临床药师参与1例热带念珠菌血症患者抗感染治疗的实践

发布时间：2019-07-23 07:08

【摘要】：目的:探讨临床药师在重症感染患者药物治疗中的作用。方法:临床药师参与1例热带念珠菌血症患者的药物治疗过程,协助医师调整抗感染治疗方案:根据血培养结果,建议改用注射用哌拉西林钠他唑巴坦钠3.75 g,ivgtt,q8 h+注射用醋酸卡帕芬净50 mg(首剂量70 mg),ivgtt,qd对症治疗;考虑到患者行血浆置换术,建议将注射用醋酸卡帕芬净的日剂量增加至50 mg,ivgtt,bid;考虑到棘白菌素类药物可能存有"矛盾现象",建议将抗感染方案调整为注射用醋酸卡帕芬净50 mg,ivgtt,qd+注射用两性霉素B 0.1 mg/kg,ivgtt,qd,并密切监护患者有无过敏、皮疹、肾功能损害等不良反应。结果:医师采纳临床药师建议,患者生命体征平稳,血培养未见热带念珠菌,转至普通病房继续治疗。结论:临床药师参与重症感染患者的治疗过程,结合患者血培养结果、临床症状和药物作用特点,检索相关疾病治疗指南,协助医师调整抗感染方案,密切监护可能出现的不良反应,保证了抗感染治疗的有效性和安全性。
[Abstract]:Objective: to investigate the role of clinical pharmacists in drug therapy in patients with severe infection. Methods: the clinical pharmacist participated in the drug treatment process of a patient with tropical candidiasis and assisted doctors in adjusting the anti-infection treatment plan. According to the results of blood culture, it was suggested that piperacillin sodium tazobactam sodium 3.75g, ivgtt, capafenine acetate 50 mg (first dose 70 mg), ivgtt,qd) should be used for injection. Considering that patients underwent plasma exchange, it was suggested that the daily dose of capafenol acetate for injection should be increased to 50 mg,ivgtt,bid;, taking into account the possible "contradictory phenomenon" of acanthocin drugs. It was suggested that the anti-infection regimen should be adjusted to amphotericin B 0.1 mg/kg,ivgtt,qd, for injection of carbafenem acetate 50 mg,ivgtt,qd and to closely monitor the adverse reactions such as allergy, rash, renal function damage and so on. Results: the doctor adopted the suggestion of clinical pharmacist that the vital signs of the patients were stable and no candida tropicalis was found in blood culture and transferred to the general ward for further treatment. Conclusion: clinical pharmacists participate in the treatment process of patients with severe infection, combined with the results of blood culture, clinical symptoms and characteristics of drug action, retrieve the guidelines for the treatment of related diseases, assist doctors to adjust the anti-infection plan, closely monitor the possible adverse reactions, and ensure the effectiveness and safety of anti-infection treatment.
【作者单位】：深圳市罗湖区人民医院药剂科;广州军区广州总医院药剂科;
【分类号】：R519.3

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