临床药师参与1例新生儿播散性Ⅱ型单纯疱疹病毒感染的药学会诊  

Clinical pharmacists participating in pharmaceutical consultation of one case of disseminated neonatal herpes simplex virus typeⅡinfection

作　　者：李娜 邹泽 彭发兵 王鑫 李飞 谢欠 LI Na;ZOU Ze;PENG Fabing;WANG Xin;LI Fei;XIE Qian(Dept.of Pharmacy,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China;Dept.of Neonatology,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China;Dept.of Obstetrics,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China)

机构地区：[1]重庆市黔江中心医院药学部,重庆409099 [2]重庆市黔江中心医院新生儿科,重庆409099 [3]重庆市黔江中心医院产科,重庆409099

出　　处：《中国药房》2022年第21期2676-2680,2684,共6页China Pharmacy

基　　金：重庆市技术创新与应用发展专项乡村振兴项目(No.cstc2021jscx-xczxX0019);重庆市黔江区科技计划项目(No.黔科计2021014,No.黔科计2019046)。

摘　　要：本文介绍了临床药师参与1例首发症状为发热且不伴皮肤黏膜受累表现的新生儿播散性Ⅱ型单纯疱疹病毒感染的诊治过程。临床药师通过评估患儿病情,到产科了解患儿母亲病史和用药情况,查阅文献资料,分析患儿发热可能与其母亲病史相关,考虑患儿存在新生儿HSV感染可能,建议完善病毒相关检测后即刻予静脉注射阿昔洛韦20 mg/kg,q8 h抗病毒治疗,并密切监测阿昔洛韦常见的不良反应。医师接受会诊建议。患儿确诊新生儿播散性Ⅱ型HSV感染,经治疗,患儿病情相对稳定,医师再次请临床药师会诊协助制定患儿后续药物治疗方案和监护计划。临床药师参考相关文献,建议静脉用阿昔洛韦21 d后,再口服阿昔洛韦300 mg/m2,q8 h治疗6个月,且在口服用药期间继续监测其常见不良反应,并随访评估患儿神经系统发育等情况。医师采纳药师意见。患儿静脉用阿昔洛韦期间未出现不良反应,好转出院后口服阿昔洛韦第4周出现血肌酐和尿素升高,停药后恢复正常。患儿随访至1岁,预后良好,未出现神经系统后遗症。临床药师通过参与药学会诊,协助临床医师明确了治疗策略,降低了新生儿的用药风险,在药物治疗过程中发挥了积极有效的作用,体现了临床药师在多学科协作诊疗中的职业价值。This paper describes the clinical pharmacists’participation in the diagnosis and treatment for a case of disseminated neonatal herpes simplex virus(HSV)typeⅡinfection with fever as the initial symptom and without skin and mucous membrane involvement.Clinical pharmacists assessed the newborn’s condition,inquired about the disease history and medication status of the child’s mother hospitalized in the department of obstetrics,reviewed the literature,analyzed that the fever of the child might be related to the medical history of the mother,and considered that the child might have neonatal HSV infection.It was suggested to use acyclovir 20 mg/kg intravenously for q8 h immediately after completing virus-related testing,and closely monitor the common adverse drug reactions of acyclovir.The doctors accepted the consultation advice.The newborn was diagnosed as disseminated neonatal HSV typeⅡinfection.After treatment,the child’s condition was relatively stable and the doctors consulted clinical pharmacists again to help formulate the follow-up drug treatment plan and monitoring plan for the patient.After reviewing relevant literature,clinical pharmacists suggested that after 21 days of intravenous acyclovir treatment,oral acyclovir 300 mg/m2 q8 h should be continued for 6 months;moreover,common adverse drug reactions should be monitored and neurological development should be evaluated during oral acyclovir treatment,all of which were accepted by physicians.No adverse drug reactions occurred during intravenous administration of acyclovir,serum creatinine and urea increased in the 4th week of oral acyclovir administration,but returned to normal after drug withdrawal.The baby was followed up to 1 year old,and the prognosis was good without neurological sequelae.Clinical pharmacists enabled the clinicians to clarify the treatment strategy and also reduced the risk of medication for the patient by participating in the pharmaceutical consultation.Clinical pharmacists play an active and effective role in the medicati

关 键 词：Ⅱ型单纯疱疹病毒 临床药师 药学会诊 新生儿 

分 类 号：R969.3[医药卫生—药理学]