纵隔感染并发严重脓毒症患者的药学监护

发布时间：2018-11-26 09:05

【摘要】：目的:探讨临床药师对纵隔感染并发严重脓毒症患者的药学监护模式和内容。方法:临床药师参与1例纵隔感染并发严重脓毒症患者的药物治疗,从药物选择、剂量、疗效、疗程及不良反应等方面制订个体化药物治疗方案,并提供药学监护。患者的初始抗感染方案为美罗培南1.0 g,ivgtt,q8 h+万古霉素0.75 g,ivgtt,q12 h,感染控制不理想,临床药师建议更改为注射用哌拉西林钠他唑巴坦钠4.5 g,ivgtt,q8 h+甲硝唑氯化钠注射液0.5 g,ivgtt,q8 h;后考虑厌氧菌感染,更换为左氧氟沙星0.5 g,ivgtt,qd;并对抗全身炎症反应、降脱水、肠内营养等方面提出建议。结果:医师采纳临床药师建议,患者在ICU治疗14 d后,顺利脱离呼吸机,体温正常,血常规较前明显下降,各项生命体征平稳,转出ICU继续巩固治疗。结论:临床药师的个体化药学监护,为临床合理用药提供了可靠的依据,保证了患者用药的安全、有效。
[Abstract]:Objective: to explore the pharmacological monitoring model of mediastinal infection complicated with severe sepsis by clinical pharmacists. Methods: a clinical pharmacist took part in the drug therapy of a patient with severe sepsis complicated by mediastinal infection. The individual drug treatment plan was formulated from the aspects of drug selection, dosage, curative effect, course of treatment and adverse reactions, and was provided with pharmacological monitoring. The initial anti-infective regimen of the patients was meropenem 1.0 g / d iv gttt / q8 h vancomycin 0.75 g / d iv gttt q12 h, and the infection control was not satisfactory. The clinical pharmacist suggested that it should be changed to piperacillin sodium, tazobactam sodium 4.5 g / d iv gtt. for injection. Metronidazole sodium chloride injection 0.5 g / g iv Q8 h; After anaerobe infection was considered, it was replaced by levofloxacin 0.5 g / g iv GTT QD, and suggestions were put forward in aspects of anti-systemic inflammatory reaction, reducing dehydration, enteral nutrition and so on. Results: the physician suggested that after 14 days of ICU treatment, the patient got rid of the ventilator smoothly, his body temperature was normal, the blood routine was obviously decreased, the vital signs were stable, and the patient was transferred out of ICU to continue the consolidation therapy. Conclusion: the individualized pharmacological monitoring of clinical pharmacists provides reliable basis for rational use of drugs in clinic and ensures the safety and effectiveness of drug use in patients.
【作者单位】：吉林大学第一医院药品管理部;吉林大学第二医院药品管理部;
【分类号】：R459.7

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