临床药师参与颅脑损伤患者鼻饲给予丙戊酸钠的药学监护
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摘要
目的通过血药浓度监测,探讨临床药师对颅脑损伤患者鼻饲给予丙戊酸钠的药学监护模式。方法利用HPLC检测颅脑损伤患者鼻饲给予及静脉给予丙戊酸钠后丙戊酸的血药浓度,研究不同给药方式对丙戊酸血药浓度的影响,探讨临床药师药学监护的作用。结果丙戊酸钠鼻饲给药严重影响血浆药物浓度,其血药浓度均达不到有效参考范围。经临床药师建议后,丙戊酸钠改为静脉给药,血药浓度较鼻饲给药升高,达窗率提高,差异有统计学意义(P<0.01)。结论临床药师在临床治疗团队中充分运用血药浓度监测方法及扎实的药学知识,在临床药物治疗过程中起到重要作用。
OBJECTIVE To investigate the mode of clinical pharmacist participating in the nasogastric feeding sodium valproate of patients with craniocerebral injury by therapeutic drug monitoring. METHODS An HPLC method was used to monitor the plasma concentration of valproic acid by nasogastric feeding and intravenous dripping sodium valproate in patients with craniocerebral injury. The effects of different dosage forms on the concentration of valproic acid and the role of clinical pharmacist in pharmaceutical care was studied. RESULTS The nasogastric feeding of sodium valproate significantly affected the plasma drug concentration. The plasma drug concentration couldn't reach the effective reference range. After the clinical pharmacist suggested, the nasogastric feeding of sodium valproate was changed to intravenous administration, the concentration of plasma drug increased, and the success rate increased. The difference was statistically significant(P<0.01). CONCLUSION In the medical team, clinical pharmacists shall make full use of their advantages in drug characteristics to carry out clinical pharmaceutical care.
OBJECTIVE To investigate the mode of clinical pharmacist participating in the nasogastric feeding sodium valproate of patients with craniocerebral injury by therapeutic drug monitoring. METHODS An HPLC method was used to monitor the plasma concentration of valproic acid by nasogastric feeding and intravenous dripping sodium valproate in patients with craniocerebral injury. The effects of different dosage forms on the concentration of valproic acid and the role of clinical pharmacist in pharmaceutical care was studied. RESULTS The nasogastric feeding of sodium valproate significantly affected the plasma drug concentration. The plasma drug concentration couldn't reach the effective reference range. After the clinical pharmacist suggested, the nasogastric feeding of sodium valproate was changed to intravenous administration, the concentration of plasma drug increased, and the success rate increased. The difference was statistically significant(P<0.01). CONCLUSION In the medical team, clinical pharmacists shall make full use of their advantages in drug characteristics to carry out clinical pharmaceutical care.
引文
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[13]LIU X D,LIU M,SUN H,et al.Interaction of valproic acid-carbapenem antibiotics:a clinical survey[J].Chin J New Drugs(中国新药杂志),2015,24(5):595-600.
[14]唐莲,周黎,虞燕霞,等.126例丙戊酸血药浓度未达标病例的临床分析[J].中国药学杂志,2012,47(24):2040-2042.
[2]JIN J,XUE J,CHAI S W.Curative effect of sodium valproate and phenytoin on status epilepticus:a systematic review[J].Chin J Mod Appl Pharm(中国现代应用药学),2015,32(1):90-94.
[3]PINTO T F,ROCHA R,PAULA C A,et al.Tolerance to enteral nutrition therapy in traumatic brain injury patients[J].Brain Inj,2012,26(9):1113-1117.
[4]王飞,李金刚,杨博文.丙戊酸钠在颅脑损伤的应用[J].中外医疗,2011,30(28):133.
[5]邬丹莲,陈志高,窦文琴,等.鼻饲给药对血清丙戊酸浓度的影响[J].医药导报,2013,32(2):258-260.
[6]林莉.鼻饲药物粉碎机的研制与应用[J].护理学杂志,2011,26(13):73.
[7]PU Y S,HUANG Y,MA J,et al.The effect of enteral nutrition through a feeding tube on the blood drug concentration and pharmacokinetic parameters of digoxin[J].Chin J Hosp Pharm(中国医院药学杂志),2013,33(15):1253-1256.
[8]XU Y G,PU Y S,ZHANG W Y.Study on drug-nutrition interactions between oral-drugs and enteral nutrients in ICUpatients[J].Chin J Clin Pharm(中国临床药学杂志),2011,20(1):35-38.
[9]Joseph Boullata,Vincent Armenti.杜冠华译.药物与营养物质的相互作用[M].北京:人民卫生出版社,2008:393.
[10]何艳玲,钟汝海.气管切开患者3种鼻饲方法食物反流发生情况比较[J].护理学报,2011,18(3A):51-52.
[11]施云兰.脑卒中鼻饲患者的护理进展[J].全科护理,2011,9(1):78-79.
[12]李芚.实用临床药物动力学[M].成都:四川大学出版社,1996:184.
[13]LIU X D,LIU M,SUN H,et al.Interaction of valproic acid-carbapenem antibiotics:a clinical survey[J].Chin J New Drugs(中国新药杂志),2015,24(5):595-600.
[14]唐莲,周黎,虞燕霞,等.126例丙戊酸血药浓度未达标病例的临床分析[J].中国药学杂志,2012,47(24):2040-2042.