程希+蒋学华+龙恩武

    [摘要] 长期糖尿病患者往往合并多种疾病，在治疗药物的选择上需全面考量。临床药师参与1例糖尿病肾病患者诊疗全过程，结合肾功能情况，关注药物相互作用，对阿司匹林联合呋塞米引起痛风急性发作的不良反应，及时干预调整药物治疗方案，保证用药的安全性和有效性，并对患者进行正确用药和生活方式指导，使其血糖水平和痛风症状得到良好控制，提高了患者的依从性。临床药师发挥自身专业优势，协助医生优化治疗方案，在合理用药工作中发挥重要作用。

    [关键词] 糖尿病肾病；痛风；药物治疗；药学监护

    [中图分类号] R587.2 [文献标识码] A [文章编号] 1673-7210(2018)01(b)-0164-05

    [Abstract] Long term diabetes patients are often associated with a variety of diseases， the choice of therapeutic drugs need to be comprehensively considered. Clinical pharmacists participate in the whole process of diagnosis and treatment of one patient with diabetic nephropathy， in combination with renal function， pay close attention to drug interactions. To the acute attack of gout caused by Aspirin combined with Furosemide， clinical pharmacists timely intervene and adjust the drug treatment program to ensure the safety and effectiveness of medication. The patient was given correct medication and lifestyle guidance， so that the blood sugar levels and gout symptoms were well controlled， and the compliance of the patient was improved. Clinical pharmacists give full play to their professional advantages ......