纵隔感染并发严重脓毒症患者的药学监护

Pharmaceutical Care for Mediastinal Infection Patient with Severe Sepsis

目的:探讨临床药师对纵隔感染并发严重脓毒症患者的药学监护模式和内容。方法:临床药师参与1例纵隔感染并发严重脓毒症患者的药物治疗,从药物选择、剂量、疗效、疗程及不良反应等方面制订个体化药物治疗方案,并提供药学监护。患者的初始抗感染方案为美罗培南1.0 g,ivgtt,q8 h+万古霉素0.75 g,ivgtt,q12 h,感染控制不理想,临床药师建议更改为注射用哌拉西林钠他唑巴坦钠4.5 g,ivgtt,q8 h+甲硝唑氯化钠注射液0.5 g,ivgtt,q8 h;后考虑厌氧菌感染,更换为左氧氟沙星0.5 g,ivgtt,qd;并对抗全身炎症反应、降脱水、肠内营养等方面提出建议。结果:医师采纳临床药师建议,患者在ICU治疗14 d后,顺利脱离呼吸机,体温正常,血常规较前明显下降,各项生命体征平稳,转出ICU继续巩固治疗。结论:临床药师的个体化药学监护,为临床合理用药提供了可靠的依据,保证了患者用药的安全、有效。

OBJECTIVE：To explore the model and content of pharmaceutical care for a mediastinal infection patient with severe sepsis. METHODS：Clinical pharmacists participated in drug therapy for a mediastinal infection patient with severe sepsis and formulated therapy plan in respects of drug selection,dose,therapeutic efficacy,treatment course and ADR,etc. They also provided pharmaceutical care for the patient. The initial anti-infective plan was as follows：meropenem 1.0 g,ivgtt,q8 h＋vancomycin 0.75 g,ivgtt,q12 h. Due to poor infection control effect,clinical pharmacists suggested changing therapy plan： Piperacillin sodium and tazobactam sodium for injection 4.5 g,ivgtt,q8 h＋Metronidazole and sodiu chloride injection 0.5 g,ivgtt,q8 h. And then anti-infective plan was replaced considering about anaerobic infection,as levofloxacin 0.5 g,ivgtt,qd. Clinical pharmacists provide suggestions on anti-systemic inflammatory response, dehydration relief,enteral nutrition and other aspects. RESULTS：The physicians adopted the suggestion of clinical pharmacists. After 14 days of treatment in ICU,the patient took off ventilator;the patient＇s body temperature returned to normal,and blood routine decreased significantly compared to before treatment;the vital signs were sable,then the patient was transefered out of the ICU to consolidate the treatment. CONCLUSIONS：Clinical pharmacists participate in individualized pharmaceutical care,and provide reliable evidence for rational drug use to guarantee the safety of drug use.