1例中毒性表皮坏死松解型药疹患者的药学监护  

Pharmaceutical care on one patient with drug-induced toxic epidermal necrolysis

作　　者：王秀琴[1] 杨学武[2] 徐春静[1] 石蕾[1] 

机构地区：[1]北京军区263医院药剂科,北京101149 [2]天津医科大学总医院滨海医院急创综合外科,天津300480

出　　处：《中国药物应用与监测》2016年第1期21-24,共4页Chinese Journal of Drug Application and Monitoring

摘　　要：1例58岁女性患者,因药物性皮炎入院。入院后患者经历全身皮肤剥脱,脚趾甲、手指甲脱落,牙齿脱落等病情变化,同时伴有高热(40℃),WBC、CRP等指标偏高。入院后给予异丙嗪、地塞米松、葡萄糖酸钙及氢化可的松琥珀酸钠抗过敏治疗,效果欠佳,大疱逐渐破溃,皮肤松解剥脱,诊断为"中毒性表皮坏死松解型药疹"。给予甲基强的松龙琥珀酸钠加强激素治疗,并加用盐酸克林霉素联合洛美沙星进行抗感染治疗;同时给予保护胃黏膜,维持水电解质酸碱平衡,规律血液透析等治疗措施。治疗期间,临床药师对患者进行全程药学监护,包括糖皮质激素、抗菌药物的调整及药品不良反应的监测,对患者进行用药教育,保障患者用药安全有效。经综合治疗10 d后,患者病情平稳,激素逐渐减量序贯治疗,治疗99 d后,患者痊愈出院。One case of 58-year-old female patient with dermatitis medicamentosa was admitted to hospital. After admission, the patient was experienced body skin exfoliation, toenails and fingernails shedding, teeth loss and other changes in condition, accompanied by high fever （40℃） and increasement of WBC, CRP and other inflammatory markers. The patient were given antiallergic treatment by promethazine, dexamethasone, calcium gluconate and hydrocortisone sodium succinate. However the effect was not significant. Bullous was ruptured progressively. Skin became loose and fell off. The clinical diagnosis was toxic epidermal necrolysis. The patient was given methylprednisolone sodium succinate to strengthen hormone therapy accompanied by anti- infective treatment of clindamycin hydrochloride and lomefloxacin. Other treatments were given such as inhibiting gastric acid secretion to protect the gastric mucosa, maintaining water and electrolyte acid-base balance, regular hemodialysis and so on. Clinical pharmacists involved in the whole treatment, including the adjustment the dose of glucocorticoids and antimicrobials, the monitoring of adverse drug reactions, performing the drug education for patients to ensure the safe and effective use of drugs. After 10 days of comprehensive treatment, the patient＇s condition became stable, the amount of hormone was decreased gradually. About 99 days later, the patient was cured.

关 键 词：中毒性表皮坏死松解型药疹 临床药师 药学监护 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]