变应性支气管肺真菌病患者的典型案例分析与监护要点

Analysis of Typical Cases and Monitoring Points of Patients with Allergic Bronchopulmonary Mycosis

目的:分析变应性支气管肺真菌病(allergic bronchopulmonary mycosis,ABPM)患者的典型临床特点和药学监护要点,为此类患者的规范治疗和用药安全提供参考。方法:选取2021年10月—2022年10月常州市第一人民医院呼吸与危重症科收治的23例ABPM患者作为研究对象,观察患者的病原菌、合并症和基础疾病等,并对4例典型案例的药学监护要点进行剖析。结果:23例患者中,ABPM的病原菌主要为曲霉(22例,占95.65%),而患者的基础疾病以支气管扩张(7例,占30.44%)和支气管哮喘(5例,占21.74%)为主,合并症以过敏性鼻炎(8例,占34.78%)较为多见;而典型案例的药学监护分析显示,伊曲康唑、伏立康唑等抗真菌药物与阿托伐他汀、奥美拉唑等药物存在较为明显的药物相互作用,可致患者发生药物不良反应,此外糖皮质激素的使用须因人施治,及时调整,盲目使用亦可引发药物不良反应。结论:当前对ABPM的具体治疗方案尚未形成统一认识,而其常用药物又多存在潜在的用药风险,故临床药师应充分利用自身专业特长,积极参与ABPM患者的治疗,并开展药学监护,以保障患者治疗的安全和有效。

Objective:To analyze the typical clinical characteristics and pharmaceutical care points of patients with allergic bronchopulmonary mycosis(ABPM),and to provide reference for standardized treatment and medication safety of such patients.Methods:23 ABPM patients admitted to Respiratory and Critical Care Department of the First People's Hospital of Changzhou from October 2021 to October 2022 were selected as the research subjects.The pathogens,comorbidities,and underlying diseases of the patients were observed,and the pharmaceutical care points of 4 typical cases were analyzed.Results:Among 23 patients,the main pathogen of ABPM was Aspergillus(22 cases,95.65%),and the underlying diseases of the patients were mainly bronchiectasis(7 cases,30.44%) and bronchial asthma(5 cases,21.74%),with comorbidities as allergic rhinitis(8 cases,34.78%) being more common.The pharmaceutical care analysis of typical cases showed that antifungal drugs such as itraconazole and voriconazole had significant drug interactions with drugs such as atorvastatin and omeprazole,which could lead to adverse drug reactions in patients.In addition,glucocorticoids should be used according to individual circumstances and adjusted in a timely manner,and blind use might cause adverse drug reactions.Conclusion:Currently,there is no unified understanding of specific therapeutic regimens for ABPM,and many commonly used drugs have potential medication risks.Therefore,clinical pharmacists should fully utilize their professional expertise,actively participate in the treatment of ABPM patients,and carry out pharmaceutical care to ensure the safety and effectiveness of treatment on patients.