临床药师参与1例溃疡性结肠炎复发合并自身免疫性胰腺炎患者治疗的药学实践  

Pharmaceutical practice of a clinical pharmacist in the treatment of a patient with ulcerative colitis recurrence complicated by autoimmune pancreatitis

作　　者：罗广文 李冬艳 LUO Guangwen;LI Dongyan(Department of Pharmacy,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Pharmacy,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,Zhejiang Province,China)

机构地区：[1]华中科技大学同济医学院附属同济医院药学部,武汉430030 [2]浙江大学医学院附属金华医院药学部,浙江金华321000

出　　处：《药物流行病学杂志》2025年第4期474-479,共6页Chinese Journal of Pharmacoepidemiology

基　　金：湖北省自然科学基金面上项目(2021CFB362)。

摘　　要：本文报道临床药师参与1例自身免疫性胰腺炎(AIP)合并溃疡性结肠炎(UC)复发患者治疗并实施个体化用药监护的过程。入院后临床药师与医师共同制定口服泼尼松与美沙拉嗪联合的抗炎治疗方案。用药3 d后,患者腹泻症状加重,肠镜检查显示重度广泛型UC活动期。经讨论,医师与临床药师决定将口服泼尼松改为静脉用甲泼尼龙琥珀酸钠,并将美沙拉嗪栓剂更换为美沙拉嗪灌肠液。随后,患者出现发热并被诊断为艰难梭菌感染。医师采纳临床药师的建议使用甲硝唑,且药师实施严格药学监护。治疗5 d后,患者症状显著改善,且未出现不良反应。本病例展示了临床药师在复杂病情管理中的作用,尤其在治疗方案优化和药物安全性监护方面的贡献,为医师和临床药师处理此类病例提供了实践经验和借鉴。This article reported the process of individualized medication management by a clinical pharmacist in the treatment of a patient with autoimmune pancreatitis(AIP)complicated by a relapse of ulcerative colitis(UC).Upon admission,in collaboration with the clinical pharmacist,the physician formulated a combined treatment plan of oral prednisone and mesalazine based on the patient's condition and the latest research literature.After 3 days of medication,the patient's diarrhea symptoms worsened,and colonoscopy revealed a severe,extensive flare of UC.After discussing,the physician and clinical pharmacist decided to switch the oral prednisone to intravenous methylprednisolone sodium succinate and replace mesalazine suppositories with mesalazine enema.Subsequently,the patient developed a fever and was diagnosed with Clostridiodes difficile infection.After a comprehensive evaluation,the clinical pharmacist recommended the use of metronidazole and implemented careful pharmaceutical monitoring.After 5 days of treatment,the patient's symptoms significantly improved without any adverse reactions.This case highlights the critical role of clinical pharmacists in managing complex clinical situations,particularly in optimizing treatment regimens and ensuring medication safety.It also provides practical experience and guidance for physicians and clinical pharmacists in handling similar cases.

关 键 词：溃疡性结肠炎 自身免疫性胰腺炎 艰难梭菌感染 药学监护 

分 类 号：R97[医药卫生—药品]