Pharmaceutical care for a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease

WANG Qing; QUAN Shuyan

doi:10.6039/j.issn.1001-0408.2024.08.19

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Pharmaceutical care for a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease

更新时间：2025-09-25

- Pharmaceutical care for a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease
- ZHONGGUO YAOFANG Vol. 35, Issue 8, Pages: 1006-1010(2024)
- 作者机构：
  
  陆军军医大学第二附属医院药剂科，重庆　400037
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.08.19
  CLC： R969.3;R714.21
- Received：09 November 2023，
  
  Revised：2024-03-18，
  
  Accepted：26 March 2024，
  
  Published：30 April 2024
- 稿件说明：
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王庆,全淑燕.1例先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的药学监护[J].中国药房,2024,35(08):1006-1010.

WANG Qing,QUAN Shuyan.Pharmaceutical care for a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease[J].ZHONGGUO YAOFANG,2024,35(08):1006-1010.
王庆,全淑燕.1例先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的药学监护[J].中国药房,2024,35(08):1006-1010. DOI： 10.6039/j.issn.1001-0408.2024.08.19.

WANG Qing,QUAN Shuyan.Pharmaceutical care for a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after operation of congenital heart disease[J].ZHONGGUO YAOFANG,2024,35(08):1006-1010. DOI： 10.6039/j.issn.1001-0408.2024.08.19.

摘要

目的

为先天性心脏病术后心房扑动伴心房颤动（以下简称“房扑伴房颤”）合并前置胎盘出血及血小板减少先兆流产患者的安全用药提供参考。

方法

临床药师参与1例先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的诊治过程，针对其使用依诺肝素钠后出现的血小板下降，建议停用依诺肝素钠，复查血常规后改为磺达肝癸钠；针对患者心率快、血压低，建议选择美托洛尔并根据心率调整剂量，同时将呋塞米改为氢氯噻嗪；针对医师拟于剖宫产术前停用美托洛尔，改为索他洛尔，建议继续使用美托洛尔；针对患者可能出现的药物相互作用，建议密切监测血钾等指标，并进行用药教育。

结果

医师采纳临床药师建议。患者出血得到控制，住院期间各项指标均维持稳定，孕周延长，并顺利行剖宫产术。

结论

临床药师通过参与先天性心脏病术后房扑伴房颤合并前置胎盘出血及血小板减少先兆流产患者的治疗过程，以药物不良反应、药物相互作用及患者用药教育为切入点，为患者制定个体化用药方案，确保了用药的安全性和有效性。

Abstract

OBJECTIVE

To provide a reference for the safe administration of patients with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease.

METHODS

Clinical pharmacists participated in the diagnosis and treatment of a patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease. Given the thrombocytopenia caused by enoxaparin sodium， pharmacists suggested to stop enoxaparin sodium and change it to fondaparinux sodium after a blood routine review. For the patient with fast heart rate and low blood pressure， pharmacists recommended to choose metoprolol and adjust the dosage according to the heart rate， and change furosemide to hydrochlorothiazide. Pharmacists recommended to continue using metoprolol regarding doctors’ plan to replace metoprolol with sotalol before cesarean section. For possible drug interactions in the patient， pharmacists recommended to closely monitor blood potassium and other indicators， and provided drug education.

RESULTS

The doctors adopted the advice of clinical pharmacists. The patient’s bleeding was controlled， the indicators were kept stable during hospitalization， the gestational week was extended smoothly， and the cesarean section was successfully performed.

CONCLUSIONS

By participating in the treatment of the patient with atrial flutter， atrial fibrillation， placenta praevia hemorrhage and thrombocytopenia-threatened abortion after the operation of congenital heart disease， clinical pharmacists formulate individualized medication plans for the patient based on adverse drug reactions， drug interactions and medication education， ensuring the safety and effectiveness of medication.

关键词

Keywords

references

中华医学会妇产科学分会产科学组 . 妊娠合并心脏病的诊治专家共识：2016 [J ] . 中华妇产科杂志， 2016 ， 51 （ 6 ）： 401 - 409 .

Department of Obstetrics and Gynecology，Chinese Medical Association . Expert consensus on diagnosis and treatment of pregnancy complicated with heart disease：2016 [J ] . Chin J Obstet Gynecol ， 2016 ， 51 （ 6 ）： 401 - 409 .

张沛瑶，刘晋萍 . 复杂先天性心脏病术后患者的妊娠结局及围妊娠期管理 [J ] . 中国体外循环杂志， 2019 ， 17 （ 4 ）： 252 - 256 .

ZHANG P Y ， LIU J P . Pregnancy outcomes and gestational management in women after operations for complex congenital heart diseases [J ] . Chin J Extracorpor Circ ， 2019 ， 17 （ 4 ）： 252 - 256 .

黄楚冰，王晨虹，刘莹，等 . 心脏矫正术对先天性心脏病妇女妊娠结局影响的Meta分析 [J ] . 国际妇产科学杂志， 2019 ， 46 （ 6 ）： 649 - 656 .

HUANG C B ， WANG C H ， LIU Y ， et al . Effect of cardiac correction on pregnancy outcomes in women with congenital heart disease：a meta-analysis [J ] . J Int Obstet Gynecol ， 2019 ， 46 （ 6 ）： 649 - 656 .

中华医学会妇产科学分会产科学组 . 前置胎盘的诊断与处理指南：2020 [J ] . 中华妇产科杂志， 2020 ， 55 （ 1 ）： 3 - 8 .

