PDF(1234 KB)
PDF(1234 KB)
PDF(1234 KB)
一例危重症患者抗感染治疗的药学监护
Anti-Infective Pharmaceutical Care of Critically Ⅲ Patients
目的 通过临床药师参与一例颅脑损伤术后、多器官脏器不全、重症感染、电解质紊乱、双下肢静脉血栓、贫血、消化道出血患者的治疗过程,论临床药师在重症患者抗感染治疗过程中进行药学监护的重要性。方法 从抗感染治疗方案的调整、维持机体内环境稳定、减少药物不良反应等多个方面对患者进行全程药学监护。结果 经过系统性治疗,患者脏器功能基本恢复,感染得到控制,机体内环境稳定,转出重症监护室。结论 临床药师在危重症患者的抗感染治疗过程的全程药学监护对于患者的转归具有重要意义,应发挥临床药师的作用,提高危重症患者的预后。
OBJECTIVE Discuss the importance of clinical pharmacists and pharmacy care during anti-infective therapy in critically ill patients.METHODS Clinical pharmacists involved in the treatment process of a case of critically ill patients, who has craniocerebral injury, multiple organ insufficiency, severe infection, electrolyte imbalance, venous thrombosis of both lower extremities, anemia, and gastrointestinal bleeding. Pharmacy care includes adjustment of anti-infective treatment,reduce adverse drug reactions and maintain homeostasis, et al. RESULTS The patient was cured and in a stable condition after systematic treatment. CONCLUSION Clinical pharmacists could play an important role in improving the prognosis of critically ill patients.
抗感染 / 临床药师 / 药学监护 / 重症加强护理病房 {{custom_keyword}} /
anti-infection / clinical pharmacist / pharmacy care / ICU {{custom_keyword}} /
[1] YU A R, FAN X, ZHOU F, et al. Breakthrough points of pharmaceutical care in anti-infection treatment by clinical pharmacists[J]. China Pharm(中国药师),2014,17(10):1724-1728.
[2] POON W S, NG S, WAI S. CSF antibiotic prophylaxis for neurosurgical patients with ventriculostomy: a randomised study intracranial pressure and neuromonitoring in brain injury[J]. Vienna, 1998: 146-148.
[3] LIU L, FANG L Z, FU W P, et al. Efficacy and safety evaluation of teicoplanin on hospital-acquired pneumonia with renal dysfunction[J]. Chin J Nosocom(中华医院感染学杂志),2010,20(9):1307-1309.
[4] LIU Y N. Expert opinion on the diagnosis and treatment of pseudomonas aeruginosa lower respiratory tract infection[J]. Chin J Tuber Respir Dis(中华结核和呼吸杂志), 2014,37(1):9-15.
[5] CUNHA B A. Antibiotic side effects[J]. Med Clin North Ame, 2001, 85(1): 149-185.
[6] WANG M G. Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement [J]. Chin J Infect Chemother(中国感染与化疗杂志), 2017,17(1):82-92
[7] KALIL A C, METERSKY M L, KLOMPAS M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5):61-111.
[8] HANG X, DENG Z D, NI Y X, et al. Chinese experts′consensus on prevention and control of multidrug resist-ance organism healthcare-associated infection [J]. Chin J Infect Control(中国感染控制杂志), 2015,14(1):1-8.
[9] LIMPER A H, KNOX K S, SAROSI G A, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients[J]. Am J Resp Critical Care Med, 2011,183(1):96-128.
[10] ZHENG J H. Chinese experts consensus in urinary tract infection diagnosis and treatment (2015 Edition)[J]. Chin J Urol(中华泌尿外科杂志), 2015,36(4):245-248.
[11] PFALLER M A. Antifungal drug resistance: mechanisms, epidemiology, and consequences for treatment[J]. Am J Med, 2012, 125(1): 3-13.
[12] WESTPHAL J F, VETTER D, BROGARD J M. Hepatic side-effects of antibiotics[J]. J Antimicrob Chemoth, 1994,33(3): 387-401.
[13] TABER S S, MUELLER B A. Drug-associated renal dysfunction[J]. Critical Care Clin, 2006,22(2):357-374.
[14] BARTLETT J G. Antibiotic-associated diarrhea[J]. New Engl J Med, 2002, 346(5): 334-339.
[15] ASTER R H, BOUGIE D W. Drug-induced immune thrombocytopenia[J]. New Engl J Med, 2007,357(6):580-587.
[16] GONÇALVES-PEREIRA J, PÓVOA P. Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams[J]. Critical Care, 2011,15(5):1-17.
[17] ROBERTS J A, ROBERTS M S, SEMARK A, et al. Antibiotic dosing in the′at risk′critically ill patient: linking pathophysiology with pharmacokinetics/pharmacodynamics in sepsis and trauma patients[J]. BMC Anesthe, 2011,11(1): 3.
[18] ULLDEMOLINS M, ROBERTS J A, LIPMAN J, et al. Antibiotic dosing in multiple organ dysfunction syndrome[J]. Chest,2011, 139(5):1210-1220.
[19] SCAGLIONE F, PARABONI L. Pharmacokinetics/pharmacodynamics of antibacterials in the intensive care unit: setting appropriate dosing regimens[J]. Int J Antimicrob Agents,2008,32(4):294-301.
中国人民解放军总医院临床科研扶持基金资助(2017FC-CXYY-3006)
/
| 〈 |
|
〉 |
