【摘要】 目的 促进伊马替尼的临床安全应用。方法 临床药师参与1例伊马替尼致胃肠道间质瘤（GIST）切除术后多浆膜腔积液患者的临床诊疗过程，结合患者的病史、用药史，并通过治疗药物监测（TDM）反馈伊马替尼的稳态血药浓度谷值(C_ssmin)进行药品不良反应关联性评价。对症治疗后，患者重启伊马替尼治疗，继续基于TDM和疗效调整伊马替尼给药剂量。结果 患者停用伊马替尼48 h后，伊马替尼的血药浓度为1 556.8 ng/mL，预测其C_ssmin为3 913.8 ng/mL，远高于GIST的推荐治疗浓度（1 100 ng/mL）；继续予利尿治疗，病情缓解后带药出院。经8次伊马替尼TDM，调整剂量为每天1次，每次0.2 g，血药浓度稳定在1 700 ng/mL左右。结论 临床药师利用TDM调整伊马替尼的剂量，可促进临床GIST患者安全使用伊马替尼。更多还原

【Abstract】 Objective To promote the safe clinical application of imatinib.Methods A clinical pharmacist participated in the clinical diagnosis and treatment process of a patient with multiple serous cavity effusion caused by imatinib after gastrointestinal stromal tumor （GIST） surgery.Based on the patient′s medical history and medication history,and the steady-state plasmaconcentration (C_ssmin) of imatinib was fed back through therapeutic drug monitoring （TDM） to evaluate the association between the drug and adverse drug reactions.Imatinib treatment was restarted after symptomatic treatment,and the dose of imatinib was adjusted based on TDM and efficacy.Results The concentration of imatinib was 1 556.8 ng/mL after 48 h drug withdrawal,and the predicted C_ssminwas 3 913.8 ng/mL,which was much higher than the recommended therapeutic concentration of GIST（1 100 ng/mL）.The patient was relieved after receiving diuretic treatment,and discharged with imatinib.After eight times of TDM,the administration scheme of the drug was optimized as 0.2 g each time,once a day,and the plasma concentration was stable at about1 700 ng/mL.Conclusion Clinical pharmacists using TDM to adjust the dose of imatinib can promote clinic safe use of imatinib in GIST patients.更多还原