摘要
1例67岁男性患者,因冠心病、急性冠脉综合征入院治疗,入院时合并有风湿性心脏病、慢性肾功能不全尿毒症期(双侧肾脏萎缩)等多种疾病,给予扩冠、降脂、抗血小板、抗凝等治疗,并于入院后第2天行经皮冠状动脉介入治疗,术后患者出现急性左心衰合并肺部感染,给予利尿、强心、化痰、平喘、抗感染等药物治疗。针对患者需要腹膜透析的情况临床药师建议进行强心药物地高辛的血药浓度监测,规避地高辛蓄积中毒的风险。在抗感染治疗中,根据痰培养结果,结合腹膜透析可部分清除氟康唑的特点,建议在透析后给予氟康唑,并给予不受腹膜透析影响的左氧氟沙星进行抗感染治疗,同时对抗感染治疗过程中使用的亚胺培南西司他丁以及左氧氟沙星引起的震颤、失眠等不良反应进行监测。
A 67-year-old man with rheumatic heart disease, chronic kidney insufficiency was hospitalized for coronary heart disease and acute coronary syndrome. The patient was treated with the therapy of expanding coronary artery, lowering lipoid, antiplatelet and anticoagulation. On the second day, acute left-heart failure with lung-infection occurred after undergoing PCI operation and the patient was treated with diuretic, cardiotonic, eliminating sputum, antiasthmatic and anti-infection drugs. According to the characteristic of peritoneal dialysis on the patient, clinical pharmacist suggested monitoring the concentration of digoxin to avoid the risk of cumulative toxication. In the treatment of anti-infection, clinical pharmacist suggested adding fluconazol after peritoneal dialysis and levofloxacin according to the result of sputum culture and pharmacokinetic characteristic, and fremitus and insomnia induced by imipenem cilastatin and levofloxacin were monitored.
出处
《中国药物应用与监测》
CAS
2010年第1期46-48,共3页
Chinese Journal of Drug Application and Monitoring
关键词
临床药师
药学监护
腹膜透析
Clinical pharmacist
Pharmaceutical care
Peritoneal dialysis
