1例氟康唑致中毒性表皮坏死松解症患者的药学监护

Pharmaceutical Care of A Case of Toxic Epidermal Necrolysis Caused by Fluconazole

关键词:  临床药师  中毒性表皮坏死松解症  糖皮质激素  药学监护

Key words:  clinical pharmacist  toxic epidermal necrolysis  glucocorticoid  pharmaceutical care

摘要:

目的 探讨临床药师在中毒性表皮坏死松解症治疗过程中识别致敏药物、制定和调整糖皮质激素给药方案、预防和处理不良反应瀑布效应所发挥的作用。方法 临床药师参与1例中毒性表皮坏死松解症患者的药物治疗，通过筛查患者住院前后所用药物、Naranjo's评分与ALDEN评分比较，最终确定致敏药物为氟康唑。同时，根据患者临床症状、实验室检查指标、药物特点等调整糖皮质激素、人免疫球蛋白的用法用量控制过敏症状，加用碳酸钙D₃片、氯化钾缓释片稳定电解质水平，奥美拉唑肠溶胶囊保护胃黏膜，人血白蛋白改善低蛋白血症，并对治疗过程中出现的皮肤感染、口腔念珠菌感染、菌血症等并发症进行药学监护。结果 患者经治疗后病情好转，临床症状稳定后办理出院。结论 临床药师参与中毒性表皮坏死松解症的治疗过程，协助医师制定和调整药物治疗方案，通过疗效评价、并发症监控、安全性监测实现个体化给药，确保患者用药的安全性和有效性。

Abstract:

OBJECTIVE To discuss the function of clinical pharmacists in identifying sensitizing drugs, formulating and adjusting of glucocorticoid administration scheme, preventing and handling the waterfall effect of adverse reactions in the treatment of moderate toxic epidermal necrolysis METHODS The clinical pharmacists participated in the treatment of one toxic epidermal necrolysis case, screened the drugs that the patients had taken before and after being hospitalized, compared the Naranjo's scores and ALDEN scores, and finally determined that the sensing drug was likely to be fluconazole. At the same time, the pharmacists adjusted the administration method and dosage of glucocorticoid and human immunoglobulin according to the patient's clinical symptoms, laboratory examination indicators and drug characteristics to control the allergic symptoms. It was suggested to add the calcium carbonate D3 tablets and potassium chloride sustained release tablets to stabilize the electrolyte level, adopt omeprazole enteric-coated capsules to protect the gastric mucosa, and add human serum albumin to improve the hypoproteinemia. The pharmacists also conducted pharmaceutical care for complications such as skin infection, oral candidiasis and bacteremia. RESULTS The patient got improved after the treatment. The patient left the hospital after the clinical symptoms became stable. CONCLUSION By participating in the treatment of toxic epidermal necrolysis, the clinical pharmacists assisted the doctors to prepare and adjust the therapy, and administrated the drugs according to the therapeutic evaluation, complications supervision and safety monitoring, so that they ensured the safety and effectiveness of the treatment for patient.