1例多元药物过敏急性胰腺炎患者行药物激发试验的药学监护  

Pharmaceutical care of a patient with acute pancreatitis complicated with multiple drug allergy undergoing drug stimulation test

作　　者：刘婧 夏亮[2] 张世杰 LIU Jing;XIA Liang;ZHANG Shijie(Department of Pharmacy,the First Affiliated Hospital of Nanchang Medical University,Nanchang Jiangxi 330000,China;Department of Gastroenterology,the First Affiliated Hospital of Nanchang Medical University,Nanchang Jiangxi 330000,China;Department of Pharmacy,Guangdong Provincial People’s Hospital Ganzhou Hospital,Ganzhou Jiangxi 341000,China)

机构地区：[1]南昌大学第一附属医院药学部,江西南昌330000 [2]南昌大学第一附属医院消化科,江西南昌330000 [3]广东省人民医院赣州医院药剂科,江西赣州341000

出　　处：《中国药物警戒》2023年第7期822-824,共3页Chinese Journal of Pharmacovigilance

基　　金：江西省自然科学基金资助项目(20202BAB206010);江西省教育厅课题(GJJ180136)。

摘　　要：目的探讨多元药物过敏急性胰腺炎患者行药物激发试验药学监护的策略,为多元药物过敏患者药学监护提供参考。方法临床药师参与1例多元药物过敏的急性胰腺炎患者的会诊,对患者的既往过敏病史(对左氧氟沙星、哌拉西林他唑巴坦、丙基硫氧嘧啶过敏,先锋霉素V皮肤过敏试验阳性)进行评估分析,建议行药物激发试验明确药物过敏诊断,并根据患者病情及药物激发试验结果提出用药建议。结果患者急性胰腺炎合并感染,进行β-内酰胺类抗生素规范化皮试及头孢哌酮舒巴坦的药物激发试验,结果为阴性,遂选用头孢哌酮舒巴坦(3 g q8h)进行抗感染治疗,期间无过敏反应发生。治疗期间临床药师对患者进行全程药学监护。结论药品过敏史评估与药物激发试验对于多元药物过敏患者抗菌药物选择策略十分重要,临床药师应结合临床实际与患者情况,协助医生制定治疗方案,对患者进行全程药学监护,保证其用药的安全性与有效性。Objective To explore the pharmaceutical care strategy for a patient with acute pancreatitis complicated with multidrug allergy who underwent drug stimulation test,and to provide reference for pharmaceutical care of patients with multidrug allergy.Methods A clinical pharmacist participated in the consultation for a patient with acute pancreatitis complicated with multidrug allergy,analyzed the patient’s previous allergic history,recommended the drug provocation test to justify the diagnosis of drug allergy,and suggested medications based on the patient’s condition and results of the drug provocation test.Results The patient was diagnosed with acute pancreatitis complicated with infection.The standardized skin test ofβ-lactam antibiotics and the drug stimulation test of cefoperazone sulbactam were negative,so cefoperazone sulbactam(3 g q8h)was selected for anti-infection treatment.No allergic reactions occurred during the treatment.The clinical pharmacist provided whole-course pharmaceutical care for this patient.Conclusion The evaluation of drug sensitivity and allergy history and drug provocation tests are critical to the selection of antibiotics in patients with multiple drug allergy.Clinical pharmacists should assist doctors in formulating treatment plans and carrying out wholeprocess pharmaceutical care for patients so as to ensure the safety and effectiveness of drugs.

关 键 词：急性胰腺炎 多元药物过敏 药物激发性试验 抗菌药物 头孢哌酮舒巴坦 合理用药 临床药师 药学监护 

分 类 号：R916.693[医药卫生—药学] R994.11