冠状动脉搭桥术后侵袭性真菌感染患者一例药学监护

Pharmaceutical Care for a Patient with Invasive Fungal Infection after Undergoing Coronary Artery Bypass Grafting

目的:探讨临床药师在心外科实施药学监护、参与治疗方案制订的工作切入点。方法:通过对1例冠状动脉搭桥术后侵袭性真菌感染的患者进行药学监护,分析抗真菌感染治疗方案、抗真菌药物不良反应监测与处理、患者用药指导,评估抗真菌药物使用情况,讨论抗真菌感染治疗的个体化用药方案的重要性。结果:通过药学监护,临床药师为临床提供了合理用药建议及不良反应处置意见。结论:临床药师以药学监护为工作切入点,促进临床药师融入医生护士共同组成的治疗团队,有利于保证患者用药安全、有效、经济。

OBJECTIVE： To explore approaches for clinical pharmacists to provide pharmaceutical care and participate in the decision-making regarding the treatment protocol in patients undergoing cardiac surgery. METHODS： The clinical pharmacist provided pharmaceutical care for a patient with invasive fungal infection after undergoing coronary artery bypass grafting, analyzed anti-fungal infection treatment protocol, monitoring and management the adverse drug reactions induced by antibiotics, provided medication guidance, and evaluated the antibiotic use and the importance of individualized dosage regimen of anti-fungal treatment. RESULTS： Through pharmaceutical care, clinical pharmacists provided recommendations regarding rational use of drug and the management of adverse drug reactions. CONCLUSION： With pharmaceutical care as the starting point, clinical pharmacists can work together with the treatment team formed from doctors and nurses so as to achieve safe, effective and economical medication.