慈濟醫院藥物血中濃度監測報告

An Analysis of Therapeutic Drug Monitoring (TDM) Results from Tzu Chi General Hospital

楊文琴(Wen-Chin Yang) ； 莊美華(Mei-Hua Chuang) ； 謝維清(Wei-Chin Hsieh)

《慈濟醫學雜誌》 11卷4期 (1999/12) Pp. 343-349

https://doi.org/10.6440/TZUCMJ.199912.0343

摘要

目的：瞭解慈濟醫院物血中濃度監測的情形，協助臨床醫師適當的選擇及調整藥物之劑量及用法，而使藥物發揮最大療效並兼顧其安全性。材料及方法：本文迴溯性收集84年7月至87年6月共3年期間所有抽血進行藥物檢測之病患資料6689件，然後根據檢測藥物之品項、病患來源及藥物有效濃度進行分析。結果：檢測之藥物品項以phenytoin 3374件(50.44%)為最多，digoxin 1650件(24.67%)及theophlline 1462件(21.86%)居次，其他藥物共計203件(3.03%)。依病患來源分析得知住院病患共計4897件(73.215)，急診病患999件(14.93%)，門診病患793件(11.86%)。至於濃度方面，選取本院檢測數量最多的3項藥品digoxin、phenytoin、theophyllien進行分析。結果顯示符合有效濃度之比分別為50.00%，29.79%，52.215。再進一步分析住院、急診、門診的檢測結果顯示急診檢測藥物血中濃度不論是digoxin、phenytoin、theophyllien的檢測值在其有效濃度範圍都是比率較偏低的。由此可推論病人病況之惡化導致必須於急診治療與藥物血中濃度之間可能有相當關聯。結論：本文根據分析資料及參考文獻加以討論導致藥物濃度無法達到有效範圍之原因並說明改善的方向，期粉能籍此使藥物血中濃度監測的藥事服務工作更落實。相信籍此可提供臨床醫師在藥物治療上更佳之參考。(慈濟醫學 1999; 11:343-349)

關鍵字

藥物血中濃度監測 ； digoxin ； phenytoin ； theophylline

並列摘要

Objective: Therapeutic drug monitoring (TDM) has been developed to provide a rigorous yet practical approach for the application of pharmacokinetic methods, pharmacodynamic principles, and relevant pharmacotherapeutic data to optimize drug therapy for individual patients. In this article, we discussed some potential reasons for plasma concentrations outside the therapeutic range and suggested recommendations to correct the deviation from the optimal plasma levels in order to provide the best pharmaceutical care to all of the patients. Patients and Methods: We reviewed and analyzed all TDM cases that had been done at Tzu Chi General Hospital inpatients, outpatient, and emergency departments from July, 1995 to June, 1998. Results: Phenytoin (total 3374 cases, 50.44%), digoxin (total 1650 cases, 24.67%), and theophylline (total 1462 cases, 21.86%)were the three drugs that had been monitored most often for drug plasma concentrations. There were a total of 4897 TDM cases (73.215) in the inpatients department, 999 (14.935) in the emergency room, and 793 (11.86%)in the outpatient clinics. In addition, the percentages of digoxin, phenytoin, and theophylline within the targeted therapeutic drug concentration range in all TDM cases were 50.00%,29.79%,and 58.21% respectively. Conclusions: Emergency room patients had more sub-target drug concentrations in plasma when compared with the other two major patient patient populations for these three agents. We may conclude that sub- or over-therapeutic drug concentrations might be a major cause of emergency room visits. Therefore, individual adjustments of drug concentrations in plasma may prevent or minimize adverse effects due to inadvertent overdosage and it may facilitate and increase the effectiveness of therapy. (Tzu Chi Med J 1999; 11:343-349)

並列關鍵字

therapeutic drug monitoring (TDM) ； digoxin ； phenytoin ； theophylline