1例肾移植术后合并多重肺部感染患者的药学监护

Pharmaceutical Care for a Patient with Multiple Pulmonary Infection after Renal Transplantation

目的:探讨临床药师在肾移植术后合并多重肺部感染患者药物治疗中的作用。方法:临床药师参与1例肾移植术后合并多重肺部感染患者的药物治疗,协助医师制订初始用药方案:更昔洛韦250 mg,ivgtt,q12 h+头孢哌酮钠舒巴坦钠3 g,ivgtt,bid+甲泼尼龙琥珀酸钠80 mg,ivgtt,qd+复方磺胺甲唑片2片,po,qd+环孢素软胶囊75 mg,po,q12 h+碳酸氢钠片1 g,po,qd+硝苯地平控释片30 mg,po,qd+法莫替丁片20 mg,po,bid;因患者合并巨细胞病毒肺炎,故2次调整更昔洛韦剂量;因患者合并肺孢子菌肺炎,故2次调整复方磺胺甲唑片剂量;并进行药品不良反应的预防、处理和患者用药教育。结果:医师采纳临床药师建议,患者肺部感染得到控制,好转出院。结论:临床药师找准药学监护切入点,促进了患者合理用药,充分体现了药学监护在临床治疗中的价值。

OBJECTIVE：To investigate the role of clinical pharmacists in the therapy for patient with multiple pulmonary infection after renal transplantation. METHODS：Clinical pharmacists participated in drug therapy for a patient with multiple pulmonary infection after renal transplantation,and assisted physicians to formulate primary therapy plan：ganciclovir 250 mg,ivgtt,q12h＋ Cefoperazone sodium and sulbactam sodium 3 g,ivgtt,bid＋ methylprednisolone 80 mg,ivgtt,qd＋ Compound sulfamethoxazole tablet,2 piece,po,qd＋Ciclosporin soft capsule 75 mg,po,q12 h＋Sodium bicarbonate tablet 1 g,po,qd＋Nifedipine controlled release tablet 30 mg,po,qd＋Famotidine tablet 20 mg,po,bid. The dose of ganciclovir was adjusted twice because of complication cytomegaloviral pneumonia;the dose of ganciclovir was adjusted twice because of complication pneumocystis pneumonia. Prevention and disposal of ADR,patient education were also conducted. RESULTS：Physicians adopted the suggestion of clinical pharmacists;the pulmonary infection had been controlled,and the patient was discharged from hospital. CONCLUSIONS：Clinical pharmacists identify the breakthrough point to promote rational drug use,indicating the value of pharmaceutical care in the clinical treatment.