临床药师对一例暴发性心肌炎并行体外膜肺氧合及连续肾脏替代治疗患者万古霉素个体化治疗的药学服务

Pharmaceutical care of vancomycin individualized treatment in a case of fulminant myocarditis combined with extracorporeal membrane oxygenation and continuous renal replacement therapy

目的:探讨体外膜肺氧合(ECMO)联合连续肾脏替代治疗(CRRT)对万古霉素药动学/药效学(PK/PD)的影响,及临床药师在抗感染治疗中发挥的作用。方法:临床药师对1例暴发性心肌炎并行ECMO及CRRT的患者实施药学服务和药学会诊,应用万古霉素血药浓度监测为患者制订个体化给药方案。结果:基于血药浓度监测结果,临床药师积极开展药学会诊,分析ECMO与CRRT对万古霉素PK/PD的影响,协助临床医师及时调整治疗方案,保证了治疗效果。结论:重症感染患者在ECMO联合CRRT治疗时,体内抗菌药物血药浓度往往发生明显变化。临床药师利用血药浓度监测技术实施药学监护,可以确保ECMO联合CRRT治疗患者抗感染治疗的有效性和安全性。

Objective:To investigate the effect of extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy(CRRT)on the pharmacokinetics/pharmacodynamics(PK/PD)of vancomycin and the role of clinical pharmacists in anti-infection treatment.Methods:The clinical pharmacist gave pharmaceutical care and consultation to a fulminant myocarditis patient treated with a combination of ECMO and CRRT,and an individualized medication regimen was developed for the patient by using blood concentration monitoring of vancomycin.Results:Based on the blood concentration monitoring,the clinical pharmacist actively carried out pharmaceutical consultation,analyzed the effects of ECMO and CRRT on the PK/PD of vancomycin,and assisted clinicians to adjust the treatment regimen in time to ensure treatment effects.Conclusion:In severe infective patients treated with a combination of ECMO and CRRT,the blood concentration of antibacterials would occasionally change significantly.Pharmaceutical care by clinical pharmacists using blood concentration monitoring could ensure the effectiveness and safety of the patients in ECMO and CRRT anti-infective treatment.