重症乙型肝炎病史患者抗结核治疗方案的制定与药学监护

目的 探讨临床药师参与特殊结核患者个体化药物治疗方案制定及抗结核药物药学监护.方法 通过对1例重症乙型肝炎病史患者抗结核治疗方案制定与药学监护,临床药师从药物的选择、给药剂量、疗程、药物相互作用、不良反应监测等多方面给予药学服务.结果 临床药师在保证疗效的基础上,制定了最大限度减少肝功能损伤的治疗方案:①肌内注射硫酸链霉素针0.75 g,1次/d；②口服异烟肼片0.3g,1次/d;③口服盐酸乙胺丁醇片0.75 g,1次/d；④口服左氧氟沙星片0.5g,1次/d.抗结核治疗第19天,患者体温37℃,无咳嗽、气短等不适.肝功能检查结果:总蛋白71.0g/L,AST 105 U/L,ALT123 U/L,AST/ALT 0.85.转氨酶虽仍在升高,但患者无肝损害征象,继续抗结核和保肝治疗.第26天患者无咳嗽、气短,病情好转,复查血常规正常,转氨酶正常:总蛋白59.5 g/L,白蛋白37.1 g/L,AST 28 U/L,ALT 33 U/L,AST/ALT 0.8.第27天患者出院.结论 临床药师的参与使药物治疗个体化,更趋合理,有利于临床治疗的连续完整性,提高药物治疗水平.

Anti-tuberculosis treatment program and pharmaceutical care treating a patient with severe hepatitis B vi- rus infection

Objective To observe the effect of anti-TB treatment program and pharmaceutical care for a HBV infected patient.Methods The clinical pharmacist made his contribution in medication selection,dosage choice,treatment period and drug interaction pre-cautions through participating an anti-TB treatment program and pharmaceutical care for a HBV infected patient.Results This pharmaceutical service gained satisfactory clinical outcomes.Through this sufficient and effective anti-TB therapy,the patient was cured.Conclusion The clinical therapeutically consistency,rationality and level can be largely improved with clinical pharmacists participating in personalized medication.