临床药师参与1例AECOPD合并肺部感染患者的治疗实践

Participation of Clinical Pharmacists in the Therapy for a Case of AECOPD Complicated with Pulmonary Infection

目的:探讨临床药师在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺部感染患者药物治疗中的作用。方法:临床药师参与1例呼吸科重症病房AECOPD合并肺部感染患者继发真菌感染的治疗,根据患者体征、辅助检查及病情变化,先后建议予注射用哌拉西林钠舒巴坦钠(4∶1)5.0 g,ivgtt,q12 h,抗感染;予比沙可啶肠溶片5 mg,po,qd,促排便;予酪酸梭菌活菌片20 mg,po,tid,调节胃肠道菌群;予匹维溴铵片50 mg,po,tid,调节胃肠道平滑肌张力;停用加强补液,予麝香保心丸22.5 mg,po,tid,保护心脏;予单硝酸异山梨酯20 mg,po,tid,预防心绞痛;改用头孢克肟胶囊100 mg,po,tid,抗感染;予氟康唑0.4 g,ivgtt,qd,抗真菌;加用地衣芽胞杆菌500 mg,po,tid,防肠道菌群失调。结果:医师采纳临床药师建议,治疗过程未见不良反应,患者病情得到控制,转入普通病房。结论:临床药师参与药学监护有助于临床合理用药,确保用药安全。

OBJECTIVE： To investigate the role of clinical pharmacists in the therapy for acute exacerbation of chronic obstruc- tive pulmonary diseases （AECOPD） complicated with pulmonary infection. METHODS： Clinical pharmacists participated in the therapy for a case of acute exacerbation of AECOPD complicated with pulmonary infection. According to the patients＇ signs, assis- tant examination and disease condition, clinical pharmacists provided suggestions, i.e. Piperacillin sodium and sulbactam sodium for injection （4： 1） 5.0 g, ivgtt, q12 h, for anti-infective treatment; Bisacodyl enteric-coated tablet 5 mg, po, qd, for promoting defecation; Clostridium butyricum viable bacteria tablet 20 mg, po, tid, for regulating gastrointestinal flora; Pinaverium bromide tablet 50 mg, po, tid, for regulating gastrointestinal smooth muscle tension; Shexiang baoxin pills 22.5 mg,po, tid, instead of flu- id infusion for protecting heart, and isosorbide 5-mononitrate 20 mg,po,tid, for preventing angina pectoris; Cefminox capsule 100 mg, po, tid, for anti-infective treatment; fluconazol 0.4 g, ivgtt, qd, for antiftmgal treatment, and Bacillus licheniformis 500 mg,po, tid, for preventing alteration of intestinal flora. RESULTS ： The physicians adopted clinical pharmacist＇ s suggestions. No ADR was found during treatment, and the patients transferred to ordinary ward after the disease condition had been controlled. CONCLU- SIONS： The participating of clinical pharmacists in pharmaceutical care can promote rational drug use in the clinic and guarantee the safety of drug use.