本文選題：亞急性感染性心內(nèi)膜炎　切入點：血液透析　出處：《中國藥房》2016年29期 　論文類型：期刊論文

【摘要】：目的:探討臨床藥師在血液透析伴亞急性感染性心內(nèi)膜炎(IE)患者抗感染藥物治療中的作用。方法:臨床藥師參與1例血液透析伴亞急性IE患者的抗感染藥物治療過程,根據(jù)藥物抗菌譜、實驗室和影像學檢查結果和患者的病情變化,協(xié)助醫(yī)師優(yōu)化用藥方案,先后建議亞胺培南西司他丁鈉應在血液透析后給藥,調(diào)整替考拉寧的首劑量,首次給予萬古霉素負荷劑量1 g,于每次透析結束后給予維持劑量0.5 g,并根據(jù)血藥濃度監(jiān)測結果調(diào)整其使用劑量;在治療過程中,臨床藥師密切觀察抗感染藥物治療效果及藥品不良反應,并進行血藥濃度監(jiān)測、用藥提醒和用藥教育等藥學監(jiān)護。結果:醫(yī)師部分采納臨床藥師建議,患者未再出現(xiàn)發(fā)熱癥狀,血象恢復正常,心臟彩超未見異常,準予出院。結論:臨床藥師通過調(diào)整血液透析伴亞急性IE患者抗感染藥物的劑量、評價藥物療效、監(jiān)測藥品不良反應,并定期監(jiān)測萬古霉素血藥濃度,協(xié)助醫(yī)師優(yōu)化治療方案,確保了患者用藥的安全、有效。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of anti-infective drugs in hemodialysis patients with subacute endocarditis. Methods: clinical pharmacists participated in the course of anti-infective drug therapy in a case of hemodialysis with subacute IE. According to the antibacterial spectrum of the drug, the results of laboratory and imaging examinations and the changes of the patient's condition, and to assist the physician in optimizing the medication plan, it was suggested successively that imipenem cilastatin should be administered after hemodialysis to adjust the first dose of teicoplanin. Vancomycin was first administered at a load dose of 1 gg, maintained at the end of each dialysis at 0.5 g, and adjusted for use according to the results of the blood drug concentration monitoring; during the course of treatment, The clinical pharmacists closely observed the therapeutic effect of anti-infective drugs and adverse drug reactions, and carried out monitoring of blood drug concentrations, drug reminders and drug education. Results: the doctors partially accepted the advice of the clinical pharmacists, and the patients did not have fever symptoms again. Conclusion: clinical pharmacists can adjust the dosage of anti-infective drugs in hemodialysis patients with subacute IE, evaluate the efficacy of drugs, and monitor adverse drug reactions. The concentration of vancomycin was monitored regularly to help doctors to optimize the treatment plan to ensure the safety and effectiveness of drug use.
【作者單位】： 上海長征醫(yī)院藥材科;
【基金】：上海醫(yī)院藥學科研項目(No.2014-YY-01-12)
【分類號】：R542.41;R459.5

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