临床药师参与大剂量甲氨蝶呤中毒解救治疗的药学实践-中国药房.PDFVIP

临床药师参与大剂量甲氨蝶呤中毒解救治疗的药学实践 ＊ # 黄 琳 ，徐雅晶，冯婉玉（北京大学人民医院药剂科，北京 100044） 中图分类号 R977.2；R977.6；R969.3 文献标志码 C 文章编号 1001-0408（2013）46-4399-03 DOI 10.6039/j.issn. 1001-0408.2013.46.29 摘 要 目的：临床药师通过参与急性白血病患儿大剂量甲氨蝶呤（MTX ）化疗中毒解救治疗的药学实践，优化选择有利于患儿 药物治疗的方案。方法：针对1例淋巴瘤白血病B 细胞型应用大剂量MTX 致药物中毒的患儿，临床药师综合分析患儿病情，认为 常规解救治疗作用不显著，不足以缓解患儿的中毒症状。临床药师结合MTX 分子质量、药动学等特点，建议有针对性地选择血液 灌流或血液灌流联合高通量血液透析治疗。结果：经过6d 综合治疗，患儿症状好转，MTX 血药浓度逐步下降，186h 时血药浓度 为0.39µmol/L。结论：临床药师参与临床治疗实践，有利于及时发现和有效处理患儿的不良反应，并提高药物治疗水平。 关键词 甲氨蝶呤；中毒；解救；临床药师 Pharmaceutical Practice of Clinical Pharmacist Involved in the Treatment of High-dose Methotrexate Intox- ication HUANG Lin ，XU Ya-jing ，FENG Wan-yu （Dept. of Pharmacy ，People ’s Hospital of Peking University ，Beijing 100044，China ） ABSTRACT OBJECTIVE ：To optimize the therapeutic regimen through clinical pharmacists participated in the treatment of high-dose methotrexate （MTX ）intoxication in pediatric acute leukemia. METHODS ：For a case of high-dose MTX intoxication of lymphoma leukemia B cells ，clinical pharmacists analyzed the disease condition of patient and believed that conventional rescue had no significant effect and was not effective enough to relieve the intoxication. Clinical pharmacists suggested that blood perfusion com- bined with high-flux hemodialysis （HF-HD ）were good choice according to molecular weight of MTX and pharmacokinetics. RE- SULTS ：After 6 d of comprehensive treatment ，the symptom of the patient had been improved ，and the blood concentrations of MTX were decreased gradually and 0.39 µmol/L at 186h. CONCLUSIONS ：The clinical pharmacists involved in clinical treatment practice are conducive to the timely detection and treatment of ADR ，and improve the level of drug treatment. KEY WORDS Methotrexate ；Intoxication ；Rescue ；Clinical pharmacist