摘要
目的针对因异基因造血干细胞移植后继发闭塞性细支气管炎而行双肺移植的患者,探讨其肺移植术后多药联合治疗策略,为临床药师参与治疗药物管理及提升治疗药物安全性提供参考。方法选取1例异基因造血干细胞移植后因继发闭塞性细支气管炎行双肺移植术患者,在出现肺部侵袭性曲霉菌感染后接受多药联合治疗,临床药师评估药物相互作用(DDIs),通过专业知识为患者制定治疗药物剂量调整方案并行全程药学监护。结果临床药师对涉及3种或3种以上药物的复杂DDIs进行分析,通过研究药物各自代谢机制及影响因素预判起始给药方案,结合治疗药物监测方法调整药物剂量,维持关键药物血药浓度在治疗目标范围内,达到临床预期疗效并减少不良反应。结论临床药师协助移植团队制定个体化给药方案,确保移植患者多重药物治疗的有效性和安全性。
Objective To explore the multi-drug combination therapy strategy for patients with secondary bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation undergoing bilateral lung transplantation,in order to provide reference for clinical pharmacists to participate in medication therapy management and improve drug safety.Methods A patient who underwent bilateral lung transplantation for secondary bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation was selected.After developing invasive aspergillosis infection in the lungs,the patient received multi-drug combination therapy.Clinical pharmacists evaluated the drug-drug interactions(DDIs)and developed a dosage adjustment plan for the patient based on professional knowledge,and provided full-course pharmaceutical monitoring.Results Clinical pharmacists analyzed complex DDIs involving three or more drugs,predicted the initial dosing regimen by studying the metabolic mechanisms and influencing factors of each drug,adjusted drug dosage through therapeutic drug monitoring methods,and maintained key drug blood concentrations within the treatment target range,achieving expected clinical efficacy and reducing adverse reactions.Conclusion Clinical pharmacists assist the transplant team in developing individualized dosing plans to ensure the effectiveness and safety of multi-drug therapy for transplant patients.
作者
陆璐
高瑞
王晓星
Lu Lu;Gao Rui;Wang Xiaoxing(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Tianjin Fifth Central Hospital,Tianjin 300450,China;China-Japan Friendship Hospital,Beijing 100029,China)
出处
《实用药物与临床》
2026年第1期43-47,共5页
Practical Pharmacy and Clinical Remedies
基金
中日友好医院高水平医院临床业务费专项资助项目(2023‐NHLHCRF‐YYPPLC‐TJ‐22)。
关键词
异基因造血干细胞移植
肺移植
药物治疗管理
药学监护
他克莫司
伏立康唑
伊马替尼
Allogeneic hematopoietic stem cell transplantation
Lung transplantation
Medication therapy management
Pharmaceutical care
Tacrolimus
Voriconazole
Imatinib
