于丽+轩姣+李晋宝

摘 要 目的：探讨临床药师在药物致中毒诊治中的作用。方法：在外用朱砂致汞中毒患者救治中，临床药师结合患者症状和用药史，为医师提供朱砂成分信息，并提出检查尿汞浓度的建议，为及早诊断提供依据，诊断明确后参与治疗方案的设计并开展用药监护。结果：急查患者尿汞浓度超标，经驱汞、保肝等治疗后，尿汞浓度降至正常，病情明显好转。结论：临床药师能够在药物中毒救治中提供药品信息、参与制定药物治疗方案和开展药学监护。

关键词 临床药师 汞中毒 药学监护

中图分类号：R595.4 文献标识码：C 文章编号：1006-1533（2016）17-0068-03

The role of clinical pharmacists in the diagnosis and treatment of mercury poisoning caused by the topical use of cinnabar

YU Li1*， XUAN Jiao2， LI Jinbao2**（1. Pharmaceutical Department， the 7th Peoples Hospital of Zhengzhou， Zhengzhou 450016， China； 2. Yellow River Sanmenxia Hospital of Henan Province， Sanmenxia 472000， China）

ABSTRACT Objective： To explore the role of clinical pharmacists in the diagnosis and treatment of drug poisoning. Methods： According to the symptoms and medication history of the patient with mercury poisoning caused by topical use of cinnabar， clinical pharmacists provided some vermilion composition information for physicians and the basis for early diagnosis， and recommended to check the urinary mercury concentration and participated in the design of the treatment plan and carry out medication supervision after the clear diagnosis. Results： The concentration of acute urinary mercury in the patient exceeded the standard， however， it decreased to the normal level after the treatment of eliminating mercury and protecting liver and the condition was significantly improved. Conclusion： Clinical pharmacists can provide drug information for physicians in the treatment of drug poisoning， participate in making drug treatment plan and carry out pharmaceutical care.

KEY WORDS clinical pharmacists； mercury poisoning； pharmaceutical care

朱砂具有清心、镇静、安神、解毒之功效，其主要成分为硫化汞，长期久服会导致慢性汞中毒，可累及黏膜、神经及血液系统，并出现肝肾功能损害和精神症状[1]。本文对临床药师参与1例外用朱砂至汞中毒患者的救治过程中的诊断、用药方案的制定及用药监护等进行阐述，以探讨临床药师在药物致中毒患者救治中的切入点和作用。

1 病史资料

患者，女性，37岁，体重60 kg。20余天前因痔疮肛周疼痛开始用多种中药材配制外敷熏蒸治疗。8 d后肛周疼痛加剧，伴心慌、胸闷、纳差、口干口渴，胸闷，气短，间断咳嗽，无咳痰，于当地医院住院治疗。住院期间患者出现癫痫样抽搐，表现为牙关紧闭，口吐白沫，四肢僵直，病情加重转至我院EICU。转院途中，患者间断抽搐3次，给予咪达唑仑、苯巴比妥处理后抽搐停止。

入院查体：体温 36.5 ℃，心率 105次/min，呼吸20次/min，血压 80/50 mmHg。……