1例重症肺炎伴脓毒血症患者万古霉素个体化给药方案分析

Individualized dosing regimen of vancomycin for 1 patient with severe pneumonia and sepsis

临床药师对1例重症肺炎伴脓毒血症患者使用万古霉素后进行血药浓度监测,多次调整剂量,患者血药浓度仍低于有效浓度,病情反复。通过查阅文献,结合患者多次血药浓度监测结果,临床药师建议将传统间歇滴注给药方式改为24 h微电脑静脉输液泵持续静脉滴注给药,在不超过最大日剂量的同时,患者血药浓度维持在18～24μg·mL-1,较好地发挥了万古霉素的疗效,患者病情好转。临床药师结合抗菌药物PK/PD理论,优化万古霉素给药方案,为患者提供了有效的药学服务。

Clinical pharmacists monitored the blood concentration of vancomycin in 1patient with severe pneumonia and sepsis,and adjusted the dose many times,but the concentration of blood drug was still lower than the effective concentration range.Clinical pharmacists suggested that the traditional intermittent infusion method should be changed into 24hour microcomputers by consulting the literature.The blood concentration of the patient was maintained at 18-24μg·mL^-1,within the maximum daily dose of vancomycin,the effect ofvancomycin and the patient's condition were improved.Clinical pharmacists combined with PK/PD theory of antibacterial drugs to optimize the vancomycin dosage regimen and provided effective pharmaceutical care for patients.