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临床药师参与1例急性髓细胞白血病合并鼻脑型毛霉病患者的诊疗实践
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| 篇名： | 临床药师参与1例急性髓细胞白血病合并鼻脑型毛霉病患者的诊疗实践 |
| TITLE： | Practice of clinical pharmacists participating in the diagnosis and treatment for a patient with rhinocerebral mucormycosis with acute myelocytic leukemia |
| 摘要： | 目的 为急性髓细胞白血病合并鼻脑型毛霉病的诊疗提供参考。方法临床药师参与1例急性髓细胞白血病合并鼻脑型毛霉病患者的诊疗过程。临床药师通过查阅文献，根据患者基础疾病、临床表现、用药史，发现其鼻脑型毛霉病可能性大，建议医师及时进行诊断性检查，并建议使用注射用两性霉素B脂质体200mg，qd进行针对性治疗。在使用两性霉素B脂质体期间，临床药师对患者、医护人员进行了用药教育和指导，并通过每日药学查房对可能发生的不良反应进行监测。结果患者体温恢复正常，感染得到控制，使用两性霉素B脂质体期间并未发生不能耐受的不良反应，且停药后6个月未见复发。结论对于有鼻脑型毛霉病高危因素的患者，可根据其临床表现，结合既往抗感染药物使用史、实验室检查结果综合判断毛霉菌感染的风险；在进行诊断性检查的同时，可经验性使用针对性药物进行治疗，以降低病死率。毛霉菌感染的首选药物为两性霉素B脂质体，但长期、大剂量使用会增加患者不良反应发生风险，应及早采取措施干预并做好患者的用药教育，提高其依从性，保证用药剂量和疗程足够。 |
| ABSTRACT： | OBJECTIVE To provide reference for the diagnosis a nd treatment for rhinocerebral mucormycosis complicated with acute myelocytic leukemia . METHODS Clinical pharmacists were involved in the diagnosis and treatment of rhinocerebral mucormycosis complicated with acute myelocytic leukemia . Through literature review ， clinical pharmacists found that mucormycosis was highly likely according to the patient ’s underlying diseases ，clinical manifestations and medication history ，and suggested the doctors to conduct diagnostic examination in a timely manner ，and recommended Amphotericin B liposome for injection 200 mg once a day for targeted treatment . During the administration of amphotericin B liposome ，clinical pharmacists educated and instructed patientand medical staff about the drug use and monitored patient for possible adverse drug reactions through daily pharmaceutical ward round . RESULTS The patient ’s body temperature returned to normal ，infection was controlled ， and there was no intolerable adverse drug reactions during treatment . No recurrence was observed 6 months after amphotericin B liposome was discontinued . CONCLUSIONS For patients with high risk factors of rhinocerebral mucormycosis ，the risk of mucormycosis can be comprehensively judged according to their clinical manifestations ，combined with history of anti -infective drug use and the results of laboratory examination . At the same time of diagnostic examination ，targeted drugs can be empirically used to reduce the mortality . Amphotericin B liposome is the first choice for mucormycosis ，but long -term use and high dose will increase the risk of adverse drug reactions in patients . Early intervention measures should b e taken and medication education should be done for patients to improve their compliance and ensure adequate dosage and course of treatment . |
| 期刊： | 2022年第33卷第20期 |
| 作者： | 陶春，石敏，黄玉，李艳钰，肖溢 |
| AUTHORS： | TAO Chun ，SHI Min，HUANG Yu，LI Yanyu ，XIAO Yi |
| 关键字： | 急性髓细胞白血病；鼻脑型毛霉病；诊断；两性霉素B脂质体；药品不良反应；临床药师；诊疗实践 |
| KEYWORDS： | acute myelocytic leukemia ； rhinocerebral |
| 阅读数： | 201 次 |
| 本月下载数： | 15 次 |
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