摘要
目的:探讨临床药师对肾移植术后合并肠结核患者抗结核治疗开展药学监护的实践。方法:临床药师通过参与1例肾移植术后合并肠结核患者抗结核治疗方案的制订,提供药学服务,从药物选择、药品相互作用及不良反应等方面分析药物治疗的合理性。结果:医院各科室、临床医师、临床药师加强合作,制订并不断改善患者的抗结核治疗方案,入院第15日,患者症状好转;第16日,实验室检查结果显示,患者移植肾情况差,血肌酐持续不降,但患者拒绝行血液透析治疗;第19日,患者腹部一般情况好,检测他克莫司的血药谷浓度为4.4 ng/ml,患者及家属拒绝增加他克莫司的剂量;第23日,患者病情突变,积极抢救治疗;第24日,经积极治疗患者病情仍未缓解,建议转重症加强护理病房,患者及家属拒绝,放弃治疗自动出院。结论:肾移植术后合并肠结核患者抗结核治疗应结合患者基础情况,从药物抗菌活性、相互作用、不良反应等方面综合考虑,临床药师积极参与临床药物治疗过程,协助临床医师制订和完善了个体化治疗方案,促进了临床合理用药。
OBJECTIVE： To probe into the pharmaceutical care for one patient with intestinal tuberculosis after renal transplantion in anti tuberculosis treatment by clinical pharmacists. METHODS： Through participating into the formulation of anti tuberculosis treatment and pharmaceutical care for one patient with intestinal tuberculosis after renal transplantion,the clinical pharmacists analyzed the rationality of medication treatment from the aspects of drug selection,interaction and adverse drug reactions,etc. RESULTS： Different departments,clinicians and clinical pharmacists cooperated with each other,formulated and improve continuously patient＇s anti tuberculosis treatment,the patient was getting better in the fifteenth day after hospitalization. According to laboratory test results in the sixteenth day,the kidney condition was poor and blood creatinine did not decrease,yet the patient refused to be treated for hemodialysis. And in the nineteenth day,the patient＇s abdomen was generally good,the blood drug peak concentration of tacrolimus was 4. 4 ng/ml,the patient and the family members refused to increase the dosage of tacrolimus. In the twenty-third day,with the disease mutations,the patient received casespositive rescue treatment. In the twenty-fourth day,the patient＇s condition was still unrelieved after active treatment,the patient and the family members refused to be sent into intensive care unit and then gave up treatment for automatic discharge. CONCLUSIONS： It necessary to consider patient＇s basic conditions in patient with intestinal tuberculosis after renal transplantion in anti tuberculosis treatment,especially for the aspects of antibacterial activity of drugs,interactions and adverse drug reactions. The clinical pharmacists actively participate into the clinical medication treatment,assist the clinicians to formulate and improve individualized treatment program,which promote the rational drug application in clinic.
出处
《中国医院用药评价与分析》
2017年第7期985-988,共4页
Evaluation and Analysis of Drug-use in Hospitals of China
关键词
临床药师
肾移植术后
免疫抑制剂
抗结核治疗
药物相互作用
Clinical pharmacists
Renal transplantion
Immunosuppressive agents
Anti tuberculosis treatment
Drug interactions
