1例合并急性肾损伤危重症患者的营养支持药学监护.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 例合并急性肾损伤危重症患者的营养支持药学监护 1 2（1.广西医科大学第一附属医院药学部，广西 南宁 530021 ；2. 安徽医科大学第三附属医院药学部，安徽 合肥 230061 ） 唐微艳 ，秦　侃 [摘要]　1例75 岁男性患者，因“进食有哽噎感，伴胸骨后隐痛不适”就诊，入院诊断为食管癌。入院后在全麻下行经左胸食 管癌切除术，术后出现呼吸衰竭转入重症监护病房（ICU ）。治疗期间又并发急性肾损伤（AKI ）。诊断为：AKI ；食管癌；睡眠 呼吸暂停综合征；2 型糖尿病；肺部感染；呼吸衰竭。给予抗感染、营养支持，间断血液透析等治疗。临床药师主要对该患者 的肠外营养（PN ）开始时机、输注方式及氨基酸量调整、血糖监测等方面进行了药学监护和干预。患者经过1 个多月的临床 营养干预，各项蛋白质指标维持良好，整体状态好转，遂转出ICU 继续原发病的相关治疗。 [关键词]　危重症患者；急性肾损伤；营养支持；药学监护；临床药师 [ 中图分类号]　R969.3　　 [ 文献标识码]　A　 [ 文章编号]　1672 – 8157(2015)02 – 0088 – 03 Pharmaceutical care on a patient with critically acute kidney injury for nutrition support 1 2 TANG Wei-yan , QIN Kan (1. Department of Pharmacy, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; 2. Department of Pharmacy, the Third Affiliated Hospital of Anhui Medical University, Hefei 230061, China) [ABSTRACT]　One 75-year-old male patient was hospitalized for dysphagia and pain in the chest when eating, diagnosed as esophageal carcinoma. After admission, the patient received radical treatment of esophageal carcinoma. After operation, the patient was transferred to the intensive care unit (ICU) because of respiratory failure. Acute kidney injury (AKI) happened during treatment. The patient was diagnosed as AKI, esophageal carcinoma, sleep apnea syndrome, type 2 diabetes, pulmonary infection and respiratory failure. Anti-infection, nutrition support and intermittent hemodialysis were applied. Clinical pharmacist provided pharmaceutical care including the starting time of parenteral nutrition (PN), infusion regimen, adjusting the amount of amino acids, and observation of blood glucose, etc. Finally the patient was discharged from ICU with a good protein level and stable situation. [KEY WORDS]　Critically ill patient; Acute kidney injury; Nutrition suppor