临床药师参与心脏瓣膜置换术后患者的药学服务实践与体会

目的 探讨临床药师对心脏瓣膜置换术后患者实施药学服务的切入点。方法 结合典型案例阐述临床药师对心脏瓣膜置换术后患者实施药学服务的内容、重点及效果。结果 临床药师对患者实施抗凝治疗监护及华法林剂量调整方案建议，感染监测及抗菌药物合理应用与监护，围手术期气道管理，应激性溃疡（SU）预防与药学监护，对患者进行华法林用药教育等药学服务，促进了药物的合理使用，改善了患者的治疗效果。结论 临床药师深入临床对心脏瓣膜置换术后患者实施药学服务有助于提高药物治疗的安全性和有效性。

Practice and experience of clinical pharmacists participating in pharmaceutical care for patients after heart valve replacement

Objective To explore the starting point of pharmaceutical care by clinical pharmacists for patients after heart valve replacement. Methods Combined with typical cases, the content, focus and effects of pharmaceutical care for patients after heart valve replacement were summarized. Results Clinical pharmacists provided pharmaceutical services such as anticoagulant care and warfarin dosage adjustment, infection monitoring and rational use and care of antibacterial, perioperative airway management, stress ulcer (SU) prevention and pharmaceutical care, and warfarin medication education for patients, which had promoted the rational use of drugs and improved the treatment results of patients. Conclusion Pharmaceutical care by clinical pharmacists could be helpful to improve the safety and efficacy of drug treatment for patients after heart valve replacement.