摘要
1例65岁女性患者,因"车祸致颅脑损伤出血13 d,高热3 d"入院,入院诊断为车祸多发伤、特重型颅脑损伤、颅内感染、肺部感染等。入院后给予美罗培南联合万古霉素抗感染、丙戊酸钠预防癫痫等治疗,后因多次脑脊液、痰培养结果显示泛耐药鲍曼不动杆菌,故将万古霉素更换为头孢哌酮舒巴坦。在患者感染控制不佳同时间断伴癫痫发作时,临床药师对治疗方案进行评估,建议加用米诺环素胶囊抗感染,增加丙戊酸钠用量,或更换抗癫痫药物。患者因经济原因拒绝新的抗菌方案,药师又根据抗菌药物的PK/PD理论优化备选抗菌药物给药方案并给予药学监护等。医生采纳临床药师的意见并增加丙戊酸钠用量,患者癫痫未再发作,但感染未控制,患者主动出院。
One 65-year-old female patient was hospitalized mainly because of craniocerebral injury and bleeding for 13 days after car accident and fever for 3 days. The patient was diagnosed as multiple injuries, severe craniocerebral injury, intracranial infection, pulmonary infection, etc. After admission, the patient was treated with meropenem and vancomycin for anti-infection and sodium valproate for epilepsy prevention. And then, vancomycin was replaced with cefoperazone sulbactam because repeated cerebrospinal fluid culture and sputum culture showed extensively drug-resistant Acinetobacter baumannii. But the patient developed epileptic seizure with uncontrolled infection. Clinical pharmacists evaluated the previous treatment and suggested to add minocycline capsules for anti-infection, increase the dosage of sodium valproate or change the antiepileptic drugs for anti-epilepsy. The patient refused new antibacterial regime due to economic reasons. Pharmacists then optimized the anti-infective regime according to the PK/PD theory and gave pharmacological care to the patient at the same time. Epilepsy was controlled with high dose of sodium valproate while infection remained uncontrolled. And the patient was discharged automatically.
作者
马静
徐家兵
MA Jing;XU Jia-bing(Pharmaceutical Preparation Section,Dachang Hospital of Nanjing,Nanjing 210044,China)
出处
《中国药物应用与监测》
CAS
2018年第3期151-154,共4页
Chinese Journal of Drug Application and Monitoring
基金
江苏省药学会-奥赛康医院药学基金项目(A201626)
关键词
泛耐药鲍曼不动杆菌
临床药师
用药分析
药学监护
Extensively drug-resistant Acinetobacter baumannii
Clinical pharmacist
Drug analysis
Pharmaceutical care
