【作者】 杨佳丹； 朱深银； 龙锐； 刘宇； 周欣； 邱峰；

【Author】 YANG Jia-dan;ZHU Shen-yin;LONG Rui;LIU Yu;ZHOU Xin;QIU Feng;Dept.of Pharmacy,The First Affiliated Hospital of Chongqing Medical University;

【机构】 重庆医科大学附属第一医院药学部；

【摘要】 目的:建立较为完善的以问题为基础的病例教学方法(PBL),为提高临床药学带教教学水平提供参考。方法:以1例重度心衰伴利尿剂抵抗患者的临床药师会诊为例,实施PBL法,通过带教老师提出启发式问题,临床药师学员带着问题,并结合患者的具体情况进行文献检索后,与老师共同制定临床会诊意见。最后评价PBL法的教学效果。结果:学员通过分析一例心衰会诊患者,有低钠,同时有肾脏功能恶化倾向,伴利尿剂抵抗。通过PBL教学法,学员与老师共同制定会诊意见,建议使用血管加压素受体拮抗剂。之后患者病情好转,心衰明显控制,临床证实有效。结论:心力衰竭是一种复杂的临床症状群,对于有液体潴留的心衰患者,利尿剂是唯一能充分控制和有效消除液体潴留的药物,但利尿剂抵抗极大的增加了猝死或因泵衰导致死亡的风险,因此如何选择利尿剂以及如何应对利尿剂抵抗对于心衰患者,尤其急性心衰或重度心衰患者具有重要的临床意义。以此作为介入点,在临床药师的教学中运用PBL教学模式使学员加深对利尿剂抵抗策略的认识,有利于增强教学效果,培养学生的自学能力和综合思考能力,能全面提高临床药师带教的质量和学员素质。更多还原

【Abstract】 OBJECTIVE:To provide reference for the teaching level in clinical pharmacy teaching in China.METHODS:In a case of consultation on a severe heart failure patient with diuretic resistance,teachers proposed heuristic problems,clinical pharmacist students performed the literature search based on problems and specific circumstances of the patient,then students and teachers made clinical consultation together.PBL method was adopted to observe the effect of teaching.RESULTS:The patient was a severe heart failure patient with low sodium,tendency of deterioration of kidney function and diuretic resistance.The students and teachers made consultation by PBL method,the patient was recommend the use of vasopressin receptor antagonists,after the use of the drug,heart failure symptom was under control,the patient was getting better,proven effective clinically.CONCLUSIONS:Heart failure has complex clinical symptoms,diuretics is the only drug which can control or eliminate fluid retention effectively for patients with fluid retention,but diuretics resistance greatly increased the risk of sudden death or death caused by pump failure,so how to choose the diuretics and how to deal with diuretic resistance for patients with heart failure,especially in patients with acute heart failure or severe heart failure,has important clinical significance.Application of PBL method in clinical pharmacy teaching sharpen to understand of diuretic resistance strategy,strengthen the teaching effects and foster the students’ ability to study on their own and the ability of comprehensive thinking,which can elevate both quality of teaching and students’ quality.更多还原