临床药师参与1例帕瑞昔布疑致药物性肺损伤的药学实践

Pharmaceutical practice of clinical pharmacists in a patient with suspected drug-induced lung injury caused by parecoxib

1例80岁男性患者,因腰腿疼痛于2020年4月21日使用注射用帕瑞昔布钠(40 mg,bid,ivgtt)治疗7 d,出院停药3 d后出现气短、呼吸困难,对症处理后好转。本次主因“反复腰腿痛7个月,加重3 d”入院。入院后给予注射用帕瑞昔布钠(40 mg,bid,ivgtt),疼痛好转。入院第5天突发呼吸困难、喘息气促,血氧饱和度64%,予面罩吸氧、无创呼吸机辅助通气,吸入用硫酸沙丁胺醇溶液(2.5 mL,q 12 h,inh)。2 d后呼吸困难仍较明显,血氧饱和度66%,转入呼吸科,加用注射用头孢哌酮钠舒巴坦钠(3 g,q 12 h,ivgtt)抗感染。药师详细询问患者病史及用药史,不排除帕瑞昔布钠致呼吸困难可能,建议停用注射用帕瑞昔布钠,加用注射用甲泼尼龙琥珀酸钠(40 mg,qd,ivgtt),医生采纳。此后患者呼吸困难改善,予以出院。院外口服醋酸泼尼松片序贯治疗,1周后激素逐渐减量至停用。

An 80-year-old male patient had been treated with parecoxib sodium for injection(40 mg,bid,ivgtt)for 7 days since April 21st,2020 due to lumbar and leg pain.He developed shortness of breath and dyspnea 3 days after discharge and drug withdrawal,which was improved after symptomatic treatment.And he was admitted to hospital again this time mainly because of repeated lumbar and leg pain for 7 months,aggravating for 3 days.After admission,parecoxib sodium for injection(40 mg,bid,ivgtt)was given to him and the pain improved.On the 5^(th) day after admission,he suddenly developed dyspnea and shortness of breath,and the blood oxygen saturation was 64%.Mask oxygen inhalation,non-invasive ventilator assisted ventilation and salbutamol sulfate solution for inhalation(2.5 mL,q 12 h,inh)were given to him immediately.2 days later,the dyspnea was still obvious,and the blood oxygen saturation was 66%.He was transferred to the department of respiratory disease and cefoperazone sodium and sulbactam sodium for injection(3 g,q 12 h,ivgtt)was added for anti-infection.Clinical pharmacists inquired about his previous medical and medication history in detail,and dyspnea possibly caused by parecoxib was suspected.Pharmacists suggested to stop parecoxib sodium for injection and give methylprednisolone sodium succinate for injection(40 mg,qd,ivgtt)to the patient,which was accepted by the doctor.Thereafter,the patient's dyspnea improved and he was discharged.Sequential therapy with oral prednisone acetate tablets was given to the patient for one week out of the hospital.The hormone amount was gradually reduced to discontinuation.