4例精神药物治疗药物监测典型病例回顾分析  

Therapeutic drug monitoring of psychotropic drugs:a retrospective analysis of four cases

作　　者：孙川[1] 郭桂欣[1] 张军[1] 孔国强[1] 李文标[1] 果伟[1] 

机构地区：[1]首都医科大学附属北京安定医院临床精神药理实验室,北京100088

出　　处：《中国新药杂志》2011年第2期187-190,共4页Chinese Journal of New Drugs

基　　金：北京市首都医学发展科研基金(2007-3087;2009-3135)

摘　　要：目的:总结治疗药物监测在精神科应用的临床经验。方法:回顾国内外治疗药物监测在精神科发展的历史,结合临床经验对4例个案进行分析:患者氯丙嗪中毒后出现浓度反弹,通过监测药物清除过程辅助判断救治效果;通过利培酮与9-羟利培酮浓度比例判断患者CYP2D6酶活性及其代谢型,为患者个体化用药提供参考;对同时使用9种精神药物的患者进行浓度测定,结果表明该用药方案不合理,患者经单药治疗后已康复;少部分服用氯氮平患者,血药浓度长期维持在高浓度,需严密监视此类患者药物浓度波动。结果:治疗药物监测可应用于如下领域:监测药物中毒后的药物清除过程;结合代谢酶活性数据指导患者个体化用药;以浓度测定结果辅助判断合并用药是否合理;重视异常结果,结合患者症状判断浓度是否合理。结论:治疗药物监测结果需结合患者病情与临床疗效综合判断,方能实现个体化给药这一目的。Objective： To evaluate the uses and procedures of therapeutic drug monitoring in clinical treatments.Methods： The development history of therapeutic drug monitoring in psychiatrics was reviewed,and four representative cases were analyzed in conjunction with clinical experiences.These cases included concentration rebounding after chlorpromazine overdose,and the treatment was assessed through monitoring drug elimination process.The enzyme activity and metabolic types of CYP2D6 were judged to facilitate individualized medication based on the concentrations of risperidone and 9-OH risperiodne.The impropriety of the prescription was analyzed by determination of concentrations in a patient taking nine therapeutic drugs,who recovered from abnormality after taking single medicine.High-level blood concentration was intensively monitored for controlling concentration variations in patients taking clozapine.Results： Therapeutic drug monitoring could be used in the following situations： monitoring of drug elimination process in overdosed patients,guiding individualized medication through multi-drug concentration monitoring,analysis of the rationale of multi-drug combination,and elucidating abnormal results.Conclusion： Individualized medication can only be achieved on account of an overall judgment involving therapeutic drug monitoring results,patient conditions and clinical efficacy.

关 键 词：治疗药物监测 临床药学 个体化治疗 精神药物 

分 类 号：R971[医药卫生—药品]