临床药师参与1例万古霉素致药物性肝损伤及药物热临床实践

Clinical Pharmacist′Clinical Practice in a Case of Vancomycin-Induced Drug-Induced Liver Injury and Drug Fever

目的促进临床合理使用万古霉素。方法临床药师参与1例万古霉素致药物性肝损伤(DILI)及药物热的救治过程,为患者提供药学服务,结合文献及患者每日检查指标的变化,及时发现导致DILI及药物热的线索,及时停药并对症处理。结果通过DILI因果关系评估量表(RUCAM)评分发现导致DILI的药物,通过排除性诊断发现导致药物热的药物,查阅文献并结合患者的检查指标,推断万古霉素致DILI和药物热同时发生,与体液免疫的超敏反应有关。结论临床使用万古霉素时除要关注患者的肾功能不良反应外,还需关注患者的肝功能、体温变化,若出现肝功能损伤、体温升高等,则需警惕万古霉素诱发的药品不良反应。

Objective To promote the rational use of vancomycin in the clinic.Methods A clinical pharmacist participated in the treatment process of a case of drug-induced liver injury(DILI)and drug fever caused by vancomycin,and provided pharmaceutical care for the patient.Based on literature and changes in the patient's daily examination indicators,the clues leading to DILI and drug fever were discovered on time,and the drugs were stopped and treated accordingly.Results The drugs causing DILI was identified through the RUCAM score,and the drugs causing drug fever was found through exclusion diagnosis.Literature review and patient's examination indicators were used to infer that the vancomycin-induced DILI and drug fever occurred simultaneously,which was related to hypersensitivity reactions in humoral immunity.Conclusion When using vancomycin in the clinic,in addition to paying attention to adverse reactions of renal function in patients,attention should also be paid to changes in liver function and body temperature.If liver function injury or high body temperature occurs,it is necessary to be alert to adverse drug reactions induced by vancomycin.