临床药师参与1例肿瘤患者中心静脉置管感染合并深静脉血栓治疗的实践与体会

摘 要 目的：探讨临床药师参与肿瘤患者中心静脉置管（PICC）感染合并血栓的药物治疗方案的制定以及提供药学服务的方法。方法: 对1例出现PICC感染合并血栓的肿瘤患者，临床药师结合相关指南对抗感染药物及抗血栓药物治疗方案的选择提出了具体意见，建议选用万古霉素治疗导管相关性感染，选用低分子肝素钠预防性抗凝治疗，治疗同时加强凝血功能的药学监护。结果: 临床药师的建议被临床医生部分采纳，经治疗后患者的体温恢复正常，深静脉血栓得到良好控制，顺利出院。结论:临床药师通过参与临床实践，可协助医师优化治疗方案，并总结出肿瘤患者PICC感染及深静脉血栓的药学监护模式，为今后的药学监护提供方向。

Practice and Experience of Clinical Pharmacists Participating in One Case of Cancer Patients with Infection Induced by Peripherally Inserted Central Catheter Complicated with Deep Venous Thrombosis

ABSTRACT Objective: To explore the methods for drug therapy regimen formulation and pharmaceutical service of clinical pharmacists for the infection induced by peripherally inserted central catheter (PICC) complicated with deep venous thrombosis in cancer patients.Methods:Referring to the related guide, clinical pharmacists put forward concrete opinions on how to choose anti infective drugs and anti thrombotic drugs for a cancer patient with PICC infection complicated with deep venous thrombosis. Clinical pharmacists suggested that vancomycin be used for the infection and low molecular weight heparin sodium for prophylactic anticoagulation. Meanwhile, pharmaceutical care for blood clotting function should be strengthened. Results:The proposals of clinical pharmacist were partly adopted by clinicians. After the therapy, the temperature of the patient returned to normal, and the deep venous thrombosis was well controlled. The patient was out of hospital smoothly. Conclusion:Through the participation in clinical practice, clinical pharmacists can assist physicians in optimizing treatment plan and summarize the pharmaceutical care mode for the PICC infection and deep venous thrombosis in cancer patients, which can provide instructions for pharmaceutical care in the future.