1例难治性隐球菌性脑膜脑炎抗真菌用药分析  

Antifungal Medication of Refractory Cryptococcal Meningoencephalitis:A Case Report

作　　者：肖溢[1] 崔小娇 陶春 胡功利 杨勇[2] XIAO Yi;CUI Xiaojiao;TAO Chun;HU Gongli;YANG Yong(The Fourth People's Hospital of Zigong,Zigong,Sichuan,China 643000;Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital,Chengdu,Sichuan,China 610072)

机构地区：[1]四川省自贡市第四人民医院,四川自贡643000 [2]四川省医学科学院·四川省人民医院,四川成都610072

出　　处：《中国药业》2024年第2期125-128,共4页China Pharmaceuticals

摘　　要：目的为难治性隐球菌性脑膜脑炎的抗真菌治疗合理用药提供依据。方法回顾性分析四川省人民医院收治的1例难治性隐球菌性脑膜脑炎患者的抗真菌药物治疗经过。患者入院后予氟康唑氯化钠注射液(0.4 g/d)联合两性霉素B胆固醇硫酸酯复合物(100 mg/d)静脉滴注,但初次使用后者10 min后出现寒战、高热(39.8℃),考虑为其输液反应,且用药10 d复查电解质发现低钾血症;药师会诊后建议用药前20~30 min先予地塞米松或抗组胺药预处理,停用氟康唑氯化钠注射液,改用氟胞嘧啶,参考相关指南及结合患者病情,将两性霉素B胆固醇硫酸酯复合物用量由100 mg/d先升至200 mg/d,治疗2周后升至300 mg/d,同时行降温、补钾等对症治疗。医师采纳。结果调整抗真菌治疗方案效果明显,患者病情好转出院。结论临床药师参与难治性隐球菌性脑膜脑炎的抗真菌治疗,能提供合理的药学监护,保障抗真菌用药安全、有效。Objective To provide a basis for the rational use of antifungal drugs for refractory cryptococcal meningoencephalitis.Methods The antifungal treatment of a patient with refractory cryptococcal meningoencephalitis admitted to the Sichuan Provincial People's Hospital was retrospectively analyzed.After admission,the patient received the intravenous drip of Fluconazole and Sodium Chloride Injection(0.4 g/d)combined with Amphotericin B Cholesteryl Sulfate Complex for Injection(100 mg/d).However,she experienced shivering and high fever(39.8℃)10 min after initial use of the latter one,which were considered to be the infusion reactions,the electrolyte was rechecked and hypokalemia was diagnosed after 10 d of medication.After consultation,the pharmacists suggested that dexamethasone or antihistamines should be used for pretreatment 20-30 min before medication;Fluconazole and Sodium Chloride Injection should be replaced by flucytosine;the dosage of Amphotericin B Cholesteryl Sulfate Complex for Injection should be increased from 100 mg/d to 200 mg/d based on the relevant guidelines and the patient's condition,then increased to 300 mg/d after two weeks;symptomatic treatments such as cooling and potassium supplementation should be given.Physicians adopted the above suggestions.Results The adjustment of the antifungal treatment plan was effective,the patient was better and discharged.Conclusion The participation of clinical pharmacists in the antifungal treatment of refractory cryptococcal meningoencephalitis can provide rational pharmaceutical care and ensure the safety and effectiveness of antifungal medication.

关 键 词：临床药师 难治性隐球菌性脑膜脑炎 抗真菌治疗 药学监护 合理用药 

分 类 号：R969.3[医药卫生—药理学]