1例心脏移植术后肺炎患者的用药分析与药学监护

Medication analysis and pharmaceutical care:a patient with pneumonia after heart transplantation

1例59岁男性患者因心脏移植术后肺炎收入院。入院后对该患者的治疗对策的有效性、安全性和药学监护情况进行探讨。临床药师根据患者的病情变化,协助医师根据药敏结果为患者制定有效的治疗方案,通过监测血药浓度及时调整替考拉宁及环孢素的给药剂量,同时关注患者使用环孢素等药物所致不良反应,提出合理的药学监护措施。患者经过抗感染治疗后,感染得到控制,病情相对稳定而出院。通过对患者治疗方案的优化,协助医师制定个体化治疗方案,及时调整药物剂量,有利于提高临床药物治疗水平,促进临床合理用药。

A 59-year-old male patient was admitted to hospital due to pneumonia after heart transplantation.The effectiveness,safety,and pharmaceutical care of the patient were discussed after admission.According to the patient’s condition,the clinical pharmacist assists the doctor to make an effective treatment plan for the patient by the drug sensitivity results,adjusts the dosage of teicoplanin and cyclosporine in time by means of blood concentration monitoring,pays attention to the adverse reactions caused by the patient’s use of cyclosporine and other drugs,and puts forward reasonable pharmaceutical monitoring measures.After the patient’s anti-infective treatment,the infection was controlled and the condition was relatively stable,then patient was discharged.Clinical pharmacists assist physicians to formulate individualized treatment plans,and to solve adverse drug reactions timely,which is conducive to improve the effect of clinical drug treatment and promote rational drug use.