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126-6-第六节 他克莫司应用中的注意事项
大剂量FK506治疗时可引起心室或室间隔肥大,少数病例可发生心肌损害,降低剂量或停止给药可逆转。用药期间建议定期检查心电图、超声心动图等,尤其是合并心脏疾病、使用激素、高血压、肝肾功能不全,或水钠储留感染的患者。如果出现异常,应该考虑减量或者停药。
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用药期间应避免联合应用其他强效的免疫抑制剂,包括抗淋巴血清治疗。有报告在2岁以下EB病毒感染的儿童中,有增加淋巴组织异常增生的危险。因此,在用药前,最好进行EB病毒检查,并在治疗期间小心监测。
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3 L- R& m) }( t% m FK506可能引起高钾血症,所以不适用于高钾患者,肾功能异常者也应慎用,同时,用药期间应避免摄取高钾食物或使用保钾型利尿剂。
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+ n7 [) g7 O1 J! o5 V0 C2 b FK506浓缩输注液中含有聚乙烯氢化蓖麻油,曾报告会产生过敏反应,包括有皮肤潮红、呼吸困难、哮喘、血压下降及心动过速等。动物试验提示,若注射时减慢速度,或事先给予抗组胺药可降低过敏反应的发生率。
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/ v/ U% k! F% f 应用FK506期间,应对以下方面进行监测:血常规、血肌醉、尿素氮、肝功能、电解质、血糖、凝血指标、血压、心电图和眼科检查。如有异常,必需调整剂量,甚至停药观察。 k; z/ @& @4 s
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