本文選題：臨床藥師 + 藥學(xué)服務(wù)　； 參考：《中國(guó)藥學(xué)雜志》2017年02期

【摘要】：目的介紹臨床藥師對(duì)1例腎移植術(shù)后嚴(yán)重根霉菌感染患者開(kāi)展藥學(xué)服務(wù),達(dá)到較好的效果。方法臨床藥師參與1例腎移植術(shù)后嚴(yán)重根霉菌感染患者的藥物治療工作,從抗微生物治療的角度和對(duì)移植腎的保護(hù)角度推薦患者使用泊沙康唑治療,同時(shí)結(jié)合該藥的藥動(dòng)學(xué)特點(diǎn)、藥物相互作用和患者的病情等因素,對(duì)藥物治療方案進(jìn)行優(yōu)化。結(jié)果使用泊沙康唑口服混懸液200 mg qid,與腸內(nèi)營(yíng)養(yǎng)液混合給藥,患者根霉菌感染得到控制;根據(jù)泊沙康唑與他克莫司藥物相互作用特點(diǎn)和患者CYP3A5基因型檢測(cè)結(jié)果調(diào)整他克莫司用量,整個(gè)治療期間,患者他克莫司血藥濃度絕大部分時(shí)間控制在4.8~6.7μg·L~(-1)之間,保證了移植腎的安全;同時(shí),通過(guò)調(diào)整泊沙康唑服藥方法、減少麥考酚鈉的劑量和補(bǔ)充微生態(tài)制劑等措施減輕了患者的腹瀉。結(jié)論腎移植術(shù)后發(fā)生嚴(yán)重感染的患者,藥物治療一般比較復(fù)雜。臨床藥師可對(duì)此類特殊人群開(kāi)展藥學(xué)服務(wù),通過(guò)治療藥物監(jiān)測(cè)及藥動(dòng)學(xué)知識(shí)分析,發(fā)揮專業(yè)特長(zhǎng),促進(jìn)此類患者獲得最佳的藥物治療。
[Abstract]:Objective to introduce a case of severe Rhizopus infection after renal transplantation. Methods one patient with severe Rhizopus infection after renal transplantation was treated by clinical pharmacists. Posaconazole was recommended from the point of view of antimicrobial therapy and renal allograft protection. At the same time, the pharmacokinetic characteristics, drug interaction and the patient's condition were combined to optimize the drug treatment plan. Results the infection of Rhizopus was controlled by oral suspension of posaconazole 200mg Qido and enteral nutrition solution. The dosage of tacrolimus was adjusted according to the interaction characteristics of posaconazole with tacrolimus and the results of CYP3A5 genotypic test. The plasma concentration of tacrolimus was controlled between 4.8 渭 g / L and 6.7 渭 g / L during the whole treatment period. At the same time, by adjusting the dosages of posaconazole, reducing the dose of mycophenolate sodium and supplementing microecological preparations, the diarrhea of the patients was alleviated. Conclusion Drug therapy is more complicated in patients with severe infection after renal transplantation. Clinical pharmacists can provide pharmaceutical care to this kind of special population. Through monitoring of therapeutic drugs and analysis of pharmacokinetic knowledge, the clinical pharmacists can give full play to their specialty and promote the patients to obtain the best drug treatment.
【作者單位】： 廣州醫(yī)科大學(xué)附屬第二醫(yī)院藥學(xué)部;益陽(yáng)市中心醫(yī)院藥劑科;
【分類號(hào)】：R699.2;R519

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本文編號(hào)：1851915