【摘要】 目的:探讨临床药师参与心脏移植患儿药物治疗中的作用。方法:临床药师参与华南地区首例心脏移植患儿术后轻度免疫排斥反应治疗,通过查阅相关文献、借鉴肾移植相关治疗经验,为患儿提供他克莫司代谢型基因的检测、霉酚酸酯药-时曲线下面积(AUC)测算等药学监护。结果:测定患儿他克莫司代谢酶细胞色素P450(CYP)3A5基因型为慢代谢型。经临床药师建议,医师调整给药方案为他克莫司4 mg/d,并以白水空腹送服,根据稳态血药浓度调整剂量,他克莫司血药浓度达到有效治疗窗;糖皮质激素强的松用量也尽早尽快梯度减少,术后每5~7 d减量2.5 mg,出院后强的松剂量为7.5 mg/d。结论:临床药师根据药物的药动学特点,结合患者病理生理情况,通过参与制定心脏移植患儿的治疗方案,提高患儿的血药浓度,降低排斥与不良反应发生率,使患儿获得最佳治疗。更多还原

【Abstract】 OBJECTIVE:To explore the role of clinical pharmacists participating in medication for children with heart transplant(HT). METHODS:Clinical pharmacists participated in the immune suppression scheme of medication for the first child with HT who suffered from postoperative injection in South China. Related literatures were consulted and experience in the treatment of renal transplantation was learned to provide pharmaceutical care,including the testing for the tacrolimus metabolism genes of patients and estimating of the area under curve(AUC)in mycophenolic acid drugs,etc. RESULTS:The P450(CYP)3A5 genes of tacrolimus metabolism were determined as poor metabolizers. The clinical pharmacists suggested that physicians adjusted the regimen as follows:the tacrolimus dose was 4 mg/d on an empty stomach with water orally;according to the steady plasma-drug concentration,the dose was adjusted and tacrolimus concentration was achieved therapeutic window;the dosage of glucocorticoids and prednisone had gradient reduction as soon as possible,it was cut down 2.5 mg every 5 or 7 d after operation,7.5 mg/d prednisone was given after discharge. CONCLUSIONS:According to pharmacokinetic characteristics of drugs and the pathologic physiology conditions of patients,clinical pharmacists should participate in designing optimal treatment,improving the plasma concentration and reducing the incidence of exclusion and adverse reactions in order to provide professional pharmacy services for patients.更多还原