【摘要】 目的:分析无锡市儿童医院开展他克莫司和环孢素治疗药物监测(TDM)出现的危急值相关临床资料,结合临床实践评估其应用效果,提升用药安全性。方法:统计分析2016—2024年他克莫司和环孢素TDM中出现的危急值发生率、科室、标本转运时间和报告时间等。结果:共监测药物2 307例,出现危急值21例(0.9%),其中他克莫司14例,环孢素7例。他克莫司出现危急值的科室主要集中在儿科重症监护室(21.4%,3/14),主要诊断为肺移植术后(42.9%,6/14);环孢素则全部在血液科,临床诊断均为再生障碍性贫血。14例患儿经减量后再次检测恢复至正常范围。他克莫司出现危急值的标本平均转运时间和报告时间分别为89.5 min和306.5 min,环孢素标本平均转运时间和报告时间分别为134 min和401 min。结论:TDM能有效识别他克莫司和环孢素的血药浓度危急值风险,对肺移植及再生障碍性贫血患儿具有重要价值,通过及时干预可显著改善用药安全性。更多还原

【Abstract】 Objective: To analyze the clinical data related to critical values generated from therapeutic drug monitoring(TDM) of tacrolimus and cyclosporine in Wuxi Children’s Hospital, and to evaluate the application effect based on clinical practice, so as to enhance the medication safety. Methods: The incidence, departments, turnaround time and reporting time of critical values generated from TDM of tacrolimus and cyclosporine from 2016 to 2024 were statistically analyzed. Results: Among 2,307 TDM tests performed, 21 critical values(0. 9%) were detected, with 14 cases in tacrolimus and 7 cases in cyclosporine. Critical values for tacrolimus were predominantly observed in the Pediatric Intensive Care Unit( 21. 4%, 3/14), with the main diagnosis of post-lung transplantation(42. 9%, 6/14). Critical values for cyclosporine was all administered in the Hematology Department, all the patients were clinically diagnosed with aplastic anemia. Following dosage adjustment, therapeutic drug concentrations were successfully normalized in 14 patients upon repeat testing. The mean turnaround time and reporting time for samples with critical values of tacrolimus were respectively 89. 5 and 306. 5 min, while those for cyclosporine were respectively 134 and 401 min. Conclusion: TDM can effectively identify the critical value risks of tacrolimus and cyclosporine blood concentrations, holding significant value particularly for lung transplant recipients and aplastic anemia patients. Timely intervention can markedly enhance medication safety.更多还原