临床药师参与1例克罗恩病合并腹腔脓肿患者药物调整的病例分析

Medication Adjustment of One Case of Crohn's Disease with Peritoneal Abscess by Clinical Pharmacists

目的通过对1例克罗恩病合并腹腔脓肿患者药物调整的病例进行分析,为临床治疗过程中药品不良反应的判断、处理和治疗提供思路。方法 1例克罗恩病合并腹腔脓肿患者,在使用沙利度胺治疗克罗恩病过程中出现严重急性炎症性脱髓鞘性神经根神经病,及使用注射用亚胺培南西司他丁钠治疗腹腔脓肿时出现风团样荨麻疹后,临床药师参与沙利度胺和抗菌药的调整过程。同时,监测患者大便缓解情况,以及手脚麻木、口齿不清等周围神经症状是否加重,风团样荨麻疹是否消退,体温、腹腔脓肿控制情况。结果医师采纳临床药师建议,密切监测患者手脚麻木、口齿不清、体温、腹腔脓肿、腹泻控制情况。7 d后,病情基本恢复,体温正常,瘘口处无脓液流出,腹泻次数明显减少,手脚麻木、口齿不清等症状未加重。结论临床药师在临床药物治疗中,应积极与临床医师协作,积极开展药品不良反应监测和救治工作,采取有效的干预措施,及时提供合理的用药建议,共同促进合理用药,提升治疗效果。

Objective To offer new ideas about the assessment,management and treatment of adverse drug reactions during clinical treatment by analyzing the medication adjustment of one case of Crohn's disease with peritoneal abscess.Methods The patient developed acute inflammatory demyelinating radiculopathy when taking thalidomide to combat Crohn's disease.When imipenem and cilastatin sodium for injection was used to treat abdominal abscess,urticaria appeared.Clinical pharmacists participated in the whole process of treatment and adjusted the dosage and frequency of thalidomide and antimicrobials.At the same time,the patient's conditions were monitored,including stool relief,temperature and abdominal abscess control,numbness of hands and feet,lisp aggravation and subsidence of urticaria.Results Physicians took the advice of clinical pharmacists,and monitored the patient's above conditions closely.The patient was basically recovered after 7 days in that his body temperature returned to normal,diarrhea became much less frequent,no pus outflowed from the fistula,and numbness of hands and feet as well as lisp stopped aggravating.Conclusion During clinical treatment,clinical pharmacists should actively collaborate with physicians in monitoring and treatment of adverse drug reactions,take effective interventions,and offer proper medication recommendations so as to work together to promote rational drug use and improve the therapeutic effect.