血液透析伴亚急性感染性心内膜炎患者的药学监护

发布时间：2018-03-18 03:37

本文选题：亚急性感染性心内膜炎　切入点：血液透析　出处：《中国药房》2016年29期 　论文类型：期刊论文

【摘要】：目的:探讨临床药师在血液透析伴亚急性感染性心内膜炎(IE)患者抗感染药物治疗中的作用。方法:临床药师参与1例血液透析伴亚急性IE患者的抗感染药物治疗过程,根据药物抗菌谱、实验室和影像学检查结果和患者的病情变化,协助医师优化用药方案,先后建议亚胺培南西司他丁钠应在血液透析后给药,调整替考拉宁的首剂量,首次给予万古霉素负荷剂量1 g,于每次透析结束后给予维持剂量0.5 g,并根据血药浓度监测结果调整其使用剂量;在治疗过程中,临床药师密切观察抗感染药物治疗效果及药品不良反应,并进行血药浓度监测、用药提醒和用药教育等药学监护。结果:医师部分采纳临床药师建议,患者未再出现发热症状,血象恢复正常,心脏彩超未见异常,准予出院。结论:临床药师通过调整血液透析伴亚急性IE患者抗感染药物的剂量、评价药物疗效、监测药品不良反应,并定期监测万古霉素血药浓度,协助医师优化治疗方案,确保了患者用药的安全、有效。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of anti-infective drugs in hemodialysis patients with subacute endocarditis. Methods: clinical pharmacists participated in the course of anti-infective drug therapy in a case of hemodialysis with subacute IE. According to the antibacterial spectrum of the drug, the results of laboratory and imaging examinations and the changes of the patient's condition, and to assist the physician in optimizing the medication plan, it was suggested successively that imipenem cilastatin should be administered after hemodialysis to adjust the first dose of teicoplanin. Vancomycin was first administered at a load dose of 1 gg, maintained at the end of each dialysis at 0.5 g, and adjusted for use according to the results of the blood drug concentration monitoring; during the course of treatment, The clinical pharmacists closely observed the therapeutic effect of anti-infective drugs and adverse drug reactions, and carried out monitoring of blood drug concentrations, drug reminders and drug education. Results: the doctors partially accepted the advice of the clinical pharmacists, and the patients did not have fever symptoms again. Conclusion: clinical pharmacists can adjust the dosage of anti-infective drugs in hemodialysis patients with subacute IE, evaluate the efficacy of drugs, and monitor adverse drug reactions. The concentration of vancomycin was monitored regularly to help doctors to optimize the treatment plan to ensure the safety and effectiveness of drug use.
【作者单位】：上海长征医院药材科;
【基金】：上海医院药学科研项目(No.2014-YY-01-12)
【分类号】：R542.41;R459.5

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