1例脑梗死并发尿路感染患者的药学监护

Pharmaceutical Care for One Cerebral Infarction Patient with Urinary Tract Infection

目的:为临床药师参与脑梗死并发尿路感染患者药物治疗提供参考。方法:临床药师参与1例脑梗死合并尿路感染患者的药物治疗过程,并以所涉及的诊断和治疗药物的治疗指南为依据,从凝血功能、电解质、肾功能等方面进行全面药学监护,协助医师合理用药。针对溶栓药物阿替谱酶的剂量,建议先给予7 mg,iv,再给予63 mg,ivgtt;针对脱水降颅压药物甘露醇的剂量,建议由125 ml增加至500 ml;针对导管相关尿路感染,建议采用哌拉西林/他唑巴坦2 g,ivgtt,q8 h抗感染;针对预防患者应激性溃疡的发生,建议采用泮托拉唑40 mg,ivgtt,bid。结果:医师采纳临床药师建议(除甘露醇剂量的调整),治疗过程中无明显不良反应发生,患者病情得到有效控制,好转出院。结论:临床药师介入治疗并实施药学监护,有助于临床合理用药,确保患者用药安全。

OBJECTIVE： To provide reference for the clinical pharmacists participating in the treatment of cerebral infarction patients with urinary tract infections. METHODS： Clinical pharmacists participated in the comprehensive pharmaceutical care includ- ing coagulation function, electrolytes and renal function, etc. of one cerebral infarction patient with urinary tract infections. The ra- tional drug use of clinical pharmacists was assisted based on the ＂treatment guidelines＂ involved in diagnosis and therapy. The dosage of thrombolytic drug alteplase was firstly recommended for 7 mg, iv, then 63 mg, ivgtt; lowering the intracranial pressure drug mannitol was recommended to increase from 125 ml to 500 ml; catheter-associated urinary tract infections were recommended for piperacillin / tazobactam 2 g, ivgtt, q8 h for anti-infection; for the prevention of incidence of stress ulcer, clinical pharmacists recommended pantoprazole 40 mg, ivgtt, bid. RESULTS： Doctors adopted clinical pharmacists＇ suggestions （except for the adjustment of mannitol dosage）. There were no obvious adverse reactions in the treatment process. Patient＇s condition was effectively controlled and patient was cured and discharged from hospital. CONCLUSIONS： The clinical pharmacists participating in the treatment and pharmaceutical care can promote rational clinical medication and ensure medication safety.