1例肾病综合征患儿他克莫司相关可逆性后部脑病综合征的药学监护  

Pharmaceutical Care for Tacrolimus-associated Posterior Reversible Encephalopathy Syndrome in A Pediatric Patient with Nephrotic Syndrome

作　　者：唐乐丽 黄怡蝶[1] 张迅捷 朱琳[1] 李智平[1] TANG Leli;HUANG Yidie;ZHANG Xunjie;ZHU Lin;LI Zhiping(Department of Clinical Pharmacy,National Children's Medical Center,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Pharmacy,Zhuhai Women and Children's Hospital,Guangdong Province,Zhuhai 519000,China)

机构地区：[1]国家儿童医学中心,复旦大学附属儿科医院临床药学部,上海201102 [2]广东省珠海市妇幼保健院药学部,珠海519000

出　　处：《医药导报》2024年第2期292-298,共7页Herald of Medicine

基　　金：上海市科学技术委员会项目(19XD1400900、19DZ1910703);国家自然科学基金资助项目(81874325);复旦大学附属儿科医院重点发展项目疑难重症诊治中心(子项目号EK2022ZX01);广东省药学会科学研究基金(2023KP57)。

摘　　要：目的介绍1例他克莫司治疗中发生可逆性后部脑病综合征(PRES)的肾病综合征患儿的药学监护,为相关疾病的治疗和药学服务积累经验。方法临床药师对患儿服用他克莫司引起药物性PRES的关联性进行分析评价,同时参考循证证据提出优化药物治疗建议,提供个体化药物服务。结果经过止痉、控制血压、降颅压、他克莫司减量等治疗,患儿临床症状好转,复查头颅磁共振成像(MRI)提示脑内异常信号部分吸收,病灶较前明显缩小。结论对于他克莫司相关PRES,临床药师可在降压药物选择、基于血药浓度监测的治疗方案调整、施行针对性的药学监护与教育等方面,提高患者长期用药的安全性和有效性。Objective To present a pharmaceutical care case of a pediatric patient with nephrotic syndrome developing tacrolimus-inducedposterior reversible encephalopathy syndrome(PRES)during tacrolimus treatment,and to accumulate experience for the treatment and pharmaceutical services of related diseases.Methods Clinical pharmacists conduct an analysis and evaluation of the correlation of drug-induced PRES caused by tacrolimus in a pediatric patient.Simultaneously,regarding the latest evidence-based information,they propose optimized drug therapy recommendations and provide personalized pharmaceutical services.Results After treatment with antispasmodics,blood pressure control,intracranial pressure reduction,and tapering of tacrolimus,the clinical symptoms of the child improved.Follow-up cranial MRI demonstrated partial absorption of abnormal signals in the brain,and the lesions were significantly smaller than before.Conclusion For tacrolimus-related PRES,clinical pharmacists can enhance the long-term safety and effectiveness of patient medication through aspects such as choosing antihypertensive drugs,adjusting treatment plans based on drug concentration monitoring,and implementing targeted pharmaceutical monitoring and educatio.

关 键 词：他克莫司 肾病综合征 可逆性后部脑病综合征 药学服务 

分 类 号：R979.5[医药卫生—药品] R692.9[医药卫生—药学]