运用改良Naranjo量表参与亚胺培南西司他丁致继发性血小板增多症临床实践1例

Clinical Practice of Secondary Thrombocytosis Induced by Imipenem/Cilastatin by Using Modified Naranjo's Assessment Scale: A Case Report

目的 通过1例使用亚胺培南西司他丁导致继发性血小板增多症的个案,临床药师运用改良Naranjo量表法进行因果关系评价并进行药学监护,为临床用药安全提供经验借鉴。方法 基于患者的病史和用药史,分别采用国家药品不良反应检测中心制定的关联性评价依据和改良Naranjo量表分析亚胺培南西司他丁与血小板增多的相关性,并进行评价,根据结果 对患者进行用药重整并配合医师制订个体化用药方案。结果 改良Naranjo量表对亚胺培南西司他丁的评分为7分,提示该药物与血小板增多症关联性为“很可能”,与采用国家药品不良反应检测中心制定的关联性评价依据得到的评价结果 基本一致。停用该药物后患者血小板计数逐渐回落,病情好转出院。结论 亚胺培南西司他丁引起血小板增多易被忽略,可能导致血栓形成或异常出血事件的发生,医务人员应根据血小板升高的程度及患者病情采取不同的处理措施。

OBJECTIVE To evaluate the causality relationship between the adverse drug reactions(ADR) of thrombocytosis and imipenem/cilastatin by using modified Naranjo's assessment scale and provide references for clinical medication safety. METHODS Based on the medical history and medication history,the correlation between imipenem/cilastatin and thrombocytosis was analyzed using the association evaluation criteria developed by the National Center for Adverse Drug Reaction Testing and the modified Naranjo's assessment scale,and the results were evaluated.Then patient's medication was adjusted and individualized by pharmacists cooperated with physicians according to results. RESULTS The causal association between thrombocytosis and imipenem/cilastatin scored 7 points with modified Naranjo's assessment scale,indicating the probable causality of the ADR and drug,which was consistent with the evaluation result obtained using the association evaluation criteria developed by the National Center for Adverse Drug Reaction Testing. After discontinuing the medication,the platelet count of the patient gradually decreased,and the patient was discharged in a good condition. CONCLUSION Thrombocytosis induced by imipenem/cilastatin is easily ignored,which may lead to thrombosis or abnormal bleeding events. So different measures should be taken by medical personnel depending on the degree of platelet elevation and the patient's condition.