Von Ruden Serena A S, Murray Margaret A, Grice Jennifer L, Proebstle Amy K, Kopacek Karen J
Franciscan Health System, St. Joseph Hospital, Tacoma, WA, USA.
J Pharm Pract. 2012 Apr;25(2):232-49. doi: 10.1177/0897190011431635.
Advances in mechanical circulatory support, such as the use of ventricular assist devices (VADs), have become a means for prolonging survival in end-stage heart failure (HF). VADs decrease the symptoms of HF and improve quality of life by replacing some of the work of a failing heart. They unload the ventricle to provide improved cardiac output and end-organ perfusion, resulting in improvement in cardiorenal syndromes and New York Heart Association functional class rating. VADs are currently used asa bridge to heart transplantation, a bridge to recovery of cardiac function, or as destination therapy. Complications of VAD include bleeding, infections, arrhythmias, multiple organ failure, right ventricular failure, and neurological dysfunction. Patients with VAD have unique pharmacotherapeutic requirements in terms of anticoagulation, appropriate antibiotic selection, and continuation of HF medications. Pharmacists in acute care and community settings are well prepared to care for the patient with VAD. These patients require thorough counseling and follow-up with regard to prevention and treatment of infections, appropriate levels of anticoagulation, and maintenance of fluid balance. A basic understanding of this unique therapy can assist pharmacists in attending to the needs of patients with VAD.
机械循环支持技术的进展，如使用心室辅助装置（VAD），已成为延长终末期心力衰竭（HF）患者生存期的一种手段。VAD通过替代衰竭心脏的部分工作，减轻了HF症状并改善了生活质量。它们使心室减负，以提高心输出量和终末器官灌注，从而改善心肾综合征和纽约心脏协会心功能分级。目前，VAD被用作心脏移植的桥梁、心脏功能恢复的桥梁或作为终末期治疗手段。VAD的并发症包括出血、感染、心律失常、多器官衰竭、右心室衰竭和神经功能障碍。VAD患者在抗凝、选择合适的抗生素以及继续使用HF药物方面有独特的药物治疗需求。急症护理和社区医疗机构的药剂师已做好充分准备，为VAD患者提供护理。这些患者在感染的预防和治疗、适当的抗凝水平以及维持液体平衡方面需要全面的咨询和随访。对这种独特治疗方法的基本了解有助于药剂师满足VAD患者的需求。
