1例类鼻疽脓毒症患者的全程个体化药学监护  

Whole-process individualized pharmaceutical care for a case of melioidosis sepsis

作　　者：王敏[1] 林叶 赵洁 符香香 吴华[5] 吴琼诗[1] 谢甜[3] WANG Min;LIN Ye;ZHAO Jie;FU Xiangxiang;WU Hua;WU Qiongshi;XIE Tian(Dept.of Pharmacy,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Dept.of Pharmacy,Hainan Cancer Hospital,Haikou 570312,China;Dept.of Respiratory and Critical Care Medicine,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;School of Pharmacy,Hainan Medical University,Haikou 571199,China;Dept.of Clinical Laboratory,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院药学部,海口570311 [2]海南省肿瘤医院药学部,海口570312 [3]海南省人民医院/海南医学院附属海南医院呼吸与危重症医学科,海口570311 [4]海南医学院药学院,海口571199 [5]海南省人民医院/海南医学院附属海南医院检验科,海口570311

出　　处：《中国药房》2024年第1期101-106,共6页China Pharmacy

基　　金：海南省重点研发计划项目(No.ZDYF2022SHFZ050,No.ZDYF2019141);海南医学院校级创新科研项目(No.HYYS2022 B14)。

摘　　要：目的为类鼻疽脓毒症(MS)抗菌药物治疗方案的调整、不良反应的识别和个体化药学监护提供参考。方法临床药师利用血药浓度和基因检测全程参与1例MS患者强化期和根除期治疗过程。通过测定β-内酰胺类和复方磺胺甲噁唑(TMP/SMZ)血药浓度并计算其药代动力学与药效学(PK/PD)参数,结合文献对MS抗菌药物治疗方案进行调整;同时通过高通量测序检测药物相关基因多态性,对药物不良反应的发生原因进行分析并进行处理。结果临床药师利用血药浓度和基因检测手段,提出了亚胺培南西司他丁钠(IMP)给药剂量调整建议,分析了多种药物不良反应的发生原因;通过测定β-内酰胺类药物和TMP/SMZ血药浓度计算PK/PD靶标,通过查询指南和文献为临床医生解释类鼻疽患者脓毒症期和非脓毒症期状态下的达标情况;利用血药浓度和基因检测分析MS患者神经毒性与IMP cmin的相关性,并发现肾毒性与TMP/SMZ的cmax无关,而与患者饮水量相关。经全程抗菌药物治疗后,患者病情好转出院,不良反应得到有效处理。结论临床药师基于抗菌药物血药浓度和基因检测结果解读情况协助临床医生制定MS治疗方案,并为患者提供全程用药监护,提高了临床药物治疗的安全性和有效性。OBJECTIVE To provide reference for the adjustment of antibiotic treatment regimens,identification of adverse reactions,and individualized pharmaceutical care for melioidosis sepsis(MS).METHODS Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection.Based on the literature,antibiotic treatment regimens of MS were adjusted by determining the blood concentrations ofβ-lactam and trimethoprim/sulfamethoxazole(TMP/SMZ)and calculating PK/PD parameters.The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing.RESULTS Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions.PK/PD targets were calculated by measuring the blood concentrations ofβ-lactam and TMP/SMZ.Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and nonsepsis stages through reviewing guidelines and literature;the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with IMP cmin,and it was found that nephrotoxicity was not related to the cmax of TMP/SMZ,but to the patient’s water intake.After whole-process antibiotic treatment,the patient’s condition improved and was discharged,and the adverse reactions were effectively treated.CONCLUSIONS Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens,and provide whole-course pharmaceutical care for a MS patient.This method has improved the safety and effectiveness of clinical drug therapy.

关 键 词：类鼻疽脓毒症 Β-内酰胺类抗菌药物 复方磺胺甲噁唑 血药浓度 基因检测 药学监护 

分 类 号：R969.3[医药卫生—药理学]