基于血药浓度监测的药学监护在大剂量甲氨蝶呤治疗非霍奇金淋巴瘤中的应用  

Application of blood concentration monitoring-based pharmaceutical care to high-dose methotrexate therapy for non-Hodgkin's lymphoma

作　　者：顾方[1] 李允武[1] 吴飞华[1] 原永芳[1] GU Fang;LI Yun-wu;WU Fei-hua;YUAN Yong-fang(Department of Pharmacy,Shanghai Ninth People＇s Hospital ＆ Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院药剂科,上海市200011

出　　处：《广西医学》2018年第17期1965-1967,共3页Guangxi Medical Journal

摘　　要：目的探讨基于血药浓度监测的药学监护在大剂量甲氨蝶呤(MTX)治疗非霍奇金淋巴瘤(NHL)过程中的应用效果。方法建立MTX血药浓度的高效液相色谱(HPLC)检测方法,监测3例使用大剂量MTX的NHL患者的血药浓度,根据血药浓度监测结果及患者具体情况制定个体化用药方案。结果 3例患者均出现MTX后期清除延迟,考虑与合并使用奥美拉唑、地西泮、吲哚美辛有关,停用相关药物并给予对症处理后,药物浓度均低于HPLC的检测线。结论部分NHL患者发生MTX清除延迟与不合理用药有关,对使用大剂量MTX治疗的NHL患者加强药学监护效果良好。Objective To investigate the efficacy of blood concentration monitoring-based pharmaceutical care applied to high-dose methotrexate（MTX） therapy for non-Hodgkin＇s lymphoma（NHL）. Methods The high-performnce liquid chromatography（HPLC） method for blood concentration monitoring of MTX was established. The blood concentration was monitored in 3 NHL cases receiving high-dose MTX. Individualized therapeutic regimen was made according to the therapeutic drug monitoring result of MTX and the patients＇ specific condition. Results Delayed MTX elimination in later period occurred in the 3 cases,and was probably related to the co-adininistration of omeprazole, diazepam or indomethacin. The blood concentration was below the detection line of HPLC after relevant drugs withdrawal and symptomatic treatment. Conclusion Delayed MTX elimination is related to irrational drug use in some NHL cases. Strengthening the pharmaceutical care might achieve a favorable efficacy for NHL patients who receive high-dose MTX.

关 键 词：非霍奇金氏淋巴瘤 甲氨蝶呤 大剂量 药学监护 血药浓度 

分 类 号：R733[医药卫生—肿瘤]