慢性淋巴细胞白血病合并肺隐球菌病病人的治疗用药分析与监护

Analysis of the therapeutic drug and pharmaceutical care for a patient with CLL complicated with pulmonary cryptococcosis

目的探讨临床药师在慢性淋巴细胞白血病(CLL)合并肺隐球菌病病人抗感染治疗中的作用。方法总结扬州大学附属医院血液内科2022年4月收治的1例CLL合并肺隐球菌病病人的治疗方案调整和药学服务。结果在经验性抗细菌治疗效果欠佳后,给予伏立康唑抗真菌治疗。完善检查后,根据病人血清隐球菌荚膜抗原检测阳性结合临床特征、影像学表现诊断为肺隐球菌病。在感染加重,发生伏立康唑相关不良反应后,将抗感染方案调整为两性霉素B胆固醇硫酸酯复合物(ABCD)联合氟胞嘧啶(氟胞嘧啶无货时用氟康唑代替)。临床药师对病人进行药学监护和用药教育,对其发生的不良反应分析原因,提出处理建议。最终病人取得了较理想的治疗效果。结论临床药师协助医师优化用药方案,提高病人的依从性和用药安全性,在CLL合并肺隐球菌病病人治疗中起到重要作用。

Objective To explore the role of clinical pharmacists in anti-infection treatment of patients with chronic lymphocytic leukemia(CLL)complicated with pulmonary cryptococcosis.Methods The treatment plan adjustment and pharmaceutical services provided to a patient with CLL complicated with pulmonary cryptococcosis,who was admitted to the Hematology Department of Yangzhou University Affiliated Hospital in April 2022,were summarized.Results After experiencing unsatisfactory empirical antibacterial treatment,fluconazole antifungal therapy was administered.Following a comprehensive examination,the patient was diagnosed with pulmonary cryptococcosis,based on a positive detection of cryptococcal capsule antigen in their serum,along with clinical symptoms and imaging findings.As the infection worsened and adverse reactions linked to fluconazole emerged,the anti-infection regimen was shifted to a combination therapy involving Amphotericin B colloidal dispersion(ABCD)and 5-Fluorouracil(or Fluconazole when Fluorouracil was unavailable).Clinical pharmacists offered pharmaceutical care and medication education to the patient,analyzed the causes of the adverse reactions,and provided treatment recommendations.Ultimately,the patient achieved satisfactory treatment outcomes.Conclu⁃sion Clinical pharmacists can assist physicians in optimizing medication regimens to improve the safety and effectiveness and play an important role in the treatment of CLL complicated with pulmonary cryptococcosis.