临床药师参与1例车祸致重症感染患者临床治疗万古霉素谷浓度不达标的原因分析

Analysis on Causes of Substandard Concentration of Vancomycin Peak Valley in a Patients with Severe Infection in Traffic Accident

目的:分析车祸致重症感染患者万古霉素谷浓度不达标的原因,探究临床药师的药学监护过程。方法:临床药师参与万古霉素给药方案的制订,对重症感染患者开展治疗药物监测(TDM)和药学服务。结果:万古霉素的血药浓度受患者体质量、年龄、肾功能、体液量及表观分布容积等多种因素的影响。结论:万古霉素的个体差异较大,影响因素较多,临床医生和药师应对万古霉素TDM,关注其谷浓度的变化。

Objective: To analyze the causes of substandard concentration of vancomycin peak valley in a patients with severe infection in traffic accident, and to explore the process of pharmaceutical care of clinical pharmacists. Methods: Clinical pharmacists participated in the formulation of vancomycin administration plan, and carried out drug monitoring and pharmaceutical care for patients with severe infection, therapeutic drug surveillance(TDM) and pharmaceutical care for severely infected patients were implemented. Results: The blood concentration of vancomycin is affected by body mass, age, renal function, fluid volume and apparent volume of distribution. Conclusion: There are large individual differences in vancomycin and many influencing factors. Clinicians and pharmacists should pay attention to the changes in the peak valley concentration of vancomycin TDM.