药物性肝损伤的临床药学监护

Pharmaceutical Care for Drug-induced Liver Injury

目的:探讨临床药师对药物性肝损伤患者开展临床药学监护的方法。方法:详细介绍临床药师参与3例典型药物性肝损伤病例的治疗过程及分析。结果:病例1提示在临床用药过程中应警惕新的可能导致药物性肝损的药物并及时发现并采取合理诊治;病例2提示发生药物性肝损伤时,临床药师可利用TDM判断致肝损害的药物;病例3提示应关注特殊患者的肝功能对于肝功能异常的患者,应避免使用肝毒性的药物或选用肝毒性较小的药物。结论:临床药师应多途径、多环节参与药物性肝损伤的药学实践,关注新的可能导致药物性肝损伤的药物;提供TDM监测,为诊断药物性肝损伤提供客观依据;关注患者的肝肾功能,为患者提供更佳的用药方案。

Objective： To investigate the pharmaceutical care methods for the patients with drug-induced liver injury. Methods： The participation process of clinical pharmacists in 3 cases of typical drug-induced liver injury was with detailed introduction and analy- sis in the paper. Results： The case 1 indicated that new drugs probably with drug-induced liver injury should be warned in the process of clinical medication. The case 2 suggested that TDM, as a useful assessment weapon, could be fully used to find the source medi- cines when drug-induced liver injury occurred. The case 3 showed the specific cases, especially the patients with abnormal liver func- tion, should be focused on, the medicines with high liver toxicity should be avoided and the medicines with mild liver toxicity could be chosen. Conclusion： Clinical pharmacists should participate in the clinical practice of drug-induced liver injury with multi-channel and multi-link, and pay attention to the drugs with high risk of liver injury. Meanwhile, clinical pharmacists should perform TDM monito- ring to provide positive evidence for the diagnosis of drug-induced liver injury, and focus on the liver and kidney functions to provide better pharmaceutical care for the patients.