临床药师在治疗狼疮肾炎患者个体化给药方案设计的实践与分析

摘要

Objective To explore how renal medicine clinical pharmacists participate in making clinical drug treatment tailored to the individual, and how they carry out effective pharmaceutical care. Methods From the perspective of clinical pharmacists 1 case of 19-years-old systemic lupus erythematosus with lupus nephritis women was analyzed of the patient characteristics, treatment principle, the use of pharmacy theory and evidence-based medicine of the evidence. Together with clinical physicians pharmacists discussed and made sugar cortical hormone and immunosuppressive drugs scheme and conducted implementation of drug monitoring. Results SLEDAI ratings the clinical pharmacists was 22 points, which indicated lupus severe activities and renal biopsy results diffused with lupus nephritis with thickened basement membrane, IV -G (A) + V type. According to patients' individual characteristics clinical pharmacists suggested a nylon formulated on 0.5g,static drop once a day,three days and,at the same time,conducted pharmaceutical care. Five days after the interval and the basic things right,pharmacists gave patients a spilled nylon0.5 g again,static drop once a day,continuous for 3 days. Because for the patients with lupus nephritis the treatment effect was not satisfactory, pharmacists chose choose it for mycophenolate ester 0. 75 g,oral, twice a day. After January, patients achieved satisfactory effect. Conclusions Clinical pharmacists and pharmaceutical care staff team in the treatment of patient, play a more and more important role, and further promote more secure, effective and rational clinical medication.%目的 探索肾内科临床药师如何参与制定临床药物个体化治疗方案,如何实施有效药学监护的思路.方法 从临床药师角度分析1例19岁系统性红斑狼疮伴狼疮肾炎女性患者的病情特征、治疗原则,利用药学理论和循证药学的证据,与临床医师共同讨论、制定糖皮质激素和免疫抑制剂的药物治疗方案,并对患者实施药物监护.结果 临床药师对患者行SLEDAI评分结果为22分,提示狼疮重度活动,肾穿刺病理结果为弥漫性狼疮性肾炎伴基底膜增厚,Ⅳ-G(A)+Ⅴ型.临床药师根据患者的个体化特征,为患者制定甲泼尼龙0.5 g,静滴,每日1次,连用3 d,同时对患者进行密切的药学监护;间隔5 d后等患者基本情况好转后,再次使用甲泼尼龙0.5 g,静滴,每日1次,连用3 d.由于环磷酰胺(CTX)对该患者狼疮肾炎的治疗效果不满意,选用吗替麦考酚酯(MMF)0.75 g,口服,一日2次.一月后随访,患者治疗效果满意.结论 临床药师在与医药护人员组成的治疗团队在对患者的诊疗活动发挥越来越重要的作用,进一步促进临床用药更加安全、有效、合理.