1例造血干细胞移植后肺移植术后患儿的药学监护

Pharmaceutical Care of Individualized Therapy for a Child with Lung Transplantation After Hematopoietic Stem Cell Transplantation

目的介绍1例干细胞移植后肺移植术后患儿的药学监护,为相关疾病的治疗和药学服务积累经验。方法临床药师全程参与1例6岁患儿肺移植术后患者的治疗,依据国内外文献和药物的药理学特性结合治疗药物监测(therapeutic drug monitoring,TDM)结果调整优化给药方案,监测药物不良反应。结果临床药师协助医师优化患儿的治疗方案,使患儿最终生存62 d。结论儿童的特殊药动学/药效学(pharmacokinetics/pharmacodynamics,PK/PD)及药物选择均与成人有很大差异,药物方案制定需要个体化运用治疗药物监测药学等手段结合患者的检验指标制定个体化给药方案,对肺移植术后患者实施药学监护,与医护合作,提高患者用药安全性和有效性。

Objective Summarize the pharmaceutical care of a child with lung transplantation after stem cell transplantation,and accumulate experience in the treatment and pharmaceutical care of related diseases.Methods Clinical pharmacist participated in the treatment of a 6-year-old child after lung transplantation.According to the domestic and foreign literature and the pharmacological characteristics of the drug combined with the results of therapeutic drug monitoring(TDM),adjust and optimize the dosing regimen to monitor adverse drug reactions.Results The clinical pharmacist assisted the physician in optimizing the treatment plan of the child,so that the child survived for 62 days.Conclusion Children’s special PK/PD and drug selection were quite different from adults.The formulation of drug plan needs to make individualized drug administration plan by means of therapeutic drugs,monitoring pharmacy and other means combined with patient’s test indexes,carry out pharmaceutical monitoring on patients after lung transplantation,and cooperate with physician and nurses to improve the safety and effectiveness of patients’medication.