1例尿毒症伴有肺部感染患者抗感染治疗的药学监护
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摘要
目的:探究临床药师在尿毒症伴有肺部感染患者临床抗感染治疗药学监护的切入点。方法:根据慢性肾功能不全患者的药物治疗特点及相关诊疗指南,临床药师参与1例尿毒症伴有肺部感染患者治疗的全过程,协助临床医生为患者制订个体化药物治疗方案,监测患者在治疗过程中出现的药品不良反应,并对不良反应的处理方案提出药学建议,对患者进行全面的药学监护。结果:临床药师对尿毒症伴有肺部感染患者的治疗过程进行了全面的药学监护,以抗菌药物使用的合理性、安全性,监测与处理药品不良反应、肾功能不全患者的用药教育等方面为切入点,为患者提供了个体化药学服务。结论:在临床药物治疗过程中,临床药师能够发挥自身专业知识,通过药学监护参与临床多学科治疗,有效促进了临床药物治疗的安全性和有效性。
Objective: To explore the entry point of clinical pharmacists in the clinical anti-infection medication ofuremia patients with pulmonary infection and pharmacological monitoring. Methods: Based on the characteristics ofdrug therapy and related guidelines for patients with chronic renal insufficiency, the clinical pharmacist participated inthe whole course of treatment of a patient with uremia and pulmonary infection, and assisted the clinician in formulatingindividual drug treatment plan for the patient. To monitor the adverse drug reactions in the course of treatment, and toput forward some pharmacological suggestions for the treatment of the adverse reactions, the pharmcist carried out com-prehensive pharmacological monitoring of the patients. Results: The clinical pharmacist conducted comprehensive phar-macological monitoring in the course of treatment of the uremic patient with pulmonary infection. Through taking thepoint of the rationality and safety of the use of antimicrobial agents, the monitoring and management of adverse drug re-actions, and the education of drug use in patients with renal insufficiency, the clinical pharmacist provided individual-ized pharmaceutical care for the patient. Conclusion: In the process of clinical drug treatment, clinical pharmacists canbring their own professional knowledge into full play and participate in clinical multi-disciplinary treatment throughpharmaceutical monitoring, which may effectively promote the safety and effectiveness of clinical drug therapy.
Objective: To explore the entry point of clinical pharmacists in the clinical anti-infection medication ofuremia patients with pulmonary infection and pharmacological monitoring. Methods: Based on the characteristics ofdrug therapy and related guidelines for patients with chronic renal insufficiency, the clinical pharmacist participated inthe whole course of treatment of a patient with uremia and pulmonary infection, and assisted the clinician in formulatingindividual drug treatment plan for the patient. To monitor the adverse drug reactions in the course of treatment, and toput forward some pharmacological suggestions for the treatment of the adverse reactions, the pharmcist carried out com-prehensive pharmacological monitoring of the patients. Results: The clinical pharmacist conducted comprehensive phar-macological monitoring in the course of treatment of the uremic patient with pulmonary infection. Through taking thepoint of the rationality and safety of the use of antimicrobial agents, the monitoring and management of adverse drug re-actions, and the education of drug use in patients with renal insufficiency, the clinical pharmacist provided individual-ized pharmaceutical care for the patient. Conclusion: In the process of clinical drug treatment, clinical pharmacists canbring their own professional knowledge into full play and participate in clinical multi-disciplinary treatment throughpharmaceutical monitoring, which may effectively promote the safety and effectiveness of clinical drug therapy.
引文
[1]上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,37(1):28-34.
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[8]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):1-27.
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[10]中华医学会呼吸病学分会.肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J].中华结核和呼吸杂志,2017,40(8):578-583.
[11]曾世全,丁雨韫. 1例泛耐药鲍曼不动杆菌肺部感染患者临床治疗的药学监护及抗菌药物的使用分析[J].抗感染药学,2016,(5):1060-1063.
[12]张军娣,崔向丽,刘丽宏,等.亚胺培南西司他丁致癫痫的病例分析[J].中国临床药理学杂志,2018,21(23):1001-1003.
[13]桑蝶,王佳玉.亚胺培南/西司他丁钠致癫痫的临床分析及治疗[J].中国药事,2018,7(21):1002-1004.
[14]李萍.临床药师参与亚胺培南西司他丁诱发癫痫治疗1例[J].中国现代药物应用,2015,21(45):11-13.
[15]孙贤辉,谭成燕.亚胺培南西司他丁钠不同输注时间对重症监护病房患者严重病原菌感染病的疗效和安全性评价[J].抗感染药学,2017,(8):1504-1505..
[16]敖锦芳.临床药师参与胰腺炎患者亚胺培南-西司他丁钠临床治疗的药学监护[J].抗感染药学,2018,15(6):1004-1007.
[17]牟萍,廖常彬,徐蜀远,等.药师利用诺氏评估量表会诊药物不良反应病例分析[J].现代医药卫生,2018,34(20):3262-3264.
[2]中国医师协会肾内科医师分会.肾性贫血诊断与治疗中国专家共识(2014修订版)[J].中华肾脏病杂志,2014,30(9):712-716.
[3]中国医师协会肾脏内科医师分会.中国肾性高血压管理指南2016(简版)[J].中华医学杂志,2017,97(20):1547-1555.
[4]中国医师协会肾脏内科医师分会.中国肾脏疾病高尿酸血症诊治的实践指南(2017版)[J].中华医学杂志,2017,97(25):1927-1936.
[5]中国成人肾病综合征免疫抑制治疗专家组.中国成人肾病综合征免疫抑制治疗专家共识[J].中华肾脏病杂志,2014,30(6):467-474.
[6]侯金花,蒋琦,刘志红. 2017KDIG临床实践指南更新:慢性肾脏病矿物质与骨异常诊断、评估、预防和治疗[J].肾脏病与透析肾移植杂志,2017,26(5):462-466.
[7]桑德福.抗微生物治疗指南(热病,新译第46版)[M].北京:中国协和医科大学出版社,2017.
[8]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):1-27.
[9]中华医学会呼吸病学分会感染学组.中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J].中华结核和呼吸杂志,2018,41(4):255-280.
[10]中华医学会呼吸病学分会.肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J].中华结核和呼吸杂志,2017,40(8):578-583.
[11]曾世全,丁雨韫. 1例泛耐药鲍曼不动杆菌肺部感染患者临床治疗的药学监护及抗菌药物的使用分析[J].抗感染药学,2016,(5):1060-1063.
[12]张军娣,崔向丽,刘丽宏,等.亚胺培南西司他丁致癫痫的病例分析[J].中国临床药理学杂志,2018,21(23):1001-1003.
[13]桑蝶,王佳玉.亚胺培南/西司他丁钠致癫痫的临床分析及治疗[J].中国药事,2018,7(21):1002-1004.
[14]李萍.临床药师参与亚胺培南西司他丁诱发癫痫治疗1例[J].中国现代药物应用,2015,21(45):11-13.
[15]孙贤辉,谭成燕.亚胺培南西司他丁钠不同输注时间对重症监护病房患者严重病原菌感染病的疗效和安全性评价[J].抗感染药学,2017,(8):1504-1505..
[16]敖锦芳.临床药师参与胰腺炎患者亚胺培南-西司他丁钠临床治疗的药学监护[J].抗感染药学,2018,15(6):1004-1007.
[17]牟萍,廖常彬,徐蜀远,等.药师利用诺氏评估量表会诊药物不良反应病例分析[J].现代医药卫生,2018,34(20):3262-3264.