史文秀 叶晓芬 蔡映云 吕迁洲

摘 要 目的：分析电解质紊乱与药物不良反应的相关性，优化药物治疗方案。方法：通过对1例肺部感染伴咯血患者的药学监护及干预，分析在治疗过程中出现电解质紊乱的原因，探讨低钠血症、低钾血症与卡泊芬净、垂体后叶素、复方甘草酸苷之间的关系，综合评估给予合理建议。结果：经过补钠、补钾治疗后，患者低钠血症得到纠正，但血钾仍持续下降；停用复方甘草酸苷后，低钾血症纠正。结论：临床工作中要重视药物引起的电解质紊乱，如复方甘草酸苷引起的难以纠正低钾血症、垂体后叶素引起的低钠血症，密切监测电解质，及时发现药物不良反应，综合分析评估给予针对性的处理措施。

关键词 垂体后叶素 复方甘草酸苷 电解质紊乱 不良反应

中圖分类号：R969.3 文献标志码：C 文章编号：1006-1533（2019）01-0052-04

Clinical pharmacists participate in the treatment of a patient with pulmonary infection complicated with hemoptysis and electrolyte imbalance

SHI Wenxiu1*， YE Xiaofen2**， CAI Yingyun2， LYU Qianzhou2

（1. Pharmacy Intravenous Admixture Services， the First Hospital affiliated to Harbin Medical University， Harbin 150001， China； 2. Division of Pharmacy， Zhongshan Hospital， Fudan University， Shanghai 200032， China）

ABSTRACT Objective： To analyze the correlation between electrolyte disturbance and adverse drug reactions and to optimize drug treatment regimen. Methods： The causes of electrolyte disturbance in the course of treatment were analyzed by pharmaceutical care and intervention of a patient with pulmonary infection and hemoptysis and the relationship between hyponatremia， hypokalemia and caspofungin， vasopressin or compound glycyrrhizin was discussed. The reasonable advice was given after comprehensive assessment. Results： After sodium and potassium supplementation， the patients hyponatremia was corrected， but the serum potassium still continued to decline， while hypokalemia was corrected after the withdrawal of the compound glycyrrhizin. Conclusions： In clinical practice， it is necessary to pay attention to the electrolytes disorder caused by drugs， such as hyponatremia caused by vasopressin and hypokalemia by compound glycyrrhizin， which is difficult to be corrected. The electrolytes should be closely monitored to reduce the occurrence of adverse drug reactions. The counter measures should be adopted after comprehensive analysis and evaluation.

KEy WORDS vasopressin； compound glycyrrhizin； electrolyte disorder； adverse reactions

电解质紊乱是指任何原因引起人体体液内电解质的量、组成或分布的异常，并由此而导致的生理紊乱[1]。疾病和药物均可导致电解质紊乱，去除这些诱发因素是及时纠正电解质紊乱的关键。本文介绍1例肺部感染、肺曲霉菌病伴咯血的患者，在治疗期间出现电解质紊乱的病例，探讨引起电解质紊乱的原因以及调整治疗方案的建议。

1 病史摘要

患者，男性，52岁。身高1.60 m，体重35 kg。因“咳嗽、咳血、发热1月余”入院。1月前，患者受凉后出现阵发性咳嗽、咳痰，起初为黄黏痰，起病1 d后逐渐痰中带血，为棕红色血痰，每日5～6次，伴有发热，体温最高39 ℃。外院先后予左氧氟沙星0.5 g qd+头孢他啶2 g bid ivgtt 5 d、哌拉西林他唑巴坦治疗4.5 g bid ivgtt 11 d抗细菌治疗效果不佳。……