临床药师参与1例老年肺炎伴呼吸衰竭患者的药物治疗实践

Practice of Clinical Pharmacists Participating in Drug Therapy for an Elderly Patient with Pneumonia Complicating with Respiratory Failure

目的:探讨肺炎伴呼吸衰竭患者的药物治疗方案。方法:根据老年人肺炎具有病原体分布复杂及对药物易耐受的特点,结合相关药物治疗指南及文献制订患者的治疗方案并对患者实施全程的药学监护,针对耐甲氧西林金黄色葡萄球菌(替考拉宁400 mg、ivgtt、q12h)、鲍曼不动杆菌(头孢哌酮/舒巴坦3.1 g、ivgtt、q12h;米诺环素100 mg、po、bid)以及真菌(氟康唑注射液400mg、ivgtt、qd)进行抗感染治疗,辅以氧疗、祛痰、抗凝治疗。结果:患者感染得到控制,呼吸衰竭症状得到改善,且未发生药品不良反应。结论:加强对老年肺炎伴呼吸衰竭患者的临床药学监护工作,并结合患者的实际情况,可及时发现问题、解决问题,确保临床用药安全、有效、经济和适当。

OBJECTIVE： To explore the drug therapy program for the patient with pneumonia complicating with respiratory failure. METHODS： The treatment program was analyzed according to the complexity of the pathogen distribution and the characteristics of drug tolerance in pneumonia, combined with treatment guidelines and literature analysis. Patient was given pharmaceutical care during treatment. Anti-infective therapy was provided against MRSA （teicoplanin 400 mg, ivgtt, q12h）, Acinetobacter baumanii （cefoperazone/sulbactam 3.1 g, ivgtt, q12h; minocycline 100 mg, po, bid）, fungus （Fluconazol injection 400 mg, ivgtt, qd）, supplemented with oxygen therapy, eliminating phlegm and anticoagulation therapy. RESULTS： The infection was controlled and the respiratory failure symptoms were improved without drug adverse reaction. CONCLUSIONS： Clinical pharmaceutical care should be strengthened for the elderly patients with pneumonia complicating with respiratory failure. Pharmacists should find and solve the problems in time combining with the actual situation of the patient to make the clinical medication safe, effective, economical and appropriate.