临床药师参与苯扎贝特致糖尿病合并慢性肾脏病患者横纹肌溶解综合征治疗的药学实践

摘要

目的:探讨临床药师参与苯扎贝特致糖尿病合并慢性肾脏病(chronic kidney disease,CKD)患者横纹肌溶解综合征(rhabdomyolysis,RM)治疗的药学实践过程,以期为临床合理用药提供参考.方法:临床药师参与1例2型糖尿病合并CKD患者应用苯扎贝特片后出现RM的治疗过程,分析贝特类药物引发RM的危险因素,并对调脂方案的调整提出合理化建议.结果:患者经停用苯扎贝特片及积极治疗后,病情好转出院,临床药师建议将患者出院后的调脂药物改为阿托伐他汀钙片,1个月后复查,患者血脂各项指标较前明显好转.结论:糖尿病、肾功能不全、高龄等是贝特类药物引起RM的危险因素,在遴选调脂药物时,应充分权衡获益与风险,阿托伐他汀可作为首选药物之一;临床药师应积极发挥自身优势,加强用药监护及用药教育,保障患者用药安全.%OBJECTIVE:To probe into the pharmaceutical practice in the treatment of rhabdomyolysis ( RM) induced by bezafibrate in a patient with diabetes and chronic kidney disease( CKD) by clinical pharmacists, so as to provide reference for the rational drug use in clinic .METHODS:Through participated into the treatment process of RM induced by bezafibrate in a patient with diabetes and CKD, the clinical pharmacists analyzed the inducing risk factors of RM, and provided rational suggestions for adjustment of treatment regimen.RESULTS:The patient discharged from hospital after discontinuing bezafibrate and receiving effective medical treatments . The clinical pharmacist recommended that atorvastatin could be considered for the first-line drug therapy after discharged, after one month, various blood tests had been improved remarkably.CONCLUSIONS:The risk of rhabdomyolysis associated with fibrates appears to be increased for patients with diabetes, renal failure, and in older patients.It is necessary for clinicians to fully consider the benefits and risks when select lipid-regulating drugs, and atorvastatin is a preferred regimen based on its pharmacokinetic characteristics.The pharmacists should actively bring their own advantages into the supervision and education of medication , and ensure the safe medication for patients.