首页|1例重症肺炎合并心室内血栓、肺栓塞的高肾脏排泄率患儿抗血栓治疗与药学监护

1例重症肺炎合并心室内血栓、肺栓塞的高肾脏排泄率患儿抗血栓治疗与药学监护

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临床药师参与1例重症肺炎合并心室内血栓、肺栓塞高肾脏排泄率患儿的抗血栓诊疗过程.患儿因"重症肺炎"入院,结合凝血常规指标初期考虑为重症肺炎所致凝血功能异常,之后进展为右心室血栓、双肺动脉多发栓塞,临床药师结合患儿的年龄、体重、弥散性血管内凝血及血小板计数指标动态变化和肝肾功能变化,评估血栓及出血风险,协助临床医师制定个体化抗血栓治疗方案,住院期间,患儿D-二聚体进行性升高,考虑可能与患儿自身高肾脏排泄率有关,临床药师及时建议调整抗血栓药物的频次和剂量,临床医师采纳了建议,患儿血栓团块缩减消退,恢复良好并顺利出院,随访患儿血栓未复发.临床药师通过全程药学监护,协助医师制定个体化抗血栓方案,改善了患儿的预后,确保了抗血栓药物使用的有效性和安全性.本文可为类似患儿的抗血栓治疗提供参考.
Analysis of antithrombotic therapy and pharmaceutical care in a child with severe pneumonia complicated with intraventricular thrombosis and pulmonary embolism with high renal excretion rate
Clinical pharmacists participated in the antithrombotic diagnosis and treatment of a child with severe pneumonia complicated with intraventricular thrombosis,pulmonary embolism and high renal excretion rate.The child was admitted to the hospital due to"severe pneumonia".Based on the initial coagulation routine indicators,it was considered that the coagulation dysfunction was caused by severe pneumonia.Later,it progressed to right ventricular thrombus and multiple embolisms in both pulmonary arteries.The clinical pharmacist evaluated the risk of thrombus and bleeding by considering the child's age,weight,dynamic changes in disseminated intravascular coagulation and platelet count indicators,as well as liver and kidney function changes.They assisted the clinician in developing an individualized antithrombotic treatment plan.During hospitalization,the child's D-dimer level increased progressively,which was considered to be related to the child's high renal excretion rate.The clinical pharmacist promptly suggested adjusting the frequency and dosage of the antithrombotic medication.The clinician adopted the suggestion,and the child's thrombus masses reduced and dissipated.The child recovered well during hospitalization and was discharged smoothly,follow-up showed no recurrence of thrombus.Clinical pharmacists assisted physicians in developing individualized antithrombotic regimens for children through full pharmacological monitoring,which improved the prognosis of the children,ensured the effectiveness and safety of antithrombotic medication use,and could also provide a reference for antithrombotic therapy for similar children.

Severe pneumoniaPulmonary embolismHigh renal excretion rateAntithrombotic therapyPharmaceutical care

王利媛、王法财、李平

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上海交通大学医学院附属新华医院临床药学部(上海 200092)

安徽医科大学附属六安医院(六安市人民医院)药学部(安徽六安 237005)

重症肺炎 肺栓塞 高肾脏排泄率 抗血栓治疗 药学监护

安徽省高校自然科学研究重点项目

KJ2021A0342

2024

药物流行病学杂志
中国药学会 武汉医药(集团)股份有限公司

药物流行病学杂志

CSTPCD
影响因子:0.746
ISSN:1005-0698
年,卷(期):2024.33(8)