临床药师参与1例中性粒细胞缺乏伴发热白血病患儿的个体化药物治疗实践

发布时间：2018-04-17 06:40

本文选题：临床药师 + 药学监护　；参考：《中国药房》2017年35期

【摘要】：目的:探讨临床药师在中性粒细胞缺乏伴发热(以下简称"粒缺伴发热")白血病患儿的药物治疗过程中的作用。方法:临床药师参与1例粒缺伴发热白血病患儿的药物治疗过程,考虑到患儿血小板持续减少并伴有鼻衄,结合其年龄、临床症状、实验室检查指标及相关指南,临床药师分析可能与化疗药物所致的骨髓抑制以及头孢哌酮钠舒巴坦钠所致的药源性出血有关,故建议立即停用头孢哌酮钠舒巴坦钠,改用注射用美罗培南1.0 g,ivgtt,q8 h抗感染,加用重组人血小板生成素注射液15 000 U,sc,qd升血小板;治疗过程中,考虑到患儿中性粒细胞(0.17×10~9L~(-1))、血小板水平(11×10~9L~(-1))仍偏低,建议继续行抗感染、升血小板治疗,并继续使用脾多肽注射液辅助增强造血功能;待患儿病情稳定,中性粒细胞恢复正常后,先后建议停止升血小板、抗感染治疗;同时行体温监测、血常规等相关指标检查与不良反应监测等药学监护。结果:医师采纳临床药师建议。患儿体温下降,血象逐渐恢复,未发生感染,顺利进入下一轮化疗。结论:临床药师参与粒缺伴发热白血病患儿的药物治疗过程,应重视药源性疾病的预防、诊断和治疗,并利用其自身专业优势,以药物可能对血液系统所造成的影响以及药物的药效学、药动学特点为切入点,结合患儿年龄、病情等具体情况作出综合分析,协助医师制订和优化药物治疗方案,保证了用药的安全、有效。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of neutrophil deficiency with fever in children with leukemia.Methods: a clinical pharmacist took part in the course of drug therapy in a child with fever and leukemia, taking into account the persistent thrombocytopenia and epistaxis, combined with age, clinical symptoms, laboratory indicators and related guidelines.Clinical pharmacist analysis may be related to bone marrow suppression induced by chemotherapeutic drugs and drug-induced hemorrhage caused by cefoperazone sodium and sulbactam sodium. Therefore, it is recommended that cefoperazone sodium sulbactam should be stopped immediately and meropenem 1.0 g / d iv gttt Q8 h should be used for anti-infection.In the course of treatment, taking into account that neutrophils 0.17 脳 10 ~ (9) L ~ (-1) and platelet level of 11 脳 10 ~ (9) L ~ (-1) were still low, it was suggested to continue anti-infection and platelet ascending therapy in the course of treatment with recombinant human thrombopoietin injection 15 000 Usco QD.And continued to use spleen polypeptide injection to enhance hematopoietic function; after the patient's condition was stable and neutrophil returned to normal, it was recommended to stop ascending platelets and anti-infection treatment; at the same time, body temperature was monitored.Pharmacological monitoring such as blood routine examination and adverse reaction monitoring.Results: the physician accepted the advice of the clinical pharmacist.The child's body temperature drops, the hemogram recovers gradually, does not have the infection, smoothly enters the next round of chemotherapy.Conclusion: clinical pharmacists should pay attention to the prevention, diagnosis and treatment of drug-induced diseases, and take advantage of their own professional advantages.Starting with the possible effects of drugs on the blood system, the pharmacodynamics and pharmacokinetic characteristics of drugs, and combining the specific conditions of the child's age, illness and so on, to make a comprehensive analysis, and to assist doctors in formulating and optimizing drug treatment plans.The drug is safe and effective.
【作者单位】：第三军医大学第三附属医院药剂科;
【基金】：中华医学会课题(No.2016B-YX025) 重庆市高等教育教学改革研究项目(No.163198) 第三军医大学第三附属医院院所教育科研立项课题(No.50212-2434、2636)
【分类号】：R733.7

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