OBJECTIVE:To provide reference for the formulation of individualized treatment plan for patients with cardiogenic ischemic stroke. METHODS:For a patient with cardiogenic ischemic stroke,clinical pharmacists adjusted lipid-lowering scheme according to disease progress combined with treatment principle of ischemic stroke and cardiogenic ischemic stroke;recommended second-level prevention and assisted physicians to adjust anti-infective plan according to individual situation of patient. When patients suffered from liver dysfunction,it was recommended to stop using drugs that may cause liver dysfunction,detect renal function damage early,analyze renal function impairment caused by insufficient fluid circulation,timely supplement fluid and provide whole-process pharmaceutical care in respects of anticoagulation, lipid-lowering and anti infection treatment, etc. RESULTS:Physician adopted the recommend of pharmacists and they formulated individualized treatment plan for cardiogenic ischemic stroke patients together;liver and kidney function recovered,and the condition of patient was improved. INR control (1.8)was better at discharge,and discharged education was provided for the patients at the same time. CONCLUSIONS:Clinical pharmacists participate in the treatment for the patient with cardiogenic ischemic stroke and assist physicians to optimize treatment plan according to disease condition. When ADR occurs,timely adjustment of treatment plan ensures the safety and effectiveness of patient medication.%目的:为心源性缺血性脑卒中患者个体化治疗方案的制订提供参考.方法:针对1例心源性缺血性脑卒中患者,临床药师结合缺血性脑卒中、心源性缺血性脑卒中的治疗原则,依据患者病情进展调整降脂方案,依据患者个体情况推荐二级预防,并协助临床医师调整抗感染治疗方案;当患者出现肝功能损伤时,建议停用可能引起肝功能减退的药物;及早发现肾功能损伤,并分析出是因液体循环不足所引起的肾功能损伤,建议及时补液,从抗凝、降脂、抗感染治疗等多方面全程实施药学监护.结果:临床医师采纳药师建议,共同为该心源性缺血性脑卒中患者制订了其个体化治疗方案,患者病情好转,肝、肾功能恢复正常,出院时国际标准化比值(INR)为1.8,控制较好,同时临床药师对其进行出院教育.结论:临床药师参与心源性缺血性脑卒中患者治疗全过程,可依据患者病情变化情况协助医师优化治疗方案,当发生不良反应时,及时更改方案,保证了患者用药的安全性和有效性.
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