1例肺部感染患者的药学监护.pdfVIP

中国药物应用与监测 2015 年4 月第12卷第2 期 Chinese Journal of Drug Application and Monitoring, Vol.12, No.2, April 2015 1 例肺部感染患者的药学监护 1 2 2 （1.武警后勤学院附属医院药剂科，天津 300162 ；2. 解放军总医院药品保障中心，北京 100853 ） 杨　波 ，王东晓 ，朱　曼 [摘要]　1例30 岁男性患者，因发热5 d 入院，既往有十二指肠溃疡穿孔史，入院诊断为肺部感染。入院后给予头孢美唑、莫 西沙星抗感染治疗。临床药师评估其初始治疗方案，并持续关注其药物治疗，对患者进行全程药学监护，在发生莫西沙星致 QT 间期延长、万古霉素未能达到有效血药浓度时进行及时的用药分析，与医生充分沟通并提出用药建议，治疗31 d 后患者 病情好转出院。 [关键词]　临床药师；治疗方案；万古霉素；莫西沙星；药学监护 [ 中图分类号]　R97　　 [ 文献标识码]　A　 [ 文章编号]　1672 – 8157(2015)02 – 0091 – 04 Pharmaceutical care on a patient with pulmonary infection 1 2 2 YANG Bo , WANG Dong-xiao , ZHU Man (1. Department of Pharmacy, Affiliated Hospital of Logistics University of Chinese Peoples Armed Police Forces, Tianjin 300162, China; 2. Department of Pharmaceutical Care, PLA General Hospital, Beijing 100853, China) [ABSTRACT]　One 30-year-old male patient with the history of perforation of duodenal ulcer was admitted to hospital due to fever for five days. The patient was diagnosed as pulmonary infection. After admission, anti-infection therapy with cefmetazole and moxifloxacin was given. The initial therapeutic regimen and the continuing hospital medication were evaluated and the pharmaceutical care was carried out by clinical pharmacist. Timely medication analysis and suggestions involving moxifloxacin- induced QT interval prolongation, failure to achieve the effective blood drug concentration of vancomycin were given to the physician. After 31 days, the patient was in stable situation and discharged from hospital. [KEY WORDS]　Clinical pharmacist; Therapeutic regimen; Vancomycin; Moxifloxacin; Pharmaceutical care 临床药学是医院药学发展和实践的重要组成部 T 38 ℃左右，自行口服退烧药（具体不详）后体温能 分，是药师联系临床、探讨药物在治疗和应用方面的 降至正常。2014 年4 月22 日晨起患者体温升至39.5 ℃， 规律、促进合理用药的一门分支学科。临床药师参与 伴寒战，在社区医院给予盐酸左氧氟沙星和赖氨匹林 临床治疗，提供药学