郭丽萍 陈永妍 于丽

    摘 要 目的：探讨临床药师在急性冠脉综合征患者PCI围术期抗血小板治疗中的作用。方法：临床药师参与1例急性冠脉综合征患者PCI围术期出现替格瑞洛不耐受且氯吡格雷抵抗的抗血小板药物治疗，分析替格瑞洛相关呼吸困难的原因及解决策略，探讨如何从替格瑞洛转换为氯吡格雷以及出现氯吡格雷抵抗如何调整药物剂量。结果：临床药师基于循证医学证据和药代动力学特点，结合患者病情变化，协助医师制定个体化的抗血小板治疗方案并取得满意疗效。结论：临床药师利用自身专业药学知识，积极开展药学服务，优化抗血小板治疗方案，保障患者用药安全、有效。

    关键词 急性冠脉综合征 抗血小板 替格瑞洛 氯吡格雷抵抗

    中图分类号：R543.31； R973.2 文献标志码：C 文章编号：1006-1533(2020)17-0050-04

    Clinical pharmacists participate in the management of difficult antiplatelet therapy for acute coronary syndrome patients with PCI

    GUO Liping*， CHEN Yongyan， YU Li

    (Department of Pharmacy， the Seventh Peoples Hospital of Zhengzhou， Zhengzhou 450016， China)

    ABSTRACT Objective： To explore the role of clinical pharmacists in antiplatelet therapy during PCI perioperative period of patients with acute coronary syndrome. Methods： Clinical pharmacists participated in antiplatelet therapy for a patient with acute coronary syndrome who had ticagrelor intolerance and clopidogrel resistance during the perioperative period of PCI， analyzed the causes and solution of ticagrelor related dyspnea， explored the methods of switching from ticagrelor to clopidogrel and adjusted the drug dosage when clopidogrel resistance occurred. Results： Based on the evidence-based medicine evidence ......