Abstract:

Objective To improve the management of individualized drug therapy and drug safety inpregnancy patients after kidney transplantation，and to reduce maternal and fetal adverse events. Methods Toformulate individualized medication regimen and provide medication education from the aspects of adjustment ofimmunosuppressants，optimization of antihypertensive drugs，supplementation of folic acid，selection and monitoring ofanticoagulant drugs，monitoring of high uric acid and lactation were conducted. Results First trimester : The blood HCGinspection was positive indicating pregnancy .The patient's medication regimens were adjusted to the immunosuppressanttacrolimus capsule（5 mg Bid），hypotensor nifedipine controlled release tablets（30 mg QD），folic acid tablets（5 mg QD），dydrogesterone table（10 mg Q12 h）. Second trimester ：anticoagulant therapy of dapheparin sodium injection（5000 U/d）was given. At the same time，oral tacrolimus（5 mg Bid）was continued to maintain immunotherapy，and nifedipinecontrolled release tablet（30 mg QD）was used to reduce blood pressure. Perinatal period ：dexamethasone intramuscular（6 mg Q12 h）injection was given to promote fetal lung maturation and reduce lung complications of premature newborns.To prevent infection，Ceftazidime injection（2 g Bid）and metronidazole sodium chloride injection（100 ml Qd）weregiven for 5 d . Leonurus intramuscular injection was 1 ml to promote uterine contraction，in the meantime, the patients continueto take tacrolimus to maintain immunotherapy and nifedipine to reduce blood pressure. Conclusion The cooperation amongphysicians，pharmacists and nurses could provide whole-process management for kidney transplantation patients and improvetreatment effect. Meanwhile，pharmacists can effectively improve clinical dialectical thinking and evidence-based thinking throughparticipating in the whole process of treatment practice，laying a foundation for improving the level of pharmaceutical care.

Key words:

Clinical pharmacists, Kidney transplantation pregnancy, Medication therapy management

摘要：

目的 提升肾移植术后妊娠患者个体化药物治疗管理水平，提高用药安全，减少母亲、胎儿不良事件发生。方法 从免疫抑制剂的调整，降压药物的优化、叶酸的补充、抗凝药物的选择及监护、高尿酸的监护、哺乳等方面制订个体化用药方案，提供用药教育。结果 孕早期 : HCG 阳性明确妊娠，调整免疫抑制剂为他克莫司胶囊（5 mg，2 次 / d），口服硝苯地平控释片（30 mg，1 次 / d）降压，补充叶酸片（5 mgQD）、地屈孕酮片（10 mg，1 次 /12 h）。孕中期 ：给予达肝素钠注射液（5000 U/d）抗凝治疗。同时继续口服他克莫司（5 mg，2 次 / d）维持免疫治疗，硝苯地平控释片（30 mg，1 次 / d）降压。围生期 : 给予地塞米松肌注（6 mg，1 次 /12 h）促胎肺成熟治疗降低早产新生儿肺部并发症，产后注射用头孢他啶（2 g，2 次 / d）、甲硝唑氯化钠注射液（100 ml，1 次 / d），5 d 预防感染，益母草注射液肌注（1 ml，2 次 / d）促进子宫收缩，同时继续服用他克莫司维持免疫治疗，硝苯地平降压。结论 医 - 药 - 护三位一体为肾移植患者提供全程化管理，提高治疗效果，同时药师通过参与治疗实践全过程，可有效提升临床辨证思维及循证思维，为提高药学服务水平奠定基础。

关键词:

"> 临床药师 ； 肾移植妊娠 ； 药物治疗管理