胡功利　李家伟　肖溢　黄玉

中圖分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）21-2672-05

DOI 10.6039/j.issn.1001-0408.2021.21.19

摘 要 目的：介绍临床药师在卡瑞利珠单抗致中毒性表皮坏死松解症（TEN）患者治疗过程中的作用，为类似不良反应的治疗提供参考。方法：临床药师参与1例卡瑞利珠单抗致中毒性表皮坏死松解症患者的治疗过程。该患者使用注射用卡瑞利珠单抗联合甲磺酸阿帕替尼片抗肿瘤治疗，因全身大面积皮疹入院。临床药师查阅相关文献并结合患者入院诊断[重症大疱性表皮松解症、重症药疹（多形红斑型）、肝功能异常等]和检查结果（低钾血症等）建议停用上述抗肿瘤药物，予以注射用甲泼尼龙琥珀酸钠（160 mg→80 mg→60 mg，qd，静脉滴注）抗炎+注射用亚胺培南西司他丁（1 g，q8 h，静脉滴注）抗感染+氯化钾注射液（1 g，qd，静脉滴注）调节电解质+复方氨基酸注射液（3AA）（10.65 g，qd，静脉滴注）营养支持+注射用泮托拉唑钠（40 mg，qd，静脉滴注）抑酸护胃+注射用还原性谷胱甘肽（2.4 g，qd，静脉滴注）保肝等;并在用药前对患者进行认知、行为教育和用药宣讲，在患者用药期间密切监护其相关指标变化，在患者出院时进行带药指导。结果：医师采纳临床药师的建议，患者治疗16 d后躯干四肢皮疹好转，双眼睑仍糜烂渗出、有较多分泌物。患者要求转院治疗。结论：临床药师协助医师完善了卡瑞利珠单抗致TEN患者的治疗方案，对患者进行认知、行为教育和用药宣讲，保障了其用药的有效性和安全性。

关键词 卡瑞利珠单抗;中毒性表皮坏死松解症;不良反应;药学实践

ABSTRACT   OBJECTIVE： To introduce the role of clinical pharmacists in the treatment of camrelizumab-induced toxic epidermal necrolysis （TEN）， and to provide reference for the therapy of similar ADR. METHODS： The clinical pharmacist participated in therapy duration of a patient with TEN caused by camrelizumab. The patient was treated with Camrelizumab for injection combined with Apatinib mesylate tablet as anti-tumor therapy， and was admitted to hospital due to extensive skin lesions. After consulting relevant literatures and analyzing the patients admission diagnosis [severe epidermolysis bullosa， severe drug eruption （erythema multiforme）， abnormal liver function， etc.] and examination results （hypokalemia， etc.）， clinical pharmacists suggested to stop above anti-tumor drugs and given Methylprednisolone sodium succinate for injection （160 mg→80 mg→60 mg， qd， ivgtt） for anti-inflammatory treatment， Imiperan cilastatin for injection （1 g， q8 h， ivgtt） for an ti-infection treatment， Potassium chloride injection （1 g，qd，ivgtt） for electrolyte regulation， Compound amino acid injection （3AA） （10.65 g， qd， ivgtt） for nutritional support treatment， Pantoprazole sodium for injection （40 mg，qd，ivgtt） for acid inhibition and stomach protection， Reduced glutathione for injection （2.4 g，qd，ivgtt） for liver protection. Before medication， the patient was given cognitive and behavioral education and medication publicity. The changes of relevant indicators were closely monitored during medication， and the patient was given medication guidance when he was discharged. RESULTS： The doctors adopted the suggestions of clinical pharmacists， and 16 days after treatment， the skin lesions of the trunk and limbs were improved， and the double eyelids were still erosive and exuded a lot of secretions. The patient requested transfer for treatment. CONCLUSIONS： Clinical pharmacists assisted physicians to improve the treatment plan of patients with TEN caused by camrelizumab， and carried out cognitive and behavioral education and medication publicity for patients to ensure the effectiveness and safety of their medication.

KEYWORDS   Camrelizumab; Toxic epidermal necrolysis; ADR; Pharmaceutical practice

卡瑞利……