本文選題：臨床藥師 + 藥學(xué)監(jiān)護�。� 參考：《中國藥房》2017年35期

【摘要】：目的:探討臨床藥師在中性粒細胞缺乏伴發(fā)熱(以下簡稱"粒缺伴發(fā)熱")白血病患兒的藥物治療過程中的作用。方法:臨床藥師參與1例粒缺伴發(fā)熱白血病患兒的藥物治療過程,考慮到患兒血小板持續(xù)減少并伴有鼻衄,結(jié)合其年齡、臨床癥狀、實驗室檢查指標及相關(guān)指南,臨床藥師分析可能與化療藥物所致的骨髓抑制以及頭孢哌酮鈉舒巴坦鈉所致的藥源性出血有關(guān),故建議立即停用頭孢哌酮鈉舒巴坦鈉,改用注射用美羅培南1.0 g,ivgtt,q8 h抗感染,加用重組人血小板生成素注射液15 000 U,sc,qd升血小板;治療過程中,考慮到患兒中性粒細胞(0.17×10~9L~(-1))、血小板水平(11×10~9L~(-1))仍偏低,建議繼續(xù)行抗感染、升血小板治療,并繼續(xù)使用脾多肽注射液輔助增強造血功能;待患兒病情穩(wěn)定,中性粒細胞恢復(fù)正常后,先后建議停止升血小板、抗感染治療;同時行體溫監(jiān)測、血常規(guī)等相關(guān)指標檢查與不良反應(yīng)監(jiān)測等藥學(xué)監(jiān)護。結(jié)果:醫(yī)師采納臨床藥師建議。患兒體溫下降,血象逐漸恢復(fù),未發(fā)生感染,順利進入下一輪化療。結(jié)論:臨床藥師參與粒缺伴發(fā)熱白血病患兒的藥物治療過程,應(yīng)重視藥源性疾病的預(yù)防、診斷和治療,并利用其自身專業(yè)優(yōu)勢,以藥物可能對血液系統(tǒng)所造成的影響以及藥物的藥效學(xué)、藥動學(xué)特點為切入點,結(jié)合患兒年齡、病情等具體情況作出綜合分析,協(xié)助醫(yī)師制訂和優(yōu)化藥物治療方案,保證了用藥的安全、有效。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of neutrophil deficiency with fever in children with leukemia.Methods: a clinical pharmacist took part in the course of drug therapy in a child with fever and leukemia, taking into account the persistent thrombocytopenia and epistaxis, combined with age, clinical symptoms, laboratory indicators and related guidelines.Clinical pharmacist analysis may be related to bone marrow suppression induced by chemotherapeutic drugs and drug-induced hemorrhage caused by cefoperazone sodium and sulbactam sodium. Therefore, it is recommended that cefoperazone sodium sulbactam should be stopped immediately and meropenem 1.0 g / d iv gttt Q8 h should be used for anti-infection.In the course of treatment, taking into account that neutrophils 0.17 脳 10 ~ (9) L ~ (-1) and platelet level of 11 脳 10 ~ (9) L ~ (-1) were still low, it was suggested to continue anti-infection and platelet ascending therapy in the course of treatment with recombinant human thrombopoietin injection 15 000 Usco QD.And continued to use spleen polypeptide injection to enhance hematopoietic function; after the patient's condition was stable and neutrophil returned to normal, it was recommended to stop ascending platelets and anti-infection treatment; at the same time, body temperature was monitored.Pharmacological monitoring such as blood routine examination and adverse reaction monitoring.Results: the physician accepted the advice of the clinical pharmacist.The child's body temperature drops, the hemogram recovers gradually, does not have the infection, smoothly enters the next round of chemotherapy.Conclusion: clinical pharmacists should pay attention to the prevention, diagnosis and treatment of drug-induced diseases, and take advantage of their own professional advantages.Starting with the possible effects of drugs on the blood system, the pharmacodynamics and pharmacokinetic characteristics of drugs, and combining the specific conditions of the child's age, illness and so on, to make a comprehensive analysis, and to assist doctors in formulating and optimizing drug treatment plans.The drug is safe and effective.
【作者單位】： 第三軍醫(yī)大學(xué)第三附屬醫(yī)院藥劑科;
【基金】：中華醫(yī)學(xué)會課題(No.2016B-YX025) 重慶市高等教育教學(xué)改革研究項目(No.163198) 第三軍醫(yī)大學(xué)第三附屬醫(yī)院院所教育科研立項課題(No.50212-2434、2636)
【分類號】：R733.7

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