| 宋继辰,唐秀花,贾立华.临床药师参与1例食管上段鳞癌合并肺部及腹腔感染患者的药学监护[J].中国药事,2018,32(1):38-44 |
| 临床药师参与1例食管上段鳞癌合并肺部及腹腔感染患者的药学监护 |
| On the Role of Clinical Pharmacists in Pharmaceutical Care of a Patient with Upper Esophageal Squamous Cell Carcinoma Associated with Pulmonary and Abdominal Infection |
| 投稿时间：2017-02-14 |
| DOI：10.16153/j.1002-7777.2018.01.007 |
| 中文关键词: 临床药师 食管上段鳞癌 肺部感染 腹腔感染 药学监护 |
| 英文关键词: clinical pharmacists upper esophageal squamous cell carcinoma pulmonary infection abdominal infection pharmaceutical care |
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| 中文摘要: |
| 目的：探讨临床药师在1例食管上段鳞癌合并肺部及腹腔感染患者治疗中的作用。方法：临床药师参与患者药物治疗过程，协助医师多次调整抗菌药物，优化治疗方案。经验治疗阶段应用美罗培南1 g ivgtt，q8 h（持续泵入时间大于3 h），联合使用盐酸万古霉素1 g，ivgtt，q12 h抗感染；目标治疗阶段依据两次腹水细菌培养结果及药敏，增加环丙沙星注射液0.4 g，ivgtt，q12 h，氟康唑注射液200mg，ivgtt，qd，感染指标呈下降趋势，采用哌拉西林他唑巴坦2.5 g，ivgtt，q8 h降阶梯治疗；依据痰培养检出嗜麦芽寡糖单胞菌和溶血葡萄球菌，停用哌拉西林他唑巴坦，增加复方磺胺甲噁唑2片，po，q12 h，联合头孢哌酮舒巴坦钠注射液3 g，ivgtt，q8 h，覆盖阳性球菌抗感染。结果：医生采纳了临床药师的建议。经过21天治疗患者感染指标得到明显控制并出院。结论：临床药师依据腹腔感染常见致病菌与药敏结果分析感染可能致病菌，配合医师采用降阶梯治疗方案多次调整抗菌药物，根据血药浓度判断用药效果，最大限度地减少药物对患者肝肾功能的损伤。 |
| 英文摘要: |
| Objective: To investigate the role of clinical pharmacists in the treatment of a patient with upper esophageal squamous cell carcinoma associated with pulmonary and abdominal infection. Methods: The clinical pharmacists participated in the treatment of patients with drugs, helped doctors repeatedly adjust the antibiotics and optimized treatment. In the empiric therapy stage, meropenem ivgtt, 1 g, q8 h (continuous infusion pump for more than 3 hours) was used. Vancomycin hydrochloride 1g, ivgtt q12 h was used in combination. In the target therapy stage, ciprofloxacin 0.4 g, ivgtt, q12 h and Fluconazole 200 mg, ivgtt, qd were added on the basis of the twice ascites bacterial culture results and drug sensitivity. Infection index showed a downward trend. Pharmacists recommended the use of piperacillin/tazobactam De-escalation therapy. Piperacillin/tazobactam were stopped according to sputum culture result of Pseudomonas maltophilia oligosaccharide and Staphylococcus haemolyticus. Compound sulfamethoxazole tablets 2 tablet, po, q12 h, combined with cefoperazone/sulbactam 3 g, ivgtt, q8 h were administrated to treat the infection caused by gram-positive cocci. Results: Doctor adopted clinical pharmacists' recommendations. The infection index of the patient was significantly controlled after 21 days of treatment and the patient was discharged. Conclusion: Based on common pathogenic bacteria of abdominal infections and drug susceptibility analysis of pathogenic bacteria, clinical pharmacists repeatedly adjusted the antibiotics using de-escalation therapy. The clinical pharmacists also determined the medication effect according to the blood drug concentration to minimize the damage of the drugs on the function of liver and kidney of the patient. |
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