1例胰十二指肠切除术后并发胰瘘患者的药学监护

Pharmaceutical care on a patient with pancreatic fistula after pancreaticoduodenectomy

1例45岁男性患者,因“皮肤巩膜黄染2个月余”入院,诊断为梗阻性黄疸、胆道占位。入院第5天在全麻下行“胰十二指肠切除术”,术后给予抗感染、镇痛、预防应激性溃疡以及营养支持等治疗。临床药师对该患者进行营养状况评估,协助医师制定个体化营养支持方案,并进行全程药学监护。后患者出现胰瘘,临床药师立即对抗感染与营养支持方案做出调整,并予患者胰酶替代疗法。治疗20 d后,患者营养状况改善,经口进食无不适,恢复良好出院。

A 45-year-old male patient was admitted to the hospital because of yellow staining of skin and sclera for more than 2 months.He was diagnosed with obstructive jaundice and biliary space occupying.On the fifth day of admission,pancreaticoduodenectomy was performed under general anesthesia.After the operation,treatment including anti-infection,analgesia,prevention of stress ulcer,and nutritional support were given to him.Clinical pharmacists assessed the nutritional status of the patient,assisted the doctor to make an individualized nutritional support plan,and carried out the whole pharmaceutical care.Later,the patient developed pancreatic fistula,and the clinical pharmacists immediately adjusted the anti-infection and nutritional support plan,and gave him pancreatic enzyme replacement therapy.After 20 days of treatment,the nutritional status of the patient was improved,and there was no discomfort in oral eating.He recovered well and was discharged.