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临床药师优化重症肺部感染患者抗感染药物治疗方案的实践
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| 篇名： | 临床药师优化重症肺部感染患者抗感染药物治疗方案的实践 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在重症肺部感染患者抗感染药物治疗中药学监护的模式和作用。方法：临床药师参与1例重症肺部感染患者的诊疗过程，评估药物方案合理性，根据患者的各项相关指标变化评估药物疗效，协助医师优化治疗方案：患者感染加重，临床药师建议停用莫西沙星，予注射用美罗培南1.0 g，ivgtt，q12 h加强抗感染；感染控制较为稳定后，根据痰培养结果建议停用美罗培南，予盐酸左氧氟沙星注射液0.5 g，ivgtt，qd+注射用氨曲南2.0 g，ivgtt，q12 h巩固抗感染；感染加重后，因不能排除耐甲氧西林金黄色葡萄球菌（MRSA）感染，建议停用左氧氟沙星，予万古霉素1.0 g，ivgtt，q12 h；肺部感染再次加重后，建议停用氨曲南，予注射用盐酸头孢吡肟2.0 g，ivgtt，q12 h+硫酸阿米卡星注射液0.4 g，ivgtt，qd，监测万古霉素血药浓度；痰培养未见MRSA，建议停用万古霉素，继续头孢吡肟+阿米卡星抗感染。结果：医师采纳临床药师建议，患者生命体征稳定，感染较前得到明显控制，转至普通病房继续治疗。结论：临床药师参与优化抗感染药物治疗方案，可提高疗效，减少药品不良反应和避免药物相互作用的发生。 |
| ABSTRACT： | OBJECTIVE： To explore the mode and role of clinical pharmacists participating in pharmaceutical care of anti-infective therapy for patients with severe pulmonary infection. METHODS： Clinical pharmacists participated in diagnosis and treatment for a patient with severe pulmonary infection. The rationality of therapy regimen was evaluated， and therapeutic efficacy was also evaluated according to the change of relative index； clinical pharmacists assisted physicians to optimize therapy plan： suggest to stop taking moxifloxacin and give Meropenem for injection 1.0 g，ivgtt，q12 h for anti-infective therapy if getting worse； suggest to stop taking meropenem and give Levofloxacin hydrochloride injection 0.5 g，ivgtt，qd+Aztreonam for injection 2.0 g，ivgtt，q12 h according to sputum culture if infection controlled； suggest to stop taking levofloxacin and give vancomycin 1.0 g，ivgtt，q12 h after infection aggravated because MRSA infection can not be excluded； suggest to stop taking aztreonam and give Cefepime hydrochloride for injection 2.0 g，ivgtt，q12 h+Amikacin sulfate injection 0.4 g，ivgtt，qd，and blood concentration of vancomycin if pulmonary infection aggravated； suggest to stop taking vancomycin and continue to take cefepime+amikacin for anti-infective therapy due to MRSA was not found in sputum culture. RESULTS： Physicians adopted clinical pharmacist’ s suggestion； vital sign of patients become stable， and infection have been controlled significantly compared to before treatment； the patient was transferred to common ward. CONCLUSIONS： The participation of clinical pharmacists in the optimization of anti-infective therapy plan can improve efficacy， reduce ADR and avoid drug interaction. |
| 期刊： | 2016年第27卷第14期 |
| 作者： | 姚慧娟，曾芳，沈艳琳，卜书红 |
| AUTHORS： | YAO Huijuan，ZENG Fang，SHEN Yanlin，BU Shuhong |
| 关键字： | 临床药师；抗感染；重症肺部感染；万古霉素 |
| KEYWORDS： | Clinical pharmacist； Anti-infection； Severe pulmonary infection； Vancomycin |
| 阅读数： | 302 次 |
| 本月下载数： | 5 次 |
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