对1例脑出血患者的药学监护  

Pharmaceutical care on a patient with thalamic hemorrhage

作　　者：欧扬[1] 王兆云[2] 夏文[3] 周文[1] 

机构地区：[1]山东大学齐鲁医院药剂科,山东济南250012 [2]山东大学齐鲁医院急诊外科,山东济南250012 [3]山东大学齐鲁医院神经内科,山东济南250012

出　　处：《中国药物应用与监测》2010年第2期113-115,共3页Chinese Journal of Drug Application and Monitoring

摘　　要：1例61a男性患者,因"丘脑出血合并高血压、2型糖尿病"入院,给予脱水、利尿、脑保护、促脑代谢、降血压、降血糖等治疗。入院后第11天患者发生吸入性肺炎,医生经验性给予哌拉西林/他唑巴坦抗感染治疗。结合患者肾功能低下、哌拉西林/他唑巴坦与依达拉奉联合应用可能出现肾衰竭加重情况,临床药师建议将抗菌药物改为头孢哌酮/舒巴坦;同时对硝苯地平合用二甲双胍出现低血糖症状进行分析,并建议两药间隔2h以上服用;并对糖尿病合并高血压患者降压药物选择进行讨论,建议将硝苯地平改为培哚普利。经合理优化治疗方案后,患者避免了肾损伤加重,血压及血糖控制平稳,病情明显好转。A 61-year-old male patient with thalamic hemorrhage,hypertension and type 2 diabetes mellitus was hospitalized.The patient was treated with dehydration,diuresis,cerebral protection,promoting brain metabolism,controlling blood pressure and lowering blood sugar.Eleven days after his hospitalization,the patient developed aspiration pneumonia,and he was given empirical anti-infection treatment with piperacillin/tazobactam.As the interaction between edaravone and piperacillin/tazobactam may exacerbate renal failure,considering the renal insufficiency of the patient,clinical pharmacist proposed to replace antimicrobial drugs with cefoperazone/sulbactam.Hypoglycemic symptom induced by nifedipine combination with metformin was analyzed,and clinical pharmacist recommended the interval time of the two drugs taken should be more than 2 hours.In addition,according to the patient＇s condition of diabetes mellitus complicating with hypertension,the selection of antihypertensive drugs was discussed,and nifedipine should be changed to perindopril for antihypertensive therapy.The rational optimization of the treatment can avoid the kidney damage in the patient,and the blood pressure and the blood glucose were controlled stably.The symptom of this patient improved markedly.

关 键 词：临床药师 药学监护 丘脑出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R96[医药卫生—临床医学]