临床药师参与1例颅脑损伤术后感染治疗的实践与体会

目的：探讨临床药师在重症感染患者救治中的作用.方法：临床药师参与l例重型脑外伤后合并肺部和真菌性血流感染患者的联合治疗,对抗感染药物治疗方案的制订提出了具体意见,采取先用亚胺培南/西司他汀然后降阶梯使用哌拉西林/他唑巴坦抗细菌感染,采用氟康唑抗真菌的联合抗感染的治疗方案,治疗的同时加强对必要的血常规、肾功能、肝功能,凝血功能药学监护.结果：临床药师提供的合理治疗方案取得了良好的治疗效果,患者体温、血常规、肾功能恢复正常,神志意识恢复,治愈出院.结论：临床药师通过实施药学监护,协助医师优化治疗方案,减少不必要的抗生素换用,提高了治疗效果,减少了细菌耐药和药品不良反应的发生.

Practice and Experience of Clinical Pharmacists in Participation in One Case of Brain Injury with Infections

ABSTRACT Objective: To investigate the role of clinical pharmacist in the treatment of patients with severe infections. Methods: The clinical pharmacists participated in the combination therapy for one case of severe traumatic brain injury with pulmonary infection and fungal bloodstream infection, and provided suggestions for the anti-infective drug treatment made by the doctors. As for antibacterial, imipenem/cystatins were used first, and then piperacillin/tazobactam were taken by de-escalation therapy. Fluconazole was chosen as the antifungal agent. Meanwhile, the pharmaceutical care for blood routine examination, kidney function, liver function and blood coagulation were strengthened.Results:The clinical pharmacists provided a reasonable regimen, a promising therapeutic effect was achieved, and the patient recovered. Conclusion:Through the implementation of pharmaceutical care, clinical pharmacists can assist physicians in optimizing treatment regimen, reducing unnecessary antibiotic use, improving treatment effect, reducing bacterial resistance and adverse drug reactions.