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·药师与药学服务·

临床药师参与1例重症天疱疮患者的药学监护 Δ

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谢 凯 ，李志平 ，杨 洋 ，谢碧香 ，薛汝增（1.南方医科大学皮肤病医院药剂科，广州 510095；2. 南方医科
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大学皮肤病医院皮肤科，广州 510095）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2020）10-1272-05
DOI 10.6039/j.issn.1001-0408.2020.10.21
摘 要 目的：探讨临床药师在重症天疱疮患者药物治疗过程中的作用。方法：临床药师参与1例重症天疱疮患者的药物治疗过
程。根据患者出现的症状、不良反应及时调整医师的用药方案：针对可能因糖皮质激素减量所致的双手、后背出现数粒新发水疱，
临床药师建议将醋酸泼尼松片用量调整为入院前剂量70 mg，每日1次；针对患者感染控制不佳，建议将米诺环素胶囊剂量调整为
100 mg，每日2次；针对低钾血症，临床药师嘱患者口服补钾，并将其加入果汁、牛奶或者蜂蜜中服用；为预防糖皮质激素引起的骨
质疏松，临床药师建议患者服用碳酸钙D3咀嚼片的同时加服阿仑膦酸钠维D3片70 mg，每周1次；针对患者口腔黏膜出现的白色
念珠菌，根据药敏试验结果，临床药师建议将伊曲康唑胶囊调整为氟康唑胶囊50 mg，每日1次；同时密切关注利妥昔单抗注射液
输注后可能出现的输液反应，并行不良反应监测、出院用药教育等药学监护。结果：医师均采纳临床药师建议。患者病情好转，于
治疗47 d后出院。结论：临床药师参与了重症天疱疮患者的药物治疗过程，协助医师完善了其治疗方案，保证了患者用药的有效
性和安全性。
关键词 天疱疮；重症；药学监护；临床药师
Pharmaceutical Care for a Patient with Severe Pemphigus by Clinical Pharmacist
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XIE Kai ，LI Zhiping ，YANG Yang ，XIE Bixiang ，XUE Ruzeng（1. Dept. of Pharmacy，Dermatology Hospital
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of Southern Medical University，Guangzhou 510095，China；2. Dept. of Dermatology，Dermatology Hospital of
Southern Medical University，Guangzhou 510095，China）
ABSTRACT OBJECTIVE：To investigate the role of clinical pharmacists in drug therapy for patients with severe pemphigus.
METHODS：Clinical pharmacists participated in drug therapy for a patient with severe pemphigus. Clinical pharmacist adjusted the
doctor’s medication plan in time according to the symptoms and adverse reactions of the patients. In view of several new blisters on
the hand palms and back that may be caused by hormone reduction，the clinical pharmacist suggested that the dosage of Prednisone
acetate tablets should be adjusted to 70 mg before administration，once a day. For poor infection control，it was recommended to
adjust the dose of minocycline to 100 mg，bid；for hypokalemia，the clinical pharmacist advised the patients to take potassium
orally，and added it into juice，milk or honey for taking；in order to prevent osteoporosis caused by glucocorticoid，the clinical
pharmacist suggested that patients supplement Calcium carbonate and vitamin D3 chewable tablets and Alendronate sodium and
vitamin D3 tablets 70 mg at the same time，once a week. For Candida albicans in patient’s oral mucosa，according to the results of
drug sensitivity test，the clinical pharmacists suggested that Itraconazole capsules should be adjusted to Fluconazole capsules 50
mg，once a day. At the same time，pharmacist paid close attention to the adverse reactions after the infusion of Rituximab injection
and pharmaceutical care was provided，such as ADR monitoring，discharge medication education. RESULTS：The doctors took all
the advice of clinical pharmacists. The patient recovered and was discharged 47 days later. CONCLUSIONS：During drug therapy
for the patient with severe pemphigus. Clinical pharmacists can help doctors improve the treatment plan so as to ensure the
effectiveness and safety of patients’medication.
KEYWORDS Pemphigus；Severe；Pharmaceutical care；Clinical pharmacist

天疱疮是一种由表皮细胞松解引起的自身免疫性 病的治疗药物主要包括糖皮质激素、免疫抑制剂、免疫
大疱性皮肤病，以皮肤和黏膜上广泛分布的大疱和糜烂 球蛋白及抗菌药物等。目前，治疗天疱疮的首选药物仍
为特征，严重时可引起继发感染而危及患者生命 。该 是糖皮质激素，但由于该病病程较长，长期应用糖皮质
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Δ 基金项目：国家自然科学基金资助项目（No.81703123）；南方医 激素后引起的不良反应较多，如胃肠道溃疡甚至出血、
科大学科研启动计划（No.PY2018N101） 骨质疏松、血糖血脂异常等 ，故需在应用糖皮质激素的
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＊主管药师，硕士。研究方向：临床药学。电话：020-83027581。
同时予以患者护胃、补钙、补钾等对症治疗，并密切关注
E-mail：848005353@qq.com
血糖血脂变化。有研究发现，糖皮质激素联合免疫抑制
# 通信作者：主任药师。研究方向：医院药学。电话：020-83028375。
E-mail：Dantegz@foxmail.com 剂和新型生物制剂，不仅可减少激素的用量，还能提高

·1272 · China Pharmacy 2020 Vol. 31 No. 10 中国药房 2020年第31卷第10期