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伏立康唑联合米卡芬净治疗曲霉菌性心内膜炎患者的药学监护
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| 篇名： | 伏立康唑联合米卡芬净治疗曲霉菌性心内膜炎患者的药学监护 |
| TITLE： | Pharmaceutical care of voriconazole combined with micafungin in the treatment of aspergillus endocarditis |
| 摘要： | 目的 为真菌性心内膜炎的临床诊疗提供思路。方法对临床药师全程参与的１例曲霉菌性心内膜炎患者的诊断和治疗过程进行分析。临床药师建议行血宏基因组二代测序（mNGS）检测和血培养来辅助真菌性心内膜炎的诊断；从药物的作用机制、作用靶点和安全性等方面考虑，建议采用伏立康唑联合米卡芬净进行抗真菌治疗；结合患者病情，权衡利弊，将米卡芬净调整至每天300mg；预防、评估和处理治疗过程中的药物不良反应，并对患者进行用药指导和出院长期随访。结果医师采纳了临床药师的建议。患者血mNGS检出烟曲霉，为其早期诊断和个体化治疗争取了时间；采用伏立康唑联合米卡芬净进行抗真菌治疗1个月后，患者病情得到了良好控制；给予丁二磺酸腺苷蛋氨酸治疗后，患者碱性磷酸酶和γ-谷氨酰转肽酶恢复正常；在临床药师的用药指导、教育和出院随访协助下，患者的用药依从性良好，病情平稳。结论临床药师参与了该患者的诊疗过程，为其制订了个体化的抗感染治疗方案并取得了良好的效果，体现了临床药师的专业能力和服务水平，为真菌性心内膜炎的临床诊疗提供了思路。 |
| ABSTRACT： | OBJECTIV E To provide ideas for diagnosis and treatment of fungal endocarditis. METHODS The diagnosis and treatment of 1 case of aspergillus endocarditis participated by clinical pharmacists were analyzed. Clinical pharmacists suggested that blood macrogenomic next-generation sequencing （mNGS）detection and blood microbial culture should be performed to assist in the diagnosis of fungal endocarditis ；considering the mechanism ，target and safety of the drug ，it was suggested to use voriconazole combined with micafungin for antifungal treatment ；through combining with the patient ’s condition and weighing up the pros and cons ，the dose of micafungin was adjusted to 300 mg per day ；clinical pharmacists prevented ，evaluated and dealt with adverse drug reactions during treatment ，and also provided medication guidance and long-term follow-up for the patient after discharge. RESULTS The clinician adopted the advice of the clinical pharmacists. Aspergillus fumigatus was detected in blood mNGS，which bought time for early diagnosis and individualized treatment of the patient. After 1 month treatment of voriconazole combined with micafungin ，the patient ’s condition was well controlled. The alkaline phosphatase and γ-glutamyl transferase of the patient returned to normal after treatment with adenosylmethionine succinate. With the help of medication guidance ，education and discharge follow-up of clinical pharmacists ，the medication compliance of the patient was good and the condition was stable. CONCLUSIONS The clinical pharmacists participate in the diagnosis and treatment process of the patient ，formulate an individualized anti-infective treatment plan for the patient and achieve good results ，which reflect the professional ability and service level of the clinical pharmacist ，and provide ideas for the clinical treatment of fungal endocarditis. |
| 期刊： | 2022年第33卷第04期 |
| 作者： | 张新茹，王冬雪，于玲，李馨 |
| AUTHORS： | ZHANG Xinru，WANG Dongxue ，YU Ling，LI Xin |
| 关键字： | 真菌性心内膜炎；曲霉菌性心内膜炎；烟曲霉；伏立康唑；米卡芬净；宏基因组二代测序；药学监护；临床药师 |
| KEYWORDS： | fungal endocarditis ；aspergillus endocarditis ；Aspergillus fumigatus；voriconazole；micafungin；macrogenomic |
| 阅读数： | 406 次 |
| 本月下载数： | 16 次 |
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