临床药师参与1例肾移植术后合并复杂感染患者个体化治疗的药学实践

Pharmaceutical practice of clinical pharmacists participating in individualized treatment for a patient with complicated infection after kidney transplantation

目的以1例肾移植术后合并复杂感染患者为例,探讨临床药师在肾移植术后患者个体化药物治疗和合理用药中的作用。方法临床药师全程参与1例肾移植术后合并结核及耐碳青霉烯的肺炎克雷伯菌(CRKP)复杂感染患者的诊疗过程,通过多学科会诊、联合查房、密切用药监护等多维模式加入临床治疗团队,提供个体化药学服务。结果临床药师协助医生对患者的感染进行分析并制订了有效的抗感染治疗方案,患者感染得到控制;利用药物相互作用原理,结合药物浓度监测,使他克莫司血药浓度维持在有效治疗范围;通过密切药学监护,避免了严重不良反应的发生。结论临床药师可通过多种方式融入临床,成为药物治疗团队的重要一员,为患者提供高质量的药学服务。

Objective To explore the role of clinical pharmacists in the individualized treatment and rational medication of kidney transplantation patients by taking a patient with complicated infection after kidney transplantation as an example.Methods Clinical pharmacist participated in the whole treatment process of a renal transplantation patient with tuberculosis and carbapenem-resistant Klebsiella pneumoniae(CRKP)infection.Clinical pharmacist joined the clinical treatment team through multi-dimensional modes such as multidisciplinary consultation,union ward rounds and drug monitoring.Results Clinical pharmacist assisted the doctors to analyze the infection and formulate the effective anti-infection treatment plans,so the infection of the patient was effectively controlled.According to the principle of drug interaction and combined with therapeutic drug monitoring,the blood concentration of tacrolimus was maintained in the range of effective therapeutic concentration.Serious adverse reactions were avoided through close pharmaceutical care.Conclusion Clinical pharmacists can gradually integrate into the clinical treatment team through various ways to provide high-quality pharmaceutical care for patients.