药师参与头孢哌酮钠舒巴坦钠联合孟鲁司特钠致严重血小板减少的药学监护  

Pharmaceutical care of severe thrombocytopenia caused by cefoperazone sodium/sulbactam sodium combined with montelukast sodium

作　　者：杨强 姚宇 张鹏[1] 叶晓芬 张询研 Qiang YANG;Yu YAO;Peng ZHANG;Xiao-Fen YE;Xun-Yan ZHANG(Department of Pharmacy,Suining Central Hospital,Suining 629000,Sichuan Province,China;Department of Respiratory and Critical Care Medicine,Suining Central Hospital,Suinning 629000,Sichuan Province,China;Department of Pharmacy,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China)

机构地区：[1]遂宁市中心医院药学部,四川遂宁629000 [2]遂宁市中心医院呼吸与危重症医学科,四川遂宁629000 [3]复旦大学附属中山医院药剂科,上海200032

出　　处：《药物流行病学杂志》2023年第6期710-714,共5页Chinese Journal of Pharmacoepidemiology

基　　金：四川省医院协会青年药师科研专项资金项目(22018)。

摘　　要：1例慢性阻塞性肺疾病急性加重患者在住院期间出现严重血小板减少,血小板计数(Plt)22×10^(9)·L^(-1),考虑为药品不良反应,认为最有可能由头孢哌酮钠舒巴坦钠引起。立即停用该药,并予升血小板治疗。但患者Plt继续降低(4×10^(9)·L^(-1)),并出现出血症状,予以输注血小板治疗,骨髓穿刺未能明确原因。药师考虑可能还存在其他原因,通过用药分析及查阅文献,考虑孟鲁司特钠是导致Plt降低的另一个因素。停用孟鲁司特钠后,患者Plt较前升高,出血症状消失。患者出院后自行服用孟鲁司特钠,Plt持续降低(最低7×10^(9)·L^(-1)),虽积极治疗,效果仍不佳。药师随访,再次建议患者停用孟鲁司特钠,停药2周后,复查Plt恢复正常(163×10^(9)·L^(-1))。A patient with acute exacerbation of chronic obstructive pulmonary disease developed severe thrombocytopenia(Plt 22×10^(9)·L^(-1))during hospitalization.Considering it as an adverse drug reaction,the most likely cefoperazone sodium/sulbactam sodium was discontinued and the patient was treated with platelet-raising therapy.However,the patient's platelets continued to decrease(Plt 4×10^(9)·L^(-1)),and bleeding occurred.Then,the patient was treated with platelet transfusion.Bone marrow biopsy could not identify cause.The pharmacist considered that there may be other causes of thrombocytopenia.By medication analysis and literature reviewing,montelukast sodium was considered as another factor leading to thrombocytopenia.After discontinuation of montelukast sodium,the patient's platelets increased and the bleeding symptoms disappeared.After discharging from the hospital,the patient took montelukast sodium again and the thrombocytopenia was still existed(minimum Plt 7×10^(9)·L^(-1)).Despite aggressive treatment,it was still ineffective.The pharmacist followed up the patient and advised the patient to stop using montelukast sodium.After 2 weeks of montelukast discontinuing,the platelets returned to normal(Plt 163×10^(9)·L^(-1)).

关 键 词：头孢哌酮钠舒巴坦钠 孟鲁司特钠 血小板减少 药学监护 

分 类 号：R969.3[医药卫生—药理学]