肾移植患者他克莫司血药浓度异常值评析及药学监护

目的:探讨肾移植患者他克莫司(Tac)血药浓度异常值的产生原因及药学监护模式。方法:临床药师对某院2016年1月-2018年4月行Tac血药浓度监测的肾移植患者实施药学监护,通过异常值评析后提出个体化给药建议。结果:290例患者进行6 250次血药浓度监测,有124例患者出现196次异常值,其中真异常110次、伪异常15次和不明原因异常71次。除6例患者因异常值造成明显药物不良反应外,其余未对肾移植预后造成明显影响。结论:Tac血药浓度个体内差异较大,药师可通过对肾移植个体内Tac血药浓度异常值监测,开展肾移植患者药学监护工作,提高医院药学服务水平。

Pharmaceutical care for renal transplantation patients by evaluation and analysis of abnormal value of tacrolimus blood concentration

OBJECTIVE To investigate the cause of abnormal blood concentration of tacrolimus (Tac) and the model of pharmaceutical care in renal transplantation patients.METHODS The blood concentration of Tac was measured by electrochemiluminescence method.From January 2016 to April 2018,pharmaceutical care was conducted in the renal transplantation patients who monitored blood concentration of tacrolimus in our hospital,and then the individualized drug administration suggestion was proposed after the evaluation and analysis of abnormal values.RESULTS Totally 6 250 blood concentration data from 290 renal transplantation patients were obtained.A total of 195 abnormal values were observed in 124 cases.According to the true and false abnormal values,they were divided into three groups:true abnormal for 110 times,false abnormal for 15 times and unknown cause abnormal for 71 times.According to the abnormal value by different causes,the abnormal value was relieved after the corresponding measures were taken in time.Except for 6 cases with adverse reactions,the prognosis of renal transplantation was not significantly affected.CONCLUSION Individual differences in tacrolimus blood concentrations are significant.Pharmacists can monitor the abnormal value of Tac blood concentration to carry out pharmaceutical care for renal transplantation patients and improve the level of pharmaceutical service in the hospital.