摘要
目的:探讨临床药师在消化科开展药学服务和参与临床实践的模式和方法。方法:根据消化科患者及所使用药物的特点,对标准化流程、抗菌药物管理、药品不良反应(ADR)监测、个体化用药监护、护理人员用药安全指导等方面进行回顾性总结。结果:1例男性肝脓肿患者,帕尼培南调整为1 g,bid,患者用药后4 d未出现体温反跳,逐渐趋于平稳,治疗后复查B超肝脓肿明显缩小。1例女性肝脓肿伴肾功能重度损害患者,调整亚胺培南/西司他丁钠0.25 g,tid,ivgtt抗感染治疗10 d,CT显示肝脓肿明显缩小,且血肌酐下降至128μmol/L,遂将亚胺培南/西司他丁钠改为0.5 g,tid,ivgtt,12 d后调整为头孢吡肟1 g,bid,ivgtt继续治疗。18 d后,患者好转出院。临床药师共填报消化科病区ADR 26例,其中与输液相关16例,占61.54%;与抗生素相关12例,占46.15%;严重ADR 10例,其中新的严重ADR 3例;8例为院外已发生药物性肝损伤。应结合消化科疾病种类繁多、联合用药普遍、药源性疾病发生率高等特点,找准切入点,为临床提供适宜的药学服务。
OBJECTIVE： To explore the modes and methods of pharmaceutical care and clinical practice in digestive department. METHODS： According to the characteristics of patients and drugs in digestive department, the standardization process, anti- biotics management, ADR monitoring, individual medication care and safe medication guidance for nurses were retrospectively summarized. RESULTS： For the one male patient with liver abscess, the panipenem was adjusted to 1 g, bid, and the patients＇ condition had stabilized after treatment. For the one female liver abscess patient with severe renal function damage, the imipen- em-cilastatin sodium was adjusted to 0.25 g, tid, ivgtt; the CT showed that liver abscess was obviously reduced after 10 d and the serum creatinine was decreased to 128 ~tmol/L; the imipenem-cilastatin sodium was adjusted to 0.5 g, tid, ivgtt, cefepime （lg, bid, ivgtt） was used for continue treatment after 12 d and the patient was discharged after 18 d. There were totally 26 ADR cases in the digestive department, 16 of which were related to infusion （61.54%） and 12 were related to antibiotics （46.15 % ）. There were 10 cases of severe ADR, 3 of which were new and 8 were drug-induced liver injury occurred outside the hospital. CONCLU- SIONS ： Based on a wide rariety of disease, universal drug combination, high incidence of drug-induced disease and other characteristics, looking for breakthrough point, Clinical pharmacists can provides more suitable pharmaceutical care.
出处
《中国药房》
CAS
北大核心
2015年第17期2417-2420,共4页
China Pharmacy
关键词
临床药师
药学服务
合理用药
消化科
Clinical pharmacists
Pharmaceutical care
Rational drug use
Digestive department
