张枫艳 王素梅

    摘 要 目的：通过案例实践探讨临床药师对住院患者药学服务的模式。方法：临床药师参与1 例急性冠脉综合征合并糖尿病、高血压、肾功能不全患者的药物治疗过程，并提供个体化药学监护与用药教育。结果：通过对患者的个体化药学服务，提高了患者的临床药物治疗学水平及用药的依从性，避免或减少了药物不良反应的发生，患者病情好转出院。结论：临床药师参与用药实践可以提高临床药物使用的规范性、合理性。

    关键词 临床药师 急性冠脉综合征 药学服务

    中图分类号：R541.4； R969.3 文献标志码：B 文章编号：1006-1533(2022)01-0063-04

    Pharmaceutical care for a patient with acute coronary syndrome complicated with diabetes， hypertension and renal insufficiency

    ZHANG Fengyan， WANG Sumei

    (Department of Pharmacy， Qingpu Branch of Zhongshan Hospital， Shanghai 201700， China)

    ABSTRACT Objective： To explore the mode of pharmacy service of clinical pharmacists to inpatients by case practice. Methods： Clinical pharmacists participated in the medical treatment of a patient with acute coronary syndrome complicated with diabetes， hypertension and renal insufficiency and provided individualized pharmaceutical care and medication education. Results： Through the individualized pharmaceutical service for patients， the clinical pharmacotherapy level and medication compliance of patients were improved， the occurrence of adverse drug reactions was avoided or reduced ......