临床药师参与颅脑术后感染患者抗感染治疗的药学监护

Pharmaceutical Care for Anti-infection Treatment in Intracranial Infections Patients after Craniotomy by Clinical Pharmacists

目的:探讨颅脑术后继发颅内感染患者的抗感染药物选用与治疗方法及开展药学监护的方法。方法:针对颅脑术后颅内感染患者,临床药师从药物选择、疗程、治疗方法、不良反应监测等方面进行药学监护。结果:颅脑围术期预防用药可依据本院、本科室细菌流行病学特点,选择透过血脑屏障好的抗菌药物;颅内感染患者应根据细菌培养与药敏结果选用抗菌药物;可结合脑室抗菌药物冲洗或腰椎穿刺鞘内注射抗菌药物避开血脑屏障;患者各项指标恢复正常3 d后可停用抗菌药物,不能过早停药;应重视二重感染和药物热等不良反应。结论:临床药师在参与颅脑术后引起的发热症状会诊时应多方面综合考虑,分析发热原因,不但要合理选用有效抗菌药物,同时也要注意因应用抗菌药物而产生的不良反应,才能更好地服务于临床工作。

OBJECTIVE： To investigate the selection of anti-infection agent, treatment method and the development of pharma- ceutical care for intracranial infection patients after craniotomy. METHODS： Clinical pharmacist supplied pharmaceutical care for in- tracranial infection patients after craniotomy in respects of drug selection, treatment course, treatment method, adverse drug reaction monitoring, etc. RESULTS： For perioperative prophylactic medication of patients under craniocerebral operation, antibiotics with good blood-brain barrier crossing should be selected according to bacterial epidemiological characteristics. The patients with intracrani- al infection should select antibiotics according to results of bacterial culture and drug sensitivity test. Antibiotics combined with ventri- cle antibacterial rinse or lumbar puncture intrathecal injection of antibiotics to avoid blood-brain barrier. The patients should stop tak- ing antibiotics 3 days after the lab indictor returned to normal, and drug dose couldn＇t be reduced prematurely. Great importance should be attached to ADR as superinfection and drug fever.CONCLUSIONS： For fever due to craniotomy, clinical pharmacist should consider multiple aspects and analyze the reasons. They should not only select effective antibiotics rationally, but also pay at- tention to antibiotics-induced ADR; and then they can provide better pharmaceutical service.