西妥昔单抗致细胞因子释放综合征的案例分析与药事干预

Case Analysis and Pharmaceutical Intervention to Cytokine Release Syndrome Induced by Cetuximab

目的:提高对输液反应中细胞因子释放综合征的重视程度,加强对细胞因子释放综合征的鉴别诊断,规范处方审核和预处理,以减少不良反应的发生。方法:通过一例罕见的西妥昔单抗致细胞因子释放综合征的案例,回顾性查阅病史并运用PDCA(Plan-Do-Check-Action,PDCA)循环方法进行专项点评,分析查找原因,提出优化措施。结果:白介素-6(IL-6)是细胞因子释放综合征主要的炎症介质,短时间内高于正常水平250倍或多个细胞因子(IL-8、IL-10等)同时高于正常水平75倍,并结合临床主要症状(如低血压、高热、血氧饱和度下降等)可作为判断细胞因子释放综合征发生的依据。通过建立统一处方审核标准、规范用药流程和加强患者用药宣教,可减少或避免细胞因子释放综合征的发生。结论:通过对案例的专项分析并与药事管理方法相结合,可为临床合理用药及相关不良反应的防治提供经验参考。

Objective:To attach more importance to cytokine release syndrome in infusion reaction,strengthen the differential diagnosis of cytokine release syndrome,and standardize prescription review and pretreatment in order to reduce the occurrence of adverse reactions.Methods:Through analyzing a rare case of cytokine release syndrome caused by cetuximab,the medical history was reviewed retrospectively,the PDCA(Plan-Do-CheckAction) cycle method was used to make special comments and after the causes were analyzed and identified,the optimization measures were put forward.Results:Interleukin-6(IL-6) was the main inflammatory mediator of cytokine release syndrome.If IL-6 is 250 times higher than the normal level in a short time or more cytokines(IL-8,IL-10,etc.) are 75 times higher than the normal level at the same time or more.The occurrence can be reduced or avoided by establishing unified prescription review standards,standardizing medication process and strengthening patient medication education.Conclusion:By combining the pharmaceutical management methods with a special case analysis,this study will provide references for clinical rational use of drugs and the prevention and treatment of related adverse reactions.