1例伏立康唑治疗支气管扩张继发肺曲霉球患者的药学监护

目的 为临床肺曲霉球的诊治和药学监护提供经验和参考。方法 回顾性分析临床药师参与的1例伏立康唑治疗支气管扩张继发肺曲霉球患者的药学服务过程。临床药师通过协助方案制定、不良反应监测、基于血药浓度监测的剂量调整、用药分析及指导等对患者进行全方位的药学监护。结果 临床药师结合患者病情建议予以伏立康唑抗真菌治疗，针对患者出现的不良反应进行全程药学监护，并基于血药浓度监测及时地调整剂量方案，使患者病情稳定出院。结论 临床药师基于循证药学证据和血药浓度监测手段对支气管扩张继发肺曲霉球患者实施药学监护，既保证了抗感染治疗的有效性，又及时缓解了药物相关不良反应，充分体现了临床药师在多学科诊疗中的重要价值。

Pharmaceutical Care of Voriconazole in the Treatment of One Case of Pulmonary Aspergilloma Secondary to Bronchiectasis

OBJECTIVE To provide experience and reference for clinical pharmacists to participate in the pharmaceutical care of pulmonary aspergilloma. METHODS The pharmaceutical care process in a patient with pulmonary aspergilloma secondary to bronchiectasis treated with voriconazole was analyzed retrospectively. Clinical pharmacists provided comprehensive pharmaceutical care for the patients by assisting in treatment plan making, adverse reactions monitoring, dose adjustment based on therapeutic drug monitoring, drug analysis and guidance. RESULTS Clinical pharmacists recommended the anti-fungal treatment with voriconazole, and conducted whole-course monitoring for the adverse reactions of the patient, and timely adjusted the dose of voriconazole based on the therapeutic drug monitoring, so as to make the patient's condition stable and discharged. CONCLUSION Clinical pharmacists provide pharmaceutical care based on evidence-based pharmaceutical evidence and the therapeutic drug monitoring for the patient with pulmonary aspergilloma secondary to bronchiectasis. It not only guarantees the effectiveness of anti-infection treatment, but also timely alleviates drug-related adverse reactions and fully reflects the important value of clinical pharmacists in multidisciplinary diagnosis and treatment.