临床药师参与3例儿童大剂量甲氨蝶呤治疗及文献分析

A report of three cases and literature analysis clinical pharmacist participated in high dose Methotrexate therapy in children

大剂量甲氨蝶呤是儿童血液肿瘤治疗中的重要手段,极大提高了疾病缓解率,然而其严重的毒副作用给患儿带来巨大伤害。本文通过临床药师参与3例患儿使用大剂量甲氨蝶呤的治疗过程,根据患儿不同的情况开展个体化的药学监护,对于甲氨蝶呤浓度较高或出现消除延迟的患儿,及时且合适的亚叶酸钙解救策略和对症处理可以降低甲氨蝶呤的毒性反应。在保证甲氨蝶呤药效的同时尽可能降低严重不良反应的发生。最后,结合治疗过程和文献分析,探讨临床药师基于血药浓度监测对儿童使用大剂量甲氨蝶呤的个体化治疗和药学监护的方法。

High dose Methotrexate is an important means in the treatment of blood tumors in children,which greatly improves the remission rate of the disease.However,its severe toxic and side effects bring great harm to children.In this paper,clinical pharmacists participated in the treatment of three children with high dose Methotrexate,and individualized pharmaceutical care was carried out according to the different conditions of the children.For children with high Methotrexate concentration or delayed elimination,timely and appropriate calcium folinate rescue strategy and symptomatic treatment can reduce the toxic reaction of Methotrexate.To ensure the efficacy of Methotrexate while minimizing the occurrence of serious adverse reactions.Finally,combined with the treatment process and literature analysis,the method of individualized treatment and pharmaceutical care for children with high dose Methotrexate by clinical pharmacists based on blood concentration monitoring was discussed.