摘要
目的:分析伴脓毒症休克的结肠手术患者的抗感染治疗及其药学监护过程,为该类患者的科学治疗提供参考。方法:临床药师以会诊的形式参与了1例伴脓毒症休克的结肠手术患者的抗感染治疗,根据患者的实际病情协助医生调整和制定抗感染治疗方案,并开展药学监护。结果:患者在使用万古霉素、亚胺培南-西司他丁钠和伏立康唑进行初始抗感染治疗后出现进行性血小板减少,据此停用万古霉素后,血小板水平逐渐恢复正常;此后,还发生脑膜炎败血伊丽莎白菌血流感染,根据药敏选用左氧氟沙星治疗但效果不佳,后经临床药师会诊分析,将治疗方案调整为哌拉西林-他唑巴坦钠(4.5 g,q8h),数日后血培养结果转阴。结论:临床药师利用自身专业特长,协助医生制定科学的、个体化的抗感染治疗方法,成功地救治了脓毒症休克这样的急危重症患者,很好地体现了临床药师在团队中的作用和价值。
Objective:To analyze anti-infective treatment and pharmaceutical care process of a patient undergoing colonic surgery with septic shock,and to provide reference for scientific treatment on such patients.Methods:The clinical pharmacist participated in the anti-infective treatment of a patient undergoing colonic surgery with septic shock in the form of consultation,assisted the physician in adjusting and formulating the anti-infective treatment regimen according to the patient’s actual condition,and carried out pharmaceutical care.Results:The patient developed progressive thrombocytopenia after initial anti-infective therapy with vancomycin,imipenem-cilastatin sodium and voriconazole,whereby the platelet level gradually returned to normal after discontinuing vancomycin.Thereafter,a bloodstream infection with Elizabethkingia meningoseptica also occurred,which was treated with levofloxacin according to the drug susceptibility but with poor effect,then the treatment regimen was adjusted to piperacillin-tazobactam sodium(4.5 g,q8h)after consultation and analysis of the clinical pharmacist,and the blood culture results turned negative after several days.Conclusion:With professional expertise,the clinical pharmacist assists the physician in developing scientific and individualized anti-infection therapeutic methods to successfully treat acute and critically ill patients like septic shock,well reflecting the role and value of clinical pharmacist in the team.
作者
吴玲
张莉
WU Ling;ZHANG Li(Jiangsu Province Geriatric Hospital,Nanjing 210009,China;The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)
出处
《抗感染药学》
2022年第7期1066-1070,共5页
Anti-infection Pharmacy
作者简介
吴玲(1986—),女,副主任药师;通信作者:张莉(1983—),女,副主任药师【电子邮箱】wuling89@qq.com
