对1例急性细菌性脑膜炎患者的药学监护

Pharmaceutical care on a patient with acute bacterial meningitis

1例50a男性患者,因急性细菌性脑膜炎合并感染性休克入神经内科监护室治疗,转入前曾使用多种抗生素,感染控制不佳。在监护室治疗期间,临床药师参与患者抗感染治疗方案的制定,参照急性细菌性脑膜炎诊疗指南,根据患者可能致病菌,结合患者肌酐清除率,建议给予去甲万古霉素联合足剂量美罗培南抗感染治疗,3d后感染得到有效控制;为预防神经系统后遗症,在使用抗生素同时应给予激素治疗,综合考虑激素的剂量、疗程和减药等问题后,建议采用氢化可的松,3d后患者度过病情危险期;鉴于患者输液的特殊性,在了解药物的物理化学性质后,确定合理的输液顺序,确保患者安全、有效地接受药物治疗。

A 50-year-old male patient with acute bacterial meningitis accompanied by septic shock was admitted into neurological intensive care unit （NICU）. The patient was treated with several antibiotics before admission, but the infection was not well controlled. During the intensive care of the patient in NICU, clinical pharmacist participated in making therapeutic plan of anti-infection and suggested treating with norvancomycin plus adequate dosage of meropenem according to the guidelines of acute bacterial meningitis and the possible bacterial infection as well as creatinine clearance of the patient. Then the infection was controlled after 3 days. For prophylaxis of neurological sequelae, clinical pharmacist suggested simultaneous use of hydrocortisone after comparing the dosage, duration and withdrawl reaction of several available corticosteroids, and the patient passed through the dangerous period after 3 days. In addition, clinical pharmacist also designed a sequence of intravenous transfusion on the basis of physical and chemical properties of intravenous drugs to ensure the safety and efficacy of drug use.