劳力性热射病患者行CRRT过程中合并感染的药学监护

Pharmaceutical care on exertional heat stroke patient with infection during receiving continuous renal replacement therapy

目的探讨危重症患者行连续性肾脏替代治疗(Continuous renal replacement therapy,CRRT)过程中合并感染后药物的选择及剂量的确定。方法总结、分析1例劳力性热射病患者行CRRT过程中合并感染的药物治疗方案。结果患者入院后诊断为劳力性热射病,多脏器功能衰竭,积极给予液体复苏、CRRT、抗感染等治疗。入院第4天,患者出现明确的感染征象,血培养先后回报鲍曼不动杆菌、MRSA感染,经过多次抗菌药物方案的调整及菌群失调的治疗,患者感染得到有效控制。结论正确的药物选择、给药方案的制定对于挽救危重症患者的生命及影响其预后有着重大意义。

Objective To understand the antibiotic treatment process and antibiotic dosing in critically ill adult patient receiving CRRT.Methods A case with exertional heatstroke who was infected during CRRT was summarized.Results The patient was diagnosed with heatstroke and multiple organ failure.Then admission fluid resuscitation,CRRT,anti-infection treatment were given.Treated for 4 days,there were some indications of infection,the blood cultures indicated： Acinetobacter baumannii and MRSA,after the adjustment of antibiotic treatment process and treatment of the dysbacteria and diarrhea,eventually the infection was controlled.Conclusion The proper selection and program of the drugs have a great significance on survival and prognosis of the critically ill adult patient.