小儿复杂先天性心脏病术后抗下呼吸道感染药学服务分析

Pharmacological Care for Lower Respiratory Tract Infection in Children with Complicated Congenital Heart Disease after Surgery

目的:探索临床药师为借助体外膜肺氧合(ECMO)和连续性肾脏替代治疗(CRRT)的复杂先天性心脏病患儿提供术后抗下呼吸道感染药学服务的切入点。方法:临床药师参与2例分别借助ECMO和CRRT的复杂先天性心脏病患儿的术后抗下呼吸道感染治疗。通过查阅文献,明确在ECMO和CRRT下不同抗菌药物的药代动力学特征,为正确选择和合理使用抗菌药物提供建议和指导。结果:医师采纳了临床药师的建议,调整抗感染治疗方案,2例患儿的感染指标均得到显著改善。结论:ECMO和CRRT的运用会影响抗菌药物的药代动力学参数,常规经验性用药治疗可能无法达到目的。临床药师深入临床实践,查阅文献,熟练掌握抗菌药物PK/PD特点,分析提出用药建议,有助于为患儿提供合理的治疗方案,提高临床用药的有效性及安全性。

Objective:To probe into the entry point of clinical pharmacists in providing postoperative pharmaceutical care for lower respiratory tract infection in children with complicated congenital heart disease supported by extracorporeal membrane oxygenation(ECMO)and continuous renal replacement therapy(CRRT).Methods:Clinical pharmacists participated into the postoperative antilower respiratory tract infection treatment of two children with complicated congenital heart disease respectively supported by ECMO and CRRT.By retrieving the literature,the pharmacokinetic characteristics of different antibiotics under ECMO and CRRT were clarified,and recommendations and guidance were provided for the correct selection and rational use of antibiotics in children.Results:The clinicians adopted the suggestions of the clinical pharmacists and adjusted the anti-infective treatment plan,the infection indicators of two children were significantly improved.Conclusion:The application of ECMO and CRRT can affect the pharmacokinetic parameters of antibiotics,and conventional empirical medication may not achieve the goal.In-depth clinical practice,literature review,awareness of characteristics of antimicrobial PK/PD,analysis and formulation of medication recommendations in clinic pharmacists can help to provide ration treatment plans for children and improve the effectiveness and safety of clinical medication.