临床药师对1例孤立肾患者颅脑手术后颅内感染的药学监护

Pharmaceutical Care for a Solitary Kidney Patient with Intracranial Infections after Craniocerebral Operation by Clinical Pharmacists

目的:探讨临床药师参与抗感染治疗与开展药学监护的方法。方法:针对1例侧脑室外引流术后发生颅内感染的孤立肾患者,临床药师从药物的选择、给药剂量、给药途径、疗程以及不良反应监测等方面,最终为患者制订个体化给药方案为:腰大池持续外引流+鞘内注射万古霉素,提出药学服务要点,并进行分析总结。结果:经治疗后患者体温正常,连续3 d复查脑脊液示外观清,白细胞数正常,葡葡糖、氯化物正常,血常规示白细胞数及中性粒细胞百分比正常。结论:与静脉注射万古霉素相比,鞘内注射万古霉素不仅减少了药物剂量,同时提高了药物在脑脊液中的浓度,颅内感染的发生率下降,平均住院天数下降,住院费用减少,减轻了患者经济负担,且便于操作,安全性高。

OBJECTIVE： To explore the methods of clinical pharmacist participating in antiinfection treatment and developing pharmaceutical care. METHODS： Clinical pharmacist supplied pharmaceutical care and laid down individual treatment regimen for a solitary kidney patient with intracranial infection after drainage of lateral ventricle in respects of drug selection, drug dosage, route of administration, treatment course, adverse drug reaction monitoring, i.e. continuous lumbar drainage＋intrathecal injection of vancomy cin. The points of pharmaceutical care were put forward and analyzed. RESULTS： After treatment, the body temperature of the pa tient was in normal level, and cerebrospinal fluid recheck of consecutive 3 days showed that clear appearance, normal white blood cell count and normal glucose and chlorine. Routine blood test showed normal white blood cell count and ratio of neutrophile granulo cyte. CONCLUSIONS： Compared with intravenous injection of vancomycin, intrathecal injection of vancomycin not only reduces drug dosage, but also increases the concentrations of drug in cerebrospinal fluid and decreases the incidence of intracranial infection, average hospitalization day, hospitalization cost and economical burden of patients. It is convenient and safe in operation.