临床药师优化1例CRRT脓毒症休克患者行抗感染治疗的病例分析

Analysis of a case of CRRT patient with septic shock undergoing anti-infective therapy by clinical pharmacists

目的:探讨连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)治疗脓毒症休克患者的抗菌药物给药方法及临床药师在参与药物治疗中的作用。方法:临床药师参与1例术后混合细菌感染致脓毒症休克并行床边CRRT的患者抗感染治疗的全过程,基于病原菌的药敏结果、抗菌药物特性、CRRT对药物的清除以及脓毒性休克病理生理的改变,分析抗菌药物的品种选择及美罗培南初始给药剂量、给药方式的调整。结果:患者感染得到控制,未发生明显的不良反应。结论:在CRRT所致脓毒症休克患者治疗中,临床药师发挥专业优势,可协助医师优化抗感染治疗方案,提高临床疗效。

Objective:To explore the efficacy of antibacterial drug regimen in a CRRT patient with septic shock and the role of clinical pharmacists in participating in medication.Methods:Clinical pharmacists participated in the whole process of anti-infective treatment of a patient with postoperative mixed bacterial infection and septic shock combined with bedside continuous renal replacement therapy(CRRT)and the selection of antibiotics and the adjustment of the initial dose and mode of administration of meropenem were conducted based on the susceptibility results of pathogens,antibacterial properties,and drug clearance by CRRT as well as the pathophysiological changes of septic shock.Results:The patient’s infection was controlled and no obvious adverse reactions occurred.Conclusion:Clinical pharmacists can play a professional advantage to assist physicians in optimizing anti-infective treatment programs and improving clinical efficacy in the treatment of patients with septic shock caused by CRRT.