and liver injury. Conclusion: Clinical pharmacists should use their professional knowledge to judge and analyze ADR so as to improve the safety of medication.
KEy WORDS muscle enzyme concentration rise; liver injury; adverse drug reactions
1 病歷摘要
患者,女,72歲,10月28日入院前5.5 h在進(jìn)食時(shí)無(wú)明顯誘因下出現(xiàn)左側(cè)肢體乏力,不能站立,跌倒在地,伴有頭暈,患者癥狀無(wú)明顯自行緩解趨勢(shì),遂至我院就診,擬診為“腦栓塞”收治入院。
疾病史:有高血壓病史半年,平時(shí)口服坎地沙坦、螺內(nèi)酯控制血壓治療,隨訪血壓最高180/100 mmHg。有房顫病史2年,平時(shí)口服拜阿司匹林、地高辛、比索洛爾治療。否認(rèn)糖尿病、既往卒中史及血液系統(tǒng)疾病史。入院時(shí)體格檢查:T 37 ℃,P 76 次/min,R 20 次/min,BP 160/90 mmHg。輔助檢查:頭顱影像結(jié)果:老年腦改變;血常規(guī):WBC 7.9×109/L,N 72.1%,Hb 125 g/L,PLT 133×109/L;肌酐 57 mmol/L。鉀 4.2 mmol/L,血糖 6.3 mmol/L。凝血時(shí)間:PT 11.5 s,APTT 22.5 s。心電圖提示:心房顫動(dòng),T波Ⅱ、Ⅲ、AVF、V4-V6負(fù)正雙向。
入院后次日抽血化驗(yàn),磷酸肌酸激酶(CK)、丙氨酸氨基轉(zhuǎn)移酶(ALT)以及門(mén)冬氨酸氨基轉(zhuǎn)移酶(AST)均在正常值范圍內(nèi)。治療方案為:使用阿托伐他汀鈣片(批號(hào):R65307,輝瑞制藥有限公司)20 mg,po,qn進(jìn)行調(diào)脂治療;疏血通6 ml,qd,iv.gtt活血化瘀;馬來(lái)酸桂哌齊特注射液320 mg,qd,iv.gtt改善腦循環(huán);依達(dá)拉奉30 mg,bid,iv.gtt進(jìn)行腦保護(hù);坎地沙坦分散片4 mg,po,qd控制血壓;……