临床药师参与大剂量甲氨蝶呤中毒解救治疗的药学实践

Pharmaceutical Practice of Clinical Pharmacist Involved in the Treatment of High-dose Methotrexate Intoxication

目的:临床药师通过参与急性白血病患儿大剂量甲氨蝶呤(MTX)化疗中毒解救治疗的药学实践,优化选择有利于患儿药物治疗的方案。方法:针对1例淋巴瘤白血病B细胞型应用大剂量MTX致药物中毒的患儿,临床药师综合分析患儿病情,认为常规解救治疗作用不显著,不足以缓解患儿的中毒症状。临床药师结合MTX分子质量、药动学等特点,建议有针对性地选择血液灌流或血液灌流联合高通量血液透析治疗。结果:经过6 d综合治疗,患儿症状好转,MTX血药浓度逐步下降,186 h时血药浓度为0.39μmol/L。结论:临床药师参与临床治疗实践,有利于及时发现和有效处理患儿的不良反应,并提高药物治疗水平。

OBJECTIVE： To optimize the therapeutic regimen through clinical pharmacists participated in the treatment of high-dose methotrexate （MTX） intoxication in pediatric acute leukemia. METHODS： For a case of high-dose MTX intoxication of lymphoma leukemia B cells, clinical pharmacists analyzed the disease condition of patient and believed that conventional rescue had no significant effect and was not effective enough to relieve the intoxication. Clinical pharmacists suggested that blood perfusion combined with high-flux hemodialysis （HF-HD） were good choice according to molecular weight of MTX and pharmacokinetics. RESULTS： After 6 d of comprehensive treatment, the symptom of the patient had been improved, and the blood concentrations of MTX were decreased gradually and 0.39 μmol/L at 186 h. CONCLUSIONS： The clinical pharmacists involved in clinical treatment practice are conducive to the timely detection and treatment of ADR, and improve the level of drug treatment.