临床药师参与1例造血干细胞移植术后环孢素致视力丧失患者的治疗

Pharmaceutical Care of Clinical Pharmacists for One Case of Cyclosporine-Induced Vision Loss after Hematopoietic Stem Cell Transplantation

环孢素为造血干细胞移植术后常用的抗排斥反应药物,常见不良反应有肾脏毒性和神经毒性等,但引起视力丧失极为罕见。临床药师参与1例造血干细胞移植术后视力丧失患者的治疗,结合治疗药物监测,协助临床医生及时鉴别视力丧失为环孢素引起的罕见不良反应,主要表现为特发性颅内压增高导致视盘水肿,进而造成视力丧失。临床药师建议及时停用环孢素并进行降颅压对症处理,密切关注和加强对视力和颅压的检查,并引起足够的重视。最后,患者视力恢复正常,避免了永久性视力损伤。临床药师参与到临床治疗团队中可更好地保障临床用药的安全性和有效性。

Cyclosporine( CsA) is a commonly used immunosuppressant for patients after hematopoietic stem cell transplantation( HSCT). Its most frequently reported toxicities included nephrotoxicity and neurotoxicity. However,loss of vision is extremely rare.Clinical pharmacists participated in the treatment of a case of blindness after HSCT. In combination with therapeutic drug monitoring,clinical pharmacists assisted clinicians in identifying CsA induced blindness,manifesting mainly as idiopathic intracranial hypertension induced papilledema. Clinical pharmacists recommended CsA withdrawal and symptomatic treatment such as intracranial decompression,and strengthened the examination of vision and intracranial pressure. Finally,the close pharmaceutical monitoring and management restored the patient’s vision and clinical conditions to normal,and permanent visual impairment was avoided. The participation of clinical pharmacists in clinical treatment team can better guarantee the safety and effectiveness of clinical medication.