他克莫司治疗1例肝移植术后患者的药学监护  

Pharmaceutical care of a patient after liver transplantation treated with Tacrolimus

作　　者：张欣悦 王海刚[2] 王昊[3] 杨传伟 ZHANG Xinyue;WANG Haigang;WANG Hao;YANG Chuanwei(Department of Pharmacy,the Fourth People’s Hospital of Jinan,Shandong Province,Jinan250031,China;Department of Clinical Pharmacy,Qilu Hospital of Shandong University,Shandong Province,Jinan250012,China;Department of Intensive Care,Qilu Hospital of Shandong University,Shandong Province,Jinan250012,China)

机构地区：[1]济南市第四人民医院药学部,山东济南250031 [2]山东大学齐鲁医院临床药学科,山东济南250012 [3]山东大学齐鲁医院重症医学科,山东济南250012

出　　处：《中国医药导报》2023年第14期183-187,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(82072231);山东省济南市卫生健康委员会科技发展计划项目(2021-1-19)。

摘　　要：探讨临床药师对提高肝移植术后患者合理用药的积极作用。临床药师参与1例肝移植术后多次尝试脱呼吸机、拔出气管插管患者的药物治疗过程,结合免疫抑制剂与抗感染药物之间的相互关系,协助医师监测他克莫司血药浓度、相互作用,优化给药方案,确保患者个体化用药安全。经过37 d的治疗,患者病情得到有效控制,成功脱掉呼吸机拔除气管插管,转入普通病房。临床药师与医生协作,通过对患者药学监护,可显著提高患者用药安全性和有效性,促进临床合理用药。To explore the positive effect of clinical pharmacists on improving rational drug use in patients after liver transplantation.Clinical pharmacists participated in the drug treatment process of a patient with multiple attempts to remove ventilator and tracheal intubation after liver transplantation,combined with the interaction between immunosuppressants and anti-infective drugs,assist physicians to monitor the blood concentration and interaction of tacrolimus,optimize the drug administration plan,and ensure the safety of individualized drug use for patients.After 37 days of treatment,the patient’s condition was effectively controlled.The ventilator was successfully removed and the tracheal cannula was removed.The patient was transferred to a general ward.Collaboration between clinical pharmacists and doctors can significantly improve drug safety and effectiveness and promote rational drug use through pharmaceutical care of patients.

关 键 词：免疫抑制剂 肝移植 他克莫司 药学监护 合理用药 

分 类 号：R587.1[医药卫生—内分泌]