1例类鼻疽脓毒症患者的全程个体化药学监护

王敏; 林叶; 赵洁; 符香香; 吴华; 吴琼诗; 谢甜

doi:10.6039/j.issn.1001-0408.2024.01.18

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1例类鼻疽脓毒症患者的全程个体化药学监护

药师与药学服务 | 更新时间：2024-01-11

- 1例类鼻疽脓毒症患者的全程个体化药学监护
- Whole-process individualized pharmaceutical care for a case of melioidosis sepsis
- 中国药房 2024年35卷第1期页码：101-106
- 作者机构：
  
  1.海南省人民医院/海南医学院附属海南医院药学部，海口　570311
  2.海南省肿瘤医院药学部，海口　570312
  3.海南省人民医院/海南医学院附属海南医院呼吸与危重症医学科，海口　570311
  4.海南医学院药学院，海口　571199
  5.海南省人民医院/海南医学院附属海南医院检验科，海口　570311
- 作者简介：
  
  副主任药师，硕士。研究方向：合理用药。E-mail：wangmin2020@hainmc.edu.cn
  主任医师，硕士。研究方向：呼吸与危重症医学。 E-mail：hpphxietian@163.com
- 基金信息：
  
  海南省重点研发计划项目(ZDYF2022SHFZ050;ZDYF2019141);海南医学院校级创新科研项目(HYYS2022B14)
- DOI：10.6039/j.issn.1001-0408.2024.01.18
  中图分类号： R969.3
- 纸质出版日期：2024-01-15，
  
  收稿日期：2023-06-30，
  
  修回日期：2023-11-26，
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王敏,林叶,赵洁等.1例类鼻疽脓毒症患者的全程个体化药学监护 ^Δ[J].中国药房,2024,35(01):101-106.

WANG Min,LIN Ye,ZHAO Jie,et al.Whole-process individualized pharmaceutical care for a case of melioidosis sepsis[J].ZHONGGUO YAOFANG,2024,35(01):101-106.
王敏,林叶,赵洁等.1例类鼻疽脓毒症患者的全程个体化药学监护 ^Δ[J].中国药房,2024,35(01):101-106. DOI： 10.6039/j.issn.1001-0408.2024.01.18.

WANG Min,LIN Ye,ZHAO Jie,et al.Whole-process individualized pharmaceutical care for a case of melioidosis sepsis[J].ZHONGGUO YAOFANG,2024,35(01):101-106. DOI： 10.6039/j.issn.1001-0408.2024.01.18.

摘要

目的

为类鼻疽脓毒症（MS）抗菌药物治疗方案的调整、不良反应的识别和个体化药学监护提供参考。

方法

临床药师利用血药浓度和基因检测全程参与1例MS患者强化期和根除期治疗过程。通过测定

-内酰胺类和复方磺胺甲噁唑（TMP/SMZ）血药浓度并计算其药代动力学与药效学（PK/PD）参数，结合文献对MS抗菌药物治疗方案进行调整；同时通过高通量测序检测药物相关基因多态性，对药物不良反应的发生原因进行分析并进行处理。

结果

临床药师利用血药浓度和基因检测手段，提出了亚胺培南西司他丁钠（IMP）给药剂量调整建议，分析了多种药物不良反应的发生原因；通过测定

-内酰胺类药物和TMP/SMZ血药浓度计算PK/PD靶标，通过查询指南和文献为临床医生解释类鼻疽患者脓毒症期和非脓毒症期状态下的达标情况；利用血药浓度和基因检测分析MS患者神经毒性与IMP

min

的相关性，并发现肾毒性与TMP/SMZ的

max

无关，而与患者饮水量相关。经全程抗菌药物治疗后，患者病情好转出院，不良反应得到有效处理。

结论

临床药师基于抗菌药物血药浓度和基因检测结果解读情况协助临床医生制定MS治疗方案，并为患者提供全程用药监护，提高了临床药物治疗的安全性和有效性。

Abstract

OBJECTIVE

To provide reference for the adjustment of antibiotic treatment regimens， identification of adverse reactions， and individualized pharmaceutical care for melioidosis sepsis （MS）.

METHODS

Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection. Based on the literature， antibiotic treatment regimens of MS were adjusted by determining the blood concentrations of

-lactam and trimethoprim/sulfamethoxazole （TMP/SMZ） and calculating PK/PD parameters. The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing.

RESULTS

Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions. PK/PD targets were calculated by measuring the blood concentrations of

β-

lactam and TMP/SMZ. Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and non-sepsis stages through reviewing guidelines and literature； the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with IMP

min

， and it was found that nephrotoxicity was not related to the

max

of TMP/SMZ， but to the patient’s water intake. After whole-process antibiotic treatment， the patient’s condition improved and was discharged， and the adverse reactions were effectively treated.

CONCLUSIONS

Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens， and provide whole-course pharmaceutical care for a MS patient. This method has improved the safety and effectiveness of clinical drug therapy.

关键词

类鼻疽脓毒症β-内酰胺类抗菌药物复方磺胺甲噁唑血药浓度基因检测药学监护

Keywords

β-lactam antibiotictrimethoprim/sulfamethoxazoleblood concentrationgenetic testpharmaceutical care

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