1例鼻-眶-脑型毛霉菌病患者的药学监护  

Pharmaceutical care for a patient with rhino-orbito-cerebral mucormycosis

作　　者：吴瑕[1] 赵银龙[2] 张志清[1] 董维冲 WU Xia;ZHAO Yinlong;ZHANG Zhiqing;DONG Weichong(Dept.of Pharmacy,the Second Hospital of Hebei Medical University,Shijiazhuang 050051,China;ICU,Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第二医院药学部,石家庄050051 [2]河北医科大学第二医院麻醉科ICU,石家庄050051

出　　处：《中国药房》2024年第12期1533-1538,共6页China Pharmacy

基　　金：河北省医学科学研究课题计划(No.20230648)。

摘　　要：目的 为鼻-眶-脑型毛霉菌病(ROCM)的临床诊疗和药学监护提供思路。方法 临床药师参与1例ROCM患者的诊断和治疗过程,结合相关治疗指南及药物可及性、经济性等实际情况,协助医生制定两性霉素B胆固醇硫酸酯复合物联合泊沙康唑的抗真菌治疗方案,并监测临床疗效、肝肾功能及电解质变化。根据外周血和脑脊液检查结果,临床药师建议给予两性霉素B脱氧胆酸盐鞘内注射、滴鼻、滴眼以提高感染灶局部药物浓度,并协助医生确定给药剂量及药液配制方法;针对泊沙康唑血药谷浓度不达标的问题,临床药师建议将泊沙康唑口服混悬液更换为泊沙康唑肠溶片,并对患者进行治疗药物监测(TDM)、个体化用药指导及出院长期随访。结果 医生采纳了临床药师的建议。患者经治疗后,病情好转,准予带药出院。结论 临床药师通过调整药物剂量和剂型、开展用药监护和TDM等药学服务手段,为ROCM患者制定个体化治疗方案,有助于保障患者用药的安全性。OBJECTIVE To provide ideas for clinical diagnosis,treatment and pharmaceutical care of rhino-orbito-cerebral mucormycosis(ROCM).METHODS The diagnosis and treatment of 1 case of ROCM in which clinical pharmacists participated were analyzed.Combined with treatment guidelines,the actual situation of drug accessibility and economy,clinical pharmacists recommend amphotericin B colloidal dispersion in combination with posaconazole to treat fungal infections.The clinical efficacy,liver and kidney function and electrolytes were monitored.To increase the local concentration of amphotericin B deoxycholate(AmB-D),clinical pharmacists assisted physicians in determining the dosage and formulation of AmB-D for intrathecal injection,intranasal and eye drops based on the results of blood and cerebrospinal fluid examinations.In response to the situation that the plasma trough concentration of posaconazole had not reached the target,clinical pharmacists recommended that Posaconazole oral suspension was replaced with Posaconazole enteric-coated tablets,and provided the patient with therapeutic drug monitoring(TDM),individualized medication guidance,and long-term follow-up after discharge.RESULTS The clinician adopted the advice of the clinical pharmacists.After treatment,the patient was discharged from the hospital with medicine after her condition improved.CONCLUSIONS Clinical pharmacists develop individualized treatment protocols for ROCM patients by adjusting dose and dosage forms,providing medication monitoring and TDM to ensure the safety of drug use for patients.

关 键 词：鼻-眶-脑型毛霉菌病 两性霉素B胆固醇硫酸酯复合物 泊沙康唑 治疗药物监测 临床药师 

分 类 号：R969.3[医药卫生—药理学]