临床药师参与1例肺移植患者个体化治疗的药学实践

Pharmaceutical Practice of Individualized Treatment for a Patient after Lung Transplantation by Clinical Pharmacist

目的以1例百草枯中毒后肺移植患者为例,探讨临床药师在肺移植术后患者个体化治疗中的作用。方法临床药师全程参与肺移植术后患者的治疗并进行全方位的药学监护,根据患者病情变化和治疗药物监测结果调整优化给药方案、注意药物相互作用、关注药物疗效及不良反应、提供患者用药教育等。结果通过对患者治疗方案的优化,感染得到有效控制;他克莫司血药浓度维持在有效治疗窗范围内,避免了严重不良反应的发生。对患者用药教育的实施,提高了患者用药依从性。结论临床药师深入临床,对肺移植术后患者实施药学监护,有利于促进合理用药,并提高患者用药安全性和有效性。

OBJECTIVE To explore the role of clinical pharmacist in the individualized treatment for lung transplantation patients, using a case of lung transplantation patient after paraquat poisoning. METHODS Clinical pharmacist was involved in the treatment of lung transplant recipient and provided the full range of clinical pharmacy services, by adjusting and optimizing the medication regimen according to the patient′s condition and the monitoring results of therapeutic drug, paying attention to drug interaction, drug efficacy, adverse reactions and providing education of patient medication. RESULTS The infection was effectively controlled and the blood concentration of tacrolimus was maintained within the effective treatment window which avoided the serious adverse reactions, by optimizing the treatment plan. The medication adherence was improved by providing medication education for patient. CONCLUSION It is beneficial to promote rational drug use and improve the safety and effectiveness of the drug treatment for clinical pharmacist to go into clinical practice, and carry out pharmaceutical care for lung transplant recipient.