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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
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| 篇名： | 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 |
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| 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（0.17×109 L－1）、血小板水平（11×109 L－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 explore the role of clinical pharmacists in the process of drug treatment for leukemia children with neutrophil deficiency complicated with fever （NDCF）. METHODS： Clinical pharmacists participated in the treatment for a leukemia child with NDCF. Considering about continuous decrease of platelet accompanied by epistaxis， combined with age， clinical symptom， lab indexes and related guidelines， clinical pharmacists thought it was possibly associated with bone marrow induced by chemotherapy drugs and drug-induced hemorrhage induced by cefoperazone sodium and sulbactam sodium. It was suggested to stop using cefoperazone sodium and sulbactam sodium； use Meropenem for injection 1.0 g， ivgtt， q8 h instead for anti-infection； additionally use Recombinant human thrombopoietin injection 15 000 U，sc，qd for elevating platelet. During treatment， taking into account the low levels of neutrophils （0.17×109 L－1） and platelets （11×109 L－1） in this child， it was recommended to continue anti-infection and elevating platelet treatment， and continue to use Lienal polypeptide injection to auxiliarily enhance hematopoietic function. When the child’s condition was stable and neutrophils returned to normal， it was successively recommended to stop elevating platelet and anti-infection treatment； at the same time， conduct pharmaceutical care as body temperature examination， related indicator examination （such as routine blood test） and ADR monitoring， etc. RESULTS： Physicians adopted the clinical pharmacist’s suggestions. The body temperature of the child was decreased， the hemogram recovered gradually， no infection occurred， and the next round of chemotherapy was successfully carried out. CONCLUSIONS： The clinical pharmacists participate in drug treatment for leukemia children with NDCF， pay attention to the prevention， diagnosis and treatment of drug-induced disease， and make comprehensive analysis by using their own professional advantage， taking the possible effects of drugs on blood system， pharmacodynamics and pharmacokinetic characteristics as the breakthrough point， combing with the specific situation of children’s age and illness； assist physicians to formulate and optimize drug therapy plan so as to guarantee safe and effective drug use. |
| 期刊： | 2017年第28卷第35期 |
| 作者： | 邓冬梅，杨雪，杨程，吴畏，陈剑鸿 |
| AUTHORS： | DENG Dongmei，YANG Xue，YANG Cheng，WU Wei，CHEN Jianhong |
| 关键字： | 临床药师；药学监护；骨髓抑制；中性粒细胞缺乏伴发热；白血病；儿童 |
| KEYWORDS： | Clinical pharmacists； Pharmaceutical care； Bone marrow；Neutrophil deficiency complicated with fever； Leukemia； Children |
| 阅读数： | 471 次 |
| 本月下载数： | 6 次 |
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