Department of Obstetrics and Gynecology，Chinese Medical Association . Guidelines for the diagnosis and management of placenta previa：2020 [J ] . Chin J Obstet Gynecol ， 2020 ， 55 （ 1 ）： 3 - 8 .

李清娟，张全华，张玲 . 妊娠合并血小板减少不同病因患者临床特点及治疗结局分析 [J ] . 中国计划生育学杂志， 2022 ， 30 （ 9 ）： 2081 - 2085 .

LI Q J ， ZHANG Q H ， ZHANG L . Analysis of clinical characteristics and treatment outcomes of pregnant women with thrombocytopenia because of different aetio-logies [J ] . Chin J Fam Plan ， 2022 ， 30 （ 9 ）： 2081 - 2085 .

张健，李殿富 . 妊娠期房颤的研究进展 [J ] . 实用心电学杂志， 2022 ， 31 （ 5 ）： 305 - 309 .

ZHANG J ， LI D F . Research advances in atrial fibrillation during pregnancy [J ] . J Pract Electrocardiol ， 2022 ， 31 （ 5 ）： 305 - 309 .

中华医学会心血管病学分会，中国生物医学工程学会心律分会 . 心房颤动诊断和治疗中国指南 [J ] . 中华心血管病杂志， 2023 ， 51 （ 6 ）： 572 - 618 .

Chinese Society of Cardiology ， Heart Rhythm Branch of Chinese Society of Biomedical Engineering . Chinese guidelines on diagnosis and management of atrial fibril-lation [J ] . Chin J Cardiol ， 2023 ， 51 （ 6 ）： 572 - 618 .

中华医学会妇产科学分会产科学组 . 早产临床诊断与治疗指南：2014 [J ] . 中华围产医学杂志， 2015 （ 4 ）： 241 - 245 .

Department of Obstetrics and Gynecology，Chinese Medical Association . Guidelines for clinical diagnosis and treatment of premature delivery：2014 [J ] . Chin J Perinat Med ， 2015 （ 4 ）： 241 - 245 .

BATES S M ， RAJASEKHAR A ， MIDDELDORP S ， et al . American Society of Hematology 2018 guidelines for management of venous thromboembolism：venous thromboembolism in the context of pregnancy [J ] . Blood Adv ， 2018 ， 2 （ 22 ）： 3317 - 3359 .

中华医学会心电生理和起搏分会，中国医师协会心律学专业委员会，中国房颤中心联盟心房颤动防治专家工作委员会 . 心房颤动：目前的认识和治疗建议：2021 [J ] . 中华心律失常学杂志， 2022 ， 26 （ 1 ）： 15 - 88 .

Chinese Society of Electrophysiology and Pacing ， Chinese Medical Doctor Association Arrhythmia Professional Committee ， Chinese Atrial Fibrillation Center Alliance Atrial Fibrillation Prevention and Treatment Expert Wor-king Committee . Current knowledge and management of atrial fibrillation：consensus of Chinese experts 2021 [J ] . Chin J Card Arrhythm ， 2022 ， 26 （ 1 ）： 15 - 88 .

国家食品药品监督管理局药品安全监管司，国家药品不良反应监测中心 . 药品不良反应报告和监测工作手册 [EB/OL ] .（ 2012-11-01 ）[ 2023-10-20 ] . https：//www.docin.com/p-763967330.html https://www.docin.com/p-763967330.html .

Department of Drug Safety Supervision ， State Food and Drug Administration ， National Center for ADR Monito-ring of China . ADR reporting and monitoring handbook [EB/OL ] .（ 2012-11-01 ）[ 2023-10-20 ] . https：//www.docin.com/p-763967330.html https://www.docin.com/p-763967330.html .

REGITZ-ZAGROSEK V ， ROOS-HESSELINK J W ， BAUERSACHS J ， et al . 2018 ESC guidelines for the ma-nagement of cardiovascular diseases during pregnancy [J ] . Eur Heart J ， 2018 ， 39 （ 34 ）： 3165 - 3241 .

孙艺红，刘念，薛玉梅，等 . 心房颤动节律控制药物规范应用专家共识 [J ] . 中华内科杂志， 2023 ， 62 （ 4 ）： 343 - 355 .

SUN Y H ， LIU N ， XUE Y M ， et al . Chinese consensus on the use of antiarrhythmic drugs for rhythm control in atrial fibrillation [J ] . Chin J Int Med ， 2023 ， 62 （ 4 ）： 343 - 355 .

ALI A A ， SAYED A K ， SHERIF L E ， et al . Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor [J ] . Int J Gynaecol Obstet ， 2019 ， 145 （ 2 ）： 139 - 148 .

ROVERS J F J ， THOMISSEN I J C ， JANSSEN L C E ， et al . The relationship between antenatal indomethacin as a tocolytic drug and neonatal outcomes：a retrospective cohort study [J ] . J Matern Fetal Neonatal Med ， 2021 ， 34 （ 18 ）： 2945 - 2951 .

SHIMIZU K ， NANBA M ， TAKAISHI Y ， et al . Acute pulmonary edema induced by a low dose of ritodrine hydrochloride：a case report [J ] . Kobe J Med Sci ， 2021 ， 66 （ 5 ）： E166 - E169 .

YU Y ， YANG Z ， WU L Y ， et al . Effectiveness and safety of atosiban versus conventional treatment in the management of preterm labor [J ] . Taiwan J Obstet Gynecol ， 2020 ， 59 （ 5 ）： 682 - 685 .

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