临床药师参与1例产科重症感染患者治疗的实践与分析

发布时间：2018-03-06 09:33

本文选题：临床药师　切入点：抗感染　出处：《中国药房》2015年05期 　论文类型：期刊论文

【摘要】：目的:探讨临床药师在产科重症感染患者治疗中的作用。方法:1例前置胎盘剖宫产术后重症感染患者,术后第2天引流液培养示粪肠球菌及大肠埃希菌感染,且均为超广谱β-内酰胺酶(ESBL)菌株,临床药师建议使用哌拉西林/他唑巴坦3.375 g,q8h+左氧氟沙星0.3 g,qd抗感染治疗。术后第7天,宫腔液培养示仍为粪肠球菌及产ESBL的大肠埃希菌感染,建议给予万古霉素0.5 g,q8 h+哌拉西林/他唑巴坦3.375 g,q8 h抗感染,停用地塞米松。术后第12天,致病菌仍为粪肠球菌和大肠埃西菌,且对哌拉西林/他唑巴坦已耐药,临床药师建议使用美罗培南1.5 g,q8 h+万古霉素0.5 g,q8 h+口服大蒜素胶囊40 mg,bid预防二重感染。结果:临床医师采纳建议,患者体温逐渐下降,各项体征开始恢复,痊愈出院。结论:临床药师参与治疗,可以发现临床药物治疗中需注意的问题,提出合理建议,降低不良反应发生率,进而提高临床治疗的有效率和成功率。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of severe obstetric infection. Methods: a case of severe infection after cesarean section of placenta previa was treated with a sample of Enterococcus faecalis and Escherichia coli on the second day after operation. All of them were extended-spectrum 尾 -lactamases (ESBL) strains. Clinical pharmacists suggested that piperacillin / tazobactam 3.375 g / kg / q8h levofloxacin 0.3 g / qd should be used for antiinfective therapy. On the 7th day after operation, intrauterine fluid culture showed that the infection was still Enterococcus faecalis and Escherichia coli producing ESBL. It was suggested that vancomycin 0.5 g / kg / g / h piperacillin / tazobactam 3.375 g / q8 h should be given to resist infection and stop dexamethasone. On the 12th day after operation, the pathogenic bacteria were Enterococcus faecalis and Escherichia coli, and were resistant to piperacillin / tazobactam. Clinical pharmacists recommended the use of meropenem 1.5 g / q8 h vancomycin 0.5 g / q8 h oral allicin capsule 40 mg / g bid for the prevention of double infection. Results: the clinician accepted the recommendation that the patient's body temperature gradually decreased and the signs began to recover. Conclusion: the clinical pharmacists can find the problems that should be paid attention to in the treatment of clinical drugs, and put forward reasonable suggestions to reduce the incidence of adverse reactions, and then improve the effective rate and the success rate of clinical treatment.
【作者单位】：扬州大学医学院附属淮安市妇幼保健院;
【分类号】：R719.8

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