1例慢性阻塞性肺疾病急性加重期患者的药学监护

Pharmaceutical care on a patient with acute exacerbation of chronic obstructive pulmonary disease

1例72岁女性患者,严重喘憋50年,加重20 d,带有创呼吸机入院,诊断为慢性阻塞性肺疾病急性加重期、肺源性心脏病、Ⅱ型呼吸衰竭等。入院后先后给予头孢吡肟、哌拉西林舒巴坦、替考拉宁、氟康唑、伊曲康唑、帕尼培南倍他米隆等抗感染治疗;临床药师对该例患者进行全程药学监护,为优化治疗方案合理地遴选抗感染药物,建议同时取外周静脉与静脉导管血进行培养并做药敏实验,根据药敏结果建议选用替考拉宁进行治疗,并密切监测药品不良反应,同时对患者进行用药教育。治疗21 d后,患者病情稳定出院。

One 72-year-old female patient was admitted to hospital mainly because of wheezing for 50 years and aggravationfor 20 days. Clinical diagnoses were acute exacerbation of chronic obstructive pulmonary disease, chronic pulmonary heart disease,type Ⅱ respiratory failure, etc. After hospitalization, the patient received the anti-infective therapy with cefepime, piperacillin andsulbactam sodium, teicoplanin, fluconazole, itraconazole, panipenem and betamipron, etc. Clinical pharmacists supervised theentire treatment in order to optimize the therapeutic regimen by selecting more appropriate anti-infective medications. Under thesuggestions of clinical pharmacists, the peripheral venous blood and venous catheter blood have been collected, cultured and used fordrug sensitivity test. According to the result, teicoplanin was recommended for better treatment. Moreover, the adverse drug reactionswere monitored regularly, and the patient was given medication education. The patient was in a stable condition and discharged on 21st day.