One 55-year-old female patient with chronic obstructive pulmonary disease for 30 years was hospitalized and diagnosed as pulmonary heart disease, right heart failure, NYHA class Ⅲ, type Ⅱ respiratory failure, acute exacerbation of chronic obstructive pulmonary disease, arrhythmia, atrial fibrillation with Ⅱ degree atrioventricular block. After admission, combined treatment including cefuroxime for anti-infection, salbutamol sulfate solution for expansion of the trachea, budesonide suspension for reducing inflammatory reactions, spironolactone tablets and furosemide injection for reducing cardiac preload, nitroglycerin injection for reducing cardiac afterload, dopamine hydrochloride injection for improving heart failure, warfarin sodium tablets for anticoagulation were given to the patient. The patient was improved and discharged with stable condition. Clinical pharmacist performed pharmaceutical care during the course of therapy through paying close attention on the potential drug interaction, the rational use of traditional Chinese medicine injections, the incompatibility of liquids, adverse drug reaction, communication with doctors, medication education, etc.%1例55岁女性患者,有慢性阻塞性肺疾病30年,诊断为肺源性心脏病、右心衰、心功能Ⅲ级、Ⅱ型呼吸衰竭;慢性阻塞性肺疾病急性加重;心律失常,心房纤颤伴Ⅱ度房室传导阻滞.入院给予头孢呋辛抗感染;吸入用硫酸沙丁胺醇溶液及吸入用布地奈德混悬液扩张气管,减轻炎症反应;螺内酯片、呋塞米注射液降低前负荷,硝酸甘油注射液降低后负荷,盐酸多巴胺注射液改善心衰,华法林钠片抗凝等治疗后,患者气喘、气短、咳嗽缓解,病情稳定后出院.临床药师对患者进行药学监护,针对患者治疗过程中可能出现的药物间潜在的相互作用、中药注射剂的合理使用、药品不良反应的发生、患者用药教育等方面主动与医生沟通,并提出优化方案.
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