1例肾病综合征患者并发激素性骨坏死的风险因素分析与药学监护  

Risk Factors Analysis and Pharmaceutical Care on One Case with Nephrotic Syndrome and Glucocorticoid-induced Osteonecrosis

作　　者：潘裕华[1] 劳海燕[1] 王晓星[2] 唐崑[2] 

机构地区：[1]广东省人民医院(广东省医学科学院)药学部,广州510080 [2]中日友好医院药学部,北京100029

出　　处：《临床药物治疗杂志》2016年第3期76-80,共5页Clinical Medication Journal

基　　金：青年科学基金项目(81402942)

摘　　要：目的:探讨临床药师对激素性骨坏死的预防和治疗中可提供的药学服务。方法:临床药师结合病历,查阅文献资料,对1例肾病综合征患者出现激素性骨坏死的风险因素进行了评价与分析,根据患者的用药特点和并发疾病,提出药学监护计划,制定日后同类风险预防措施。结果:该患者为肾病综合征(微小病变肾病)的青年女性,入院后诊断双侧股骨头坏死。复习患者病历资料,激素使用总量约12 300 mg(按甲泼尼龙算)、治疗时间约1年,肾病综合征的特点如严重的低蛋白血症、高脂血症、血液高凝状态,是促进激素致骨坏死的危险因素。目前给予阿仑膦酸钠、复方丹参滴丸、华法林、双嘧达莫、瑞舒伐他汀等药物治疗骨坏死。结论:临床药师在诊疗活动中及时发现与药物相关的不良事件,提供预防和治疗的药学监护,有利于提高药物治疗的安全性和有效性。Objective： To investigate the role of clinical pharmacists in prevention and treatment of patients with nephrotic syndrome complicated by glucocorticoid-induced osteonecrosis.Methods：By reviewing patients＇ medical records and searching literatures,clinical pharmacists performed evaluation and analysis on risk factors inducing glucocorticoid-induced osteonecrosis in one patient with nephrotic syndrome,provided pharmaceutical care based on the drugs administered and underlying diseases, and formulated preventive measures against the similar risks.Results：An 20 year-old female patient with mininal-change disease was diagnosed as bilateral femoral head necrosis after admission.Reviewed the patient’s medical records, the total dosage she had taken was about 12 300 mg （calculated as methylprednisolone） and the duration is about 1 year. Features of nephrotic syndrome, for example severe hypoproteinemia, hyperlipidemia and hypercoagulability, may increase the risk of glucocorticoid-induced osteonecrosis. The patient was administrated with alendronate, compound danshen dripping pills, warfarin, dipyridamole and rosuvastatin.Conclusion：Clinical pharmacists promptly discover drug-related adverse events during diagnosis and treatment activities, and provide pharmaceutical care on prevention and treatment, which can improve the safety and effectiveness of drug treatment.

关 键 词：肾病综合征 激素性骨坏死 药学监护 风险因素分析 

分 类 号：R969.3[医药卫生—药理学]