1例体外膜肺氧合重症患者的抗感染治疗及血药浓度异常值的分析与药学监护

Anti-infective treatment analysis of abnormal blood drug concentration and pharmaceutical care of a severe patient with extracorporeal membrane oxygenation

1例20岁女性患者,诊断为重症肺炎(耶氏肺孢子菌肺炎,巨细胞病毒肺炎)。予复方磺胺甲唑(1200 mg∶240 mg,q 8 h,po)、更昔洛韦(200 mg,q 12 h,ivgtt)抗感染治疗。患者呼吸困难加重,双肺渗出、实变,转入ICU后行体外膜肺氧合治疗(ECMO)。临床药师对患者实施全程药学监护,结合ECMO和肾功能亢进对抗菌药物药代动力学的影响,协助医生调整抗感染治疗方案。患者病原学转阴,呼吸情况及影像学明显改善。患者万古霉素血药浓度>100μg·mL^(-1),严重超危急值,临床药师建议立即停药,密切监测肾脏功能并核实检测流程。患者停药128 h后肾功能恢复至给药前水平。

One 20-year-old female patient was diagnosed as severe pneumonia(pneumocystis jirovecii pneumonia,cytomegalovirus pneumonia)and treated with compound sulfamethoxazole(SMZco,1200 mg∶240 mg,q 8 h,po)and ganciclovir(200 mg,q 12 h,ivgtt).The patient had severe dyspnea,bilateral lung exudation and consolidation,and was transferred to ICU for extracorporeal membrane oxygenation(ECMO).Clinical pharmacists implemented the whole process pharmaceutical care for patients,combined with the impact of ECMO and renal hyperfunction on the pharmacokinetics of antibiotics,and assisted doctors to adjust the anti-infective treatment plan.The patient was obviously improved in respiratory function,image examination and results of pathogen detect turned negative.The concentration of vancomycin was over 100μg·mL^(-1),which was far more than the target range.Clinical pharmacist suggested stopping vancomycin immediately,monitoring the patient's renal function and verifying the test process.The renal function of the patient recovered to the level before administration after 128 hours of drug withdrawal.