中药临床药师对1例可疑来氟米特引起的肝脏生化学检查异常患者的药学监护

Pharmacological Care for Patients with Abnormalities of Liver Biochemical Examination Suspected of Leflunomide by Traditional Chinese Medicine Clinical Pharmacists

目的探讨中药临床药师对风湿病患者出现肝脏生化学检查异常的中西医药学监护。方法中药临床药师参与1例类风湿关节炎并肝脏生化学检查异常患者的临床诊疗过程。中药临床药师协助医师制定治疗方案,分析患者肝脏生化学检查异常的原因,排除其他因素,考虑药物引起肝脏生化学检查异常,参考美国LiverTox网站、中国HepaTox网站以及相关指南和文献,判断致肝脏生化学检查异常的药物,建议医师停用可疑药物,在中药方剂配伍治疗中避免选择肝损伤的中草药。结果中药临床药师综合考虑患者临床表现和用药史,结合文献检索和相关资料查阅,判断可能为来氟米特引起的肝脏生化学检查异常,为临床提供了合理的中西用药方案参考。经治疗后,患者肝脏生化学检查恢复正常。结论中药临床药师可多环节参与肝脏生化学检查异常患者的临床诊疗,从中西药学2个角度发挥综合优势,判断可疑药物,优化中西医治疗方案。

OBJECTIVE To explore the the clinical and pharmacology monitoring of traditional Chinese medicine and Western medicine clinical pharmacists on abnormal biochemical examination of liver in patients with rheumatic diseases.METHODS Traditional Chinese medicine clinical pharmacists participated in the clinical diagnosis and treatment process of pharmacy supervision of one patient with rheumatoid arthritis and abnormal liver biochemical examination.Traditional Chinese medicine clinical pharmacists assisted physicians to develop a treatment plan,analyze the causes of abnormal liver biochemical examination,to exclude other factors,consider drug caused abnormal liver biochemical examination,refer to the website of LiverTox,HepaTox as well as related guidelines and literature,judgment of drugs with abnormal liver biochemical examination,recommended physicians to stop suspect drugs in Chinese medicine treatment to avoid selecting Chinese herbal medicine for liver injury.RESULTS Traditional Chinese medicine clinical pharmacists comprehensively considered the clinical manifestations and medication history of patients,combined with the literature search and related information review,judged the abnormalities of liver biochemical examination suspected of leflunomide,and provided a reasonable medication regimen for clinical reference.The patient’s liver biochemistry tests returned to normal after treatment.CONCLUSION Traditional Chinese medicine clinical pharmacists can participate in the clinical diagnosis and treatment of patients with abnormal liver biochemical tests in multiple links,and play comprehensive advantages from the two perspectives of traditional Chinese and Western medicine to judge suspected drugs and optimize treatment regimens.