他克莫司治疗药物监测异常结果干预及评价研究  

Study on the intervention and evaluation for the abnormal results of tacrolimus therapeutic drug monitoring

作　　者：王学彬 高丽红 张凌鹏 杨云云 刘红霞[1] 王卓 孙华君[1] WANG Xuebin;GAO Lihong;ZHANG Lingpeng;YANG Yunyun;LIU Hongxia;WANG Zhuo;SUN Huajun(Department of Pharmacy,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Pharmacy,Shanghai Changhai Hospital,Naval Medical University,Shanghai 200433,China;Department of Biological Medicines&Shanghai Engineering Research Center of Immunotherapeutics,Fudan University School of Pharmacy,Shanghai 201203,China)

机构地区：[1]上海市儿童医院药学部,上海200062 [2]海军军医大学第一附属医院药剂科,上海200433 [3]复旦大学药学院生物药物系,上海201203

出　　处：《中国临床药理学与治疗学》2024年第12期1322-1328,共7页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家自然科学基金资助项目(82173900);促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR4072);2022年上海青年药学人才能力提升项目(沪药会字[2023]04号)。

摘　　要：目的:探究欧洲医药保健网(Pharmaceutical Care Network Europe,PCNE)分类系统用于评价肾移植受者他克莫司浓度波动药物相关问题(drug related problems,DRPs)的作用。方法:以门诊随访中出现他克莫司血药浓度波动、临床药师介入干预的肾移植受者为研究对象,利用PCNE(9.0)分类系统评价他克莫司的DRPs,并对存在DRPs的问题、原因、介入方案、介入方案的接受和状态进行分析。结果:本研究纳入2019年7月至2021年12月肾移植受者700例,发现1014个他克莫司DRPs。DRPs的问题包括发生药物不良事件(P2.1,60.16%)和治疗效果不佳(P1.2,39.84%);原因主要包括剂量选择(C3,43%)、其他(C9,38.4%)和药物选择(C1,9.41%);临床药师从受者层面(I2,98.92%)和药物层面(I3,1.08%)积极介入;介入方案(A1.1+A1.3)的接受率达98.62%,完全执行(A1.1)率达72.09%;79.29%的DPRs被全部解决或部分解决(O1.1和O2.1)。结论:临床药师可将PCNE用于评价他克莫司治疗药物监测(therapeutic drug monitoring,TDM)相关DRPs,助力TDM药学服务模式标准化,规范TDM异常结果解读和干预工作,促进安全合理用药。AIM:To analyze the Pharmaceutical Care Network Europe(PCNE)classification system used for evaluating the drug related problems(DRPs)of tacrolimus concentration fluctuations in kidney transplant recipients.METHODS:Kidney transplant recipients were selected as the study subjects,who experienced fluctuations in tacrolimus blood concentrations and clinical pharmacist intervention during outpatient follow-up.PCNE(9.0)classification system was used to evaluate the DRPs of tacrolimus.And the DRP problems,causes,intervention plans,acceptance and status were analyzed.RESULTS:A total of 700 kidney transplant recipients were enrolled from July 2019 to December 2021,and 1014 DRPs were found.The problems of DRPs included the occurrence of adverse drug events(P2.1,60.16%)and poor treatment outcomes(P1.2,39.84%);The main reasons included dosage selection(C3,43%),others(C9,38.4%),and drug selection(C1,9.41%);Clinical pharmacists actively intervened at the recipient level(I2,98.92%)and drug level(I3,1.08%);The acceptance rate of the intervention plan(A1.1+A1.3)reached 98.62%,and the complete implementation rate(A1.1)reached 72.09%;79.29%of DPRs were fully or partially resolved(O1.1 and O2.1).CONCLUSION:Clinical pharmacists can use PCNE to evaluate tacrolimus therapeutic drug monitoring(TDM)related DRPs,help standardize TDM pharmaceutical service models,standardize TDM abnormal result interpretation and intervention workflows,and promote safe and rational drug utilization.

关 键 词：肾移植 他克莫司 治疗药物监测 结果干预 欧洲医药保健网 

分 类 号：R969[医药卫生—药理学]