1例关节置换术后并发脓毒血症患者抗感染治疗的药学监护

Pharmaceutical Care of Anti-Infection Therapy in One Patient with Sepsis after Joint Replacement

目的:分析1例关节置换术后并发脓毒血症患者抗感染治疗的药学监护过程,为类似患者的临床治疗提供参考。方法:一患者因摔伤致股骨粗隆间骨折入院,后行人工股骨头置换术,术后患者出现发热、伤口红肿,以及血培养检出大肠埃希菌等情况,多学科会诊结果为“脓毒血症”,临床药师综合患者病情建议采用万古霉素联合美罗培南抗感染治疗,并立即转入ICU;治疗期间,考虑患者有肾病需透析治疗,临床药师建议万古霉素和美罗培南的剂量随透析治疗节律调整。结果:患者在使用万古霉素和美罗培南治疗2周后,体温恢复正常,血培养转阴,其他症状和指标也基本恢复正常,顺利出院。结论:脓毒血症作为严重的感染性疾病,稍有不慎就可危及患者生命,临床药师作为多学科会诊团队的一员,利用自身在药学方面的专业特长,可以很好地协助临床制定出科学合理的抗感染治疗方案,并通过开展药学监护,跟进治疗进程,保障患者的治疗效果。

Objective:To analyze the pharmaceutical care process of anti-infection therapy in a patient with sepsis after joint replacement,and provide reference for the clinical treatment of similar patients.Methods:One patient was admitted to the hospital due to a fall-induced intertrochanteric fracture,and then underwent artificial femoral head replacement.After the operation,the patient developed fever and wound redness and swelling,and Escherichia coli was detected in blood culture.The multidisciplinary consultation indicated"sepsis".The clinical pharmacists recommended vancomycin combined with meropenem for anti-infection therapy based on the patient's conditions,and the patient was transferred to the ICU immediately;during the treatment,since the patient had kidney disease and required dialysis treatment,the clinical pharmacists recommended adjustment of the dosage of vancomycin and meropenem with the rhythm of dialysis treatment.Results:After 2 weeks of treatment with vancomycin and meropenem,the patient's body temperature returned to normal,the blood culture result turned negative,and other symptoms and indicators returned to normal basically,so the patient was discharged from the hospital.Conclusion:Sepsis is a serious infectious disease and may endanger a patient's life.As the member of multidisciplinary consultation team,clinical pharmacists can assist clinicians in developing a scientific and reasonable anti-infection treatment plan based on their professional expertise in pharmacy,carry out pharmaceutical care to follow up the treatment process and ensure the treatment effect of patients.