临床药师参与1例急性主动脉夹层患者反复肺部感染的抗感染治疗策略与思路分析

Clinical Pharmacists Participated in Anti-infective Treatment Strategies and Thoughts for a Case of Recurrent Lung Infections in Patient with Acute Aortic Dissection

关键词:  肺炎  感染  主动脉夹层  临床药师

Key words:  pneumonia  infection  aortic dissection  clinical pharmacist

摘要:

目的 介绍临床药师参与治疗1例急性Stanford B型主动脉夹层的患者经胸主动脉夹层腔内修复术（thoracic endovascular aortic repair，TEVAR）前后肺部感染的策略与思路，为临床相似病例的抗感染药学服务提供参考。方法 在患者治疗过程中，临床药师通过多次会诊、全程药学监护，根据患者的临床表现、医院细菌流行特点、临床指南和出现的可疑药物不良反应以及药动学、药效学特点，协助医师、护士制定与优化抗感染方案。结果 医师、护士采纳临床药师的用药建议，调整抗感染方案，在积极治疗及药物监护下，患者生命体征（包括脉搏、呼吸、体温、血压等）平稳，感染及各项指标均恢复正常，顺利出院。结论 临床药师发挥自身专业优势，制定并优化抗感染方案，对患者的治疗过程起到了积极的作用，成功融入以医师护士为核心的治疗团体。

Abstract:

OBJECTIVE To introduce the anti-infective strategies and approaches made by clinical pharmacists for a case of an acute Stanford B aortic dissection patient appearing recurrent pulmonary infections preoperative and postoperative thoracic endovascular aortic repair(TEVAR), which provides reference for anti-infection of clinical similar cases. METHODS During the periods of anti-infective treatment, the clinical pharmacists participated in many consultations and whole-course pharmaceutical monitoring, and finally made the optimized anti-infection regimens together with clinicians according to the patient's clinical manifestations hospital bacterial epidemiological characteristics, the latest clinical guidelines, adverse effects caused by suspected drugs, and characteristics of pharmacokinetics/pharmacodynamics. RESULTS Clinical pharmacists' treatment recommendations were accepted by doctors and nurses, who adjusted their anti-infection treatment regimens. Under the active treatment and pharmaceutical monitoring, the patient's vital signs were greatly improved(including pulse rate, respiration rate, body temperature, and blood pressure). All infection indicators returned to be normal. The patient was discharged from hospital smoothly. CONCLUSION The clinical pharmacists give full play to their professional advantages in making and optimizing anti-infection regimens. In course of the treatment, they carry out pharmaceutical care and have successfully integrated into the treatment team with doctors and nurses as the core.