临床药师参与1例脑外伤后多种微生物混合感染患者的药学监护

Pharmaceutical Care for a Brain Trauma Patient with Mixed Infection of Multiple Pathogenic Microorganisms by Clinical Pharmacists

目的:探讨临床药师在脑外伤患者的药学监护中如何发挥作用,为多种微生物混合感染患者的抗感染治疗提供参考。方法:临床药师参与1例脑外伤后多种微生物混合感染患者的联合治疗,对抗感染药物治疗方案的制订提出了具体意见,采取磷霉素联合哌拉西林/他唑巴坦时间差攻击疗法和两性霉素B超声雾化的治疗方案。结果:临床药师提供的合理治疗方案取得了良好的治疗效果,患者体温、血常规恢复正常,自主呼吸。治疗的同时加强对磷霉素可能导致过敏性休克、两性霉素B肾毒性的药学监护。结论:磷霉素联合哌拉西林/他唑巴坦采取时间差攻击疗法并两性霉素B雾化吸入可作为治疗重型颅脑损伤后混合感染的一种治疗选择。临床药师通过实施药学监护,协助医师优化治疗方案,提高了治疗效果,减少了细菌耐药和药品不良反应。

OBJECTIVE： To explore how the clinical pharmacists work best on pharmaceutical care for brain trauma patient, so as to provide reference for anti-infection treatment of the patients with mixed infection of multiple pathogenic microorganisms. METHODS： Clinical pharmacists participated in therapy for a brain trauma patient with mixed infection of multiple pathogenic mi-croorganisms and provided advices on the formulation of anti-infection therapy scheme. Combination treatment strategy of fosfomy-cin and piperacillin/tazobactam was used, which was time difference attack therapy and amphotericin B ultrasonic atomizing inhala-tion. RESULTS： Clinical pharmacists provided reasonable therapy scheme and obtained good curative effect. The body temperature and routine blood test of the patient returned to normal and spontaneous breathing was maintained. Pharmaceutical care was en-hanced for allergic shock induced by fosfomycin and nephrotoxicity of amphotericin B. CONCLUSIONS： Time difference attack therapy and amphotericin B ultrasonic atomizing inhalation of piperacillin/tazobactam combined with fosfomycin provide a choice for the treatment of mixed infection after severe brain trauma. Through clinical pharmacists provide pharmaceutical care and opti-mize therapy scheme, the effect of clinical treatment have been improved, the bacterial drug resistance and adverse drug reactions have been reduced.