运用定量药理学优化危重症病人的药物治疗方案

Using quantitative pharmacology to optimize drug treatment regimens for critical patients

目的:探讨在危重症病人中运用定量药理学优化药物治疗方案的必要性。方法:临床药师通过药物监测、药物剂量调整、疗效观察及不良反应监测等药学服务,参与1例经皮冠状动脉介入术后切口感染,并发菌血症的尿毒症病人的抗感染药物选择和剂量调整,并对药学服务结果进行分析总结。结果:病人为确诊的耐甲氧西林金黄色葡萄球菌菌血症,在初始治疗方案(万古霉素0.5g,qod)治疗效果不佳,且出现感染性心内膜炎可能时,临床药师建议更换为达托霉素(首剂予0.4g,第2天开始0.5g,qod)。为验证治疗方案的合理性,进行血药浓度监测。后病人感染得到控制,病情好转。结论:临床药师运用定量药理学参与抗感染治疗方案的制定和调整,可以提高危重症病人药物治疗的有效性和安全性。

Objective： To explore the necessity of using quantitative pharmacology to optimize drug treatment regimens for critical patients. Methods.. Through therapeutic drug monitoring, dosage adjustment, observation of efficacy, adverse drug re- action monitoring and other pharmaceutical care, clinical pharmacists cooperated with physicians in the choice of antimicrobials and dose adjustment in the treatment of one case of surgical infection after percutaneous coronary intervention（PCI） complicated with bloodstream infection and uremia, and also the results of pharmaceutical care were analyzed and evaluated. Results.. The patient was confirmed to have bacteriemia with methicillin resistant Staphylococcus aureu. He showed to have poor response to initial treatment by vacomycin at a dosage of 0.5 g every 48 h and there might be infective endoearditis. So the patient was switched to have daptomycin with a loading dosage of 0.4 g and the dosage of 0.5 g every 48 h was maintained during the course of treatment, Finally, the bloodstream infection was effectively controlled. Conclusion： The active involvement of clini- cal pharmacists in the development and adjustment of anti-infective treatment regimens by the way of quantitative pharmacology would help to improve drug efficacy and safety in the treatment of critical patients.