临床药师对2例肾移植术后肺部感染患者治疗方案的对比分析  

Comparative Analysis on Treatment Plan for 2 Patients with Lung Infections after Renal Transplantation by Clinical Pharmacists

作　　者：李薇[1] 何菊英[1] 王渝[1] 唐敏[1] 

机构地区：[1]第三军医大学西南医院药剂科,重庆400038

出　　处：《中国药房》2013年第34期3249-3251,共3页China Pharmacy

摘　　要：目的:探讨肾移植术后患者发生肺部感染时,及时调整抗感染及免疫抑制方案的意义。方法:回顾性分析2例肾移植术后发生肺部感染的患者的临床资料。抗细菌治疗:病例1治疗初期用氨曲南,2 d后改用哌拉西林/舒巴坦钠,5 d后改用万古霉素联合亚胺培南/西司他丁;病例2入院即使用哌拉西林/舒巴坦钠。抗真菌治疗:病例1治疗7 d后感染未控制,加用两性霉素B脂质体;病例2治疗4 d后即给予足量伏立康唑。免疫抑制方案:病例1感染持续加重至7 d才停用特殊免疫抑制剂;病例2在治疗初期即停用特殊免疫抑制剂。结果:病例1住院12 d后,感染持续加重,氧饱和度降低,最终转入重症监护病房(ICU)治疗;病例2于30d后成功治愈出院。比较2例患者的治疗经过可知,发生感染后应尽早使用广谱、强效的抗菌药物;积极调整免疫抑制药物用量,严密观察肾功能;怀疑发生真菌感染后,积极抗真菌治疗,是治疗成功的关键。结论:在感染早期选择合理、有效的治疗方案,在控制肺部感染的同时防止器官排斥反应发生是治疗的关键,也是临床药师进行药学监护的重要内容。OBJECTIVE：To study the importance of appropriate adjustment of anti-infection and immunodepression treatment plan in pulmonary infection patients after renal transplantation.METHODS：Clinical information of 2 patients with pulmonary infection after renal transplantation was analyzed retrospectively.Anti-bacterial treatment：case 1 received aztreonam at early stage,2 days later was given piperacillin/sulbactam sodium,5 days later received vancomycin combined with imipenem/cilastatin;case 2 received piperacillin/sulbactam sodium on admission.Antifungal treatment：case 1 received amphotericin B liposome 7 days after infection control failure;case 2 received enough voriconazole after 4 days of treatment.Immunologic suppression plan：case 1 stopped taking special immunodepressant until infection aggravated continuously for 7 days;case 2 stopped taking special immunodepressant at early stage.RESULTS：12 days after admission,infection aggravated continuously and oxygen saturation decreased in case 1,and then the patients moved to ICU finally;case 2 was cured and discharged from hospital 30 days later.Broad-spectrum powerful antibiotics should be used as early as possible after infection;the amount of immunodepressant should be adjusted and renal function should be monitored closely.Active prevention of fungal infection was the key to successful treatment after suspected as fungal infection.CONCLUSIONS：A reasonable and effective treatment plan should be selected at the early stages of infection.The control of pulmonary infection and prevention of organ rejection are very important for treatment and also play important role in pharmaceutical care.

关 键 词：临床药师 肾移植 免疫抑制剂 肺部感染 

分 类 号：R978.1[医药卫生—药品]