临床药师参与1例高血压性脑出血患者的药物治疗实践

Participation of Clinical Pharmacists in the Therapy for a Case of Hypertensive Cerebral Hemorrhage

目的:探讨临床药师在制订高血压性脑出血患者药物治疗方案中的作用。方法:临床药师参与1例高血压性脑出血患者药物治疗的全过程,对医师制订的药物治疗方案的合理性进行分析,并提出建议:输注复方氨基酸(15)双肽(2)注射液的同时应输入所需要的能量、电解质、微量元素和维生素;使用哌拉西林/他唑巴坦4.5 g,ivgtt,q8h,一方面针对葡萄球菌、肠球菌等革兰阳性球菌,另一方面覆盖痰细菌培养之铜绿假单胞菌;使用降血压药时监测血压和肝功能;根据头颅CT结果使用20%甘露醇注射液125 ml,ivgtt,视病情qd或bid。结果:医师接受了临床药师的用药方案,患者治疗过程顺利,病情好转出院。结论:临床药师需要掌握相关专科药物治疗进展,才能协助医师确立适当的个体化治疗方案。

OBJECTIVE： To investigate the role of clinical pharmacists in the formulation of therapeutic schedule for the pa- tient with hypertensive cerebral hemorrhage. METHODS： The clinical pharmacists participated in the therapy for a patient with hy- pertensive cerebral hemorrhage and evaluated the rationality of therapeutic schedule developed by physicians. The suggestions from clinical pharmacists were as follows： required energy, electrolyte, trace elements and vitamin were additionally supplemented on the basis of Compound amino acids （15） and dipeptides （2） injection; piperacillin/tazobactam 4.5 g, ivgtt, qSh were used against Staphylococcus, Enterococcus and other Gram-positive bacterials and covered Pseudomonas aeruginosa of sputum bacterial culture; blood pressure and hepatic function should be monitored when antihypertensive agents were used; 20% Mannitol injection 125 mL, ivgtt, qd or bid （depending on disease condition） was adopted according to results of brain CT scanning. RESULTS： The ther- apeutic schedule from the clinical pharmacist was accepted by physicians. The patient was treated successfully and discharged from hospital. CONCLUSIONS： The clinical pharmacist should master medication advancement thoroughly to help the physicians to es- tablish suitable individual therapeutic schedule.