肾移植术后他克莫司致癫癎的诊治及个体化用药的实践  

Diagnosis and Treatment of Tacrolimus Caused Seizure After Renal Transplantation and the Practice of Individualized Medication

作　　者：何佳珂[1,2] 刘海浪[2] 于洋[1] 尹成龙[2] 马景胜[2] 杨文涛[2] 邹华 邓娜[2] 刘烨 钟林[2] HE Jiake;LIU Hailang;YU Yang;YIN Chenglong;MA Jingsheng;YANG Wentao;ZOU Hua;DENG Na;LIU Ye;ZHONG Lin(Department of Pharmacy,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Organ Transplantation,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院药学部,南昌330006 [2]南昌大学第二附属医院器官移植科,南昌330006

出　　处：《医药导报》2020年第10期1425-1428,共4页Herald of Medicine

基　　金：国家自然科学基金资助项目(81603188);中华医学会临床药学分会-吴阶平基金会科研基金(LCYX-Q006);中国博士后科学基金面上项目(2017M612165);江西省自然科学基金青年项目(20181BAB215045);江西省教育厅科学技术研究项目青年项目(GJJ170156);江西省博士后科研项目(2017KY24)。

摘　　要：目的临床药师参与门诊随访,结合治疗药物监测(TDM),提升药学服务水平。方法临床药师通过参与1例肾移植术后他克莫司致癫癎患者的诊治过程,整理并分析用药,同时利用TDM,及时调整治疗方案。结果该患者发生癫癎为他克莫司浓度过高所致,临床药师通过参与优化临床治疗方案,使严重不良反应得以完全缓解。随访至今,未再发生免疫抑制剂相关不良反应。结论临床药师应积极参与门诊随访,评估药物疗效,并根据TDM结果,调整个体化用药方案,提升药学服务水平,促进临床用药的安全有效。Objective Clinical pharmacist participates in outpatient follow-up combined with therapeutic drug monitoring(TDM)to improve pharmaceutical care.Methods Clinical pharmacist participated in the diagnosis and treatment of tacrolimus related seizure in a renal transplant patient.An individualized regimen was sorted out and analyzed for the medication,and the treatment plan was timely adjusted by TDM.Results The seizure was caused by high concentration of tacrolimus.Serious adverse reactions were completely alleviated through the optimization of immunosuppressive regimen under the effort of clinical pharmacist and surgeon.No adverse events associated with the immunosuppressants were identified during the follow-up.Conclusion It highly suggests that clinical pharmacist could actively involve in the outpatient follow-up to evaluate the efficacy and tolerability of immunosuppressive medication and design the individualized dosing regimens.It will largely contribute in the improvement of pharmaceutical care and in the safety and effectiveness of drug use in patients after renal transplantation.

关 键 词：他克莫司 肾移植术后 癫癎 个体化用药 

分 类 号：R969.3[医药卫生—药理学] R977[医药卫生—药学]