1例食管裂孔疝合并静脉导管感染患者的药学实践

Pharmaceutical Practice for a Patient with Hiatal Hernia Complicating with Venous Catheter-related Infection

目的:为临床决策用药和规避药物不良事件提供参考。方法:临床药师参与1例食管裂孔疝合并静脉导管感染患者会诊,建议拔出久置的外周静脉穿刺置入中心静脉导管(PICC),并重新置管,将抗感染治疗方案调整为万古霉素0.5 g/次,ivgtt,q12h+氟康唑0.2 g,ivgtt,qd(首日0.4 g,ivgtt,qd),并继续头孢哌酮/舒巴坦2 g/次,ivgtt,q8 h联合抗感染。结果:医师采纳临床药师建议,拔出久置的PICC,感染得到有效治疗;患者病情得到了有效控制,感染治愈。结论:临床药师通过药学监护静脉导管感染患者,有助于医师作出正确的用药决策和规避药物不良事件。

OBJECTIVE： To provide reference for clinical desicion, drug use and ADR avoidance. METHODS： Clinical pharmacists participated in the consultations and therapy plan about a patient with hiatal hernia complicating with venous cathe- ter-related infections. Clinical pharmacists suggested pulling out peripherally inserted central catheter （PICC） and placing a cathe- ter again. Anti-infective therapy plan had been adjusted： vancomycin 0.5 g/time, ivgtt, q12 h; fluconazole 0.2 g, ivgtt, qd （0.4 g,ivgtt,qd on the first day）, cefoperazone/sulbactam 2 g, ivgtt, q8h. Vancomycin and fluconazole were additionally used for an- ti-infective therapy. RESULTS： Doctors adopted the suggestions of clinical pharmacist, and pulled out PICC; and then the infec- tion of the patient was controlled effectively. Finally, the infection had been cured. CONCLUSIONS： The participation of clinical pharmacists in the consultation contributes to rational drug use, and assists doctors to make the right clinical decisions and avoid adverse drug events.