宋梦姣 王丽敏 张斌 段金海 张晓娟

摘 要 目的：探討临床药师在临床罕见中枢神经系统人类疱疹病毒7型（HHV-7）感染患儿治疗过程中的作用。方法：1例15岁患儿因中枢神经系统感染入院后，临床药师参与其治疗过程。医师初始给予左乙拉西坦片（500 mg，bid，口服）控制癫痫症状+注射用阿昔洛韦（500 mg，q8 h，静脉滴注）进行抗病毒治疗。针对患者四肢及背部出现大片散在红色风团样皮疹，临床药师建议给予地塞米松磷酸钠注射液（10 mg，qd，静脉注射）和氯雷他定片（10 mg，qd，口服）抗过敏治疗;针对患儿出现肢体不自主抖动等症状，临床药师建议继续给予地塞米松磷酸钠注射液静脉滴注控制炎症，并给予醒脑静注射液（20 mL，qd，静脉滴注）改善抽搐;针对HHV-7感染，临床药师通过查阅相关指南及已有治疗经验，建议停用阿昔洛韦，在地塞米松治疗的基础上，联合人免疫球蛋白（pH 4）（17.5 g，qd，静脉滴注）进行冲击治疗;并同时全程监测患儿的药品不良反应和药物治疗效果。结果：医师采纳临床药师建议。患儿病情好转，于治疗18 d后带药出院。结论：在该常规抗病毒药物治疗临床罕见中枢神经系统感染性疾病无效病例的治疗过程中，临床药师协助医师完善了患儿的治疗方案，保障了其用药的有效性和安全性。

关键词 临床药师;中枢神经系统感染;人类疱疹病毒7型;药物治疗;用药分析;药学监护

ABSTRACT   OBJECTIVE： To investigate the role of clinical pharmacists on the therapy for human herpesvirus 7 （HHV-7） infection in central nervous system. METHODS： The clinical pharmacists participated in the treatment process of the hospitalized patient who was a 15-year-old patient with central nervous system infection. The doctor initially gave Levetiracetam tablets （500 mg， bid， po） to control epilepsy symptoms， and Acyclovir for injection （500 mg， q8 h， ivgtt） for antiviral treatment. According to the large red wheal scattered rubella on the limbs and back of the patient， clinical pharmacists recommended to give Dexamethasone sodium phosphate injection （10 mg， qd， iv） and Loratadine tablets （10 mg， qd， po） for anti-allergy treatment; in view of involuntary shaking of limbs in the patient， clinical pharmacists recommended to continue to give Dexamethasone sodium phosphate injection intravenously to control  inflammation and Xingnaojing injection （20 mL， qd， ivgtt） to improve the convulsion. For HHV-7 infection， based on consulting the relevant guidelines and existing treatment experience， the clinical pharmacists recommended discontinuation of acyclovir， dexamethasone combined with Human immunoglobulin （pH 4） （17.5 g， qd， ivgtt） for impact therapy should be used;  and adverse drug reactions and therapeutic effects should be monitored at the same time. RESULTS： The physicians accepted the suggestions of clinical pharmacists. The patient was improved and discharged from the hospital after 18 days of treatment.  CONCLUSIONS： During the treatment of ineffective case of clinic rare central nervous system infectious diseases with routine antiviral drugs， clinical pharmacists assisted physicians to improve their treatment plan and ensure the effectiveness and safety of patients medication.

KEYWORDS   Clinical pharmacist; Central nervous system infection; Human herpesvirus 7; Drug therapy; Medication analysis; Pharmaceutical care

中枢神经系统感染性疾病是指病原微生物入侵中枢神经系统的实质、被膜及血管等引起的急性或慢性炎症性或非炎症性疾病，其致病病原微生物包括病毒、细菌、真菌、螺旋体、寄生虫、立克次体和朊病毒等[1]。……