伏立康唑血药浓度超过推荐治疗浓度阈值的评析及药学监护  

Evaluation and Pharmacy Care of Voriconazole Therapeutic Drug Monitoring Exceeding the Recommended Treatment Concentration Threshold

作　　者：林小青 江国才 王小燕[1] LIN Xiao-qing;JIANG Guo-cai;WANG Xiao-yan(Department of Phar macy,Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院药学部,福建厦门361004

出　　处：《海峡药学》2024年第9期83-88,共6页Strait Pharmaceutical Journal

摘　　要：目的探讨伏立康唑血药浓度超过推荐治疗浓度阈值的原因及药学监护模式。方法收集厦门大学附属中山医院2022年1月至12月行伏立康唑TDM的住院患者,筛选整理并分析伏立康唑血药浓度超过推荐治疗浓度阈值的原因及其个体化用药建议的药学监护情况。结果395次TDM有131次C_(vcz)>5.5μg·mL^(-1),涉及83例患者,肺部感染80例(96.39%),其他3例(3.61%)。超阈值评析中:剂量、剂型或药品厂家的调整37次(28.24%),药物相互作用32次(24.43%),采血时机不适宜12次(9.16%),肝功能异常9次(6.87%),严重感染合并以上多种因素28次(21.37%),原因不明13次(9.92%)。83例患者中有13例(15.66%)患者出现不良反应,经处理后,10例患者ADR转归好转,3例患者ADR转归不详。结论VCZ个体化差异大,对其实施TDM并进行超阈值预警管理的药学监护模式有助于临床优化个体化用药,提升医院药学服务水平。OBJECTIVE Explore the reasons and pharmacy care mode of voriconazol e therapeutic drug monitoring exceeds the recommended treatment concentration th reshold.METHODS Collect inpatients who underwent therapeutic d rug monitoring of voriconazole in Zhongshan Hospital Affiliated to Xiamen Univer sity from January to December 2022,screen,organize,and analyze the reasons fo r the therapeutic drug monitoring of voriconazole exceeding the recommended trea tment concentration,as well as the pharmacy care of personalized medication rec ommendations.RESULTS 131 out of 395 TDM with C_(vcz)>5.5μg·mL^(-1),involving 83 patients.There were 80 cases of pulmonary infecti on(96.39%),and other 3 cases(3.61%).In the voriconazole threshold evaluation,37(28.24%)adjustments were made to the dose,dosage form or drug manufacturer,32(24.43%)Drug interaction,12(9.16%)inappropriate blood sampling times,9(6.87%)abnormal liver function,28(21.37%)severe infections combined with mult iple factors above,and 13(9.92%)unknown causes.13 out of 83 patients(15.66%)experienced adverse reactions.10 patients had improved ADR outcomes after tre atment,while 3 patients had unknown ADR outcomes.CONCLUSION T here are significant differences in the individualization of voriconazole.The pharmacy c are mode of implementing TDM and conducting threshold warning management can hel p optimize individualized medication in clinical practice and improve the level of hospital pharmaceutical services.

关 键 词：伏立康唑 血药浓度 阈值 药学监护 个体化用药 不良反应 

分 类 号：R969.4[医药卫生—药理学]