Page 112 - 《中国药房》2022年20期

·药师与药学服务·

临床药师参与 1 例急性髓细胞白血病合并鼻脑型毛霉病患者的

诊疗实践 Δ

＊
陶 春 ，石 敏，黄 玉，李艳钰，肖 溢（自贡市第四人民医院药剂科，四川 自贡 643099）
#
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2022）20-2534-06
DOI 10.6039/j.issn.1001-0408.2022.20.20

摘 要 目的 为急性髓细胞白血病合并鼻脑型毛霉病的诊疗提供参考。方法 临床药师参与1例急性髓细胞白血病合并鼻脑型
毛霉病患者的诊疗过程。临床药师通过查阅文献，根据患者基础疾病、临床表现、用药史，发现其鼻脑型毛霉病可能性大，建议医
师及时进行诊断性检查，并建议使用注射用两性霉素B脂质体200 mg，qd进行针对性治疗。在使用两性霉素B脂质体期间，临床
药师对患者、医护人员进行了用药教育和指导，并通过每日药学查房对可能发生的不良反应进行监测。结果 患者体温恢复正常，
感染得到控制，使用两性霉素B脂质体期间并未发生不能耐受的不良反应，且停药后6个月未见复发。结论 对于有鼻脑型毛霉
病高危因素的患者，可根据其临床表现，结合既往抗感染药物使用史、实验室检查结果综合判断毛霉菌感染的风险；在进行诊断性
检查的同时，可经验性使用针对性药物进行治疗，以降低病死率。毛霉菌感染的首选药物为两性霉素B脂质体，但长期、大剂量使
用会增加患者不良反应发生风险，应及早采取措施干预并做好患者的用药教育，提高其依从性，保证用药剂量和疗程足够。
关键词 急性髓细胞白血病；鼻脑型毛霉病；诊断；两性霉素B脂质体；药品不良反应；临床药师；诊疗实践

Practice of clinical pharmacists participating in the diagnosis and treatment for a patient with

rhinocerebral mucormycosis with acute myelocytic leukemia
TAO Chun，SHI Min，HUANG Yu，LI Yanyu，XIAO Yi（Dept. of Pharmacy，Zigong Fourth People’s Hospital，
Sichuan Zigong 643099，China）

ABSTRACT OBJECTIVE To provide reference for the diagnosis and treatment for rhinocerebral mucormycosis complicated with
acute myelocytic leukemia. METHODS Clinical pharmacists were involved in the diagnosis and treatment of rhinocerebral
mucormycosis complicated with acute myelocytic leukemia. Through literature review， clinical pharmacists found that
mucormycosis was highly likely according to the patient’s underlying diseases，clinical manifestations and medication history，and
suggested the doctors to conduct diagnostic examination in a timely manner，and recommended Amphotericin B liposome for
injection 200 mg once a day for targeted treatment. During the administration of amphotericin B liposome，clinical pharmacists
educated and instructed patientand medical staff about the drug use and monitored patient for possible adverse drug reactions
through daily pharmaceutical ward round. RESULTS The patient’s body temperature returned to normal，infection was controlled，
and there was no intolerable adverse drug reactions during treatment. No recurrence was observed 6 months after amphotericin B
liposome was discontinued. CONCLUSIONS For patients with high risk factors of rhinocerebral mucormycosis，the risk of
mucormycosis can be comprehensively judged according to their clinical manifestations，combined with history of anti-infective
drug use and the results of laboratory examination. At the same time of diagnostic examination，targeted drugs can be empirically
used to reduce the mortality. Amphotericin B liposome is the first choice for mucormycosis，but long-term use and high dose will
increase the risk of adverse drug reactions in patients. Early intervention measures should be taken and medication education should
be done for patients to improve their compliance and ensure adequate dosage and course of treatment.
KEYWORDS acute myelocytic leukemia； rhinocerebral
Δ 基金项目 自贡市卫生健康委员会科研课题（No.21yb053）
mucormycosis；diagnosis；amphotericin B liposome；adverse
＊第一作者 主管药师，硕士。研究方向：抗感染临床药学、药动
学、药效学。E-mail：825361356@qq.com drug reactions；clinical pharmacist；diagnosis and treatment
practice
# 通信作者 副主任药师，硕士。研究方向：药事管理学、临床药理
学。E-mail：4705700@qq.com

·2534· China Pharmacy 2022 Vol. 33 No. 20 中国药房 2022年第33卷第20期