1例肺腺癌合并肺栓塞肺部感染患者的药学监护  

Pharmaceutical care on a lung adenocarcinoma patient with pulmonary embolism and pulmonary infection

作　　者：侯继秋[1] 王冬雪[1] 朱曼[2] 孙静[1] 

机构地区：[1]吉林大学第二医院药品管理部,吉林长春130041 [2]解放军总医院药品保障中心,北京100853

出　　处：《中国药物应用与监测》2015年第5期275-277,共3页Chinese Journal of Drug Application and Monitoring

摘　　要：1例44岁女性患者,因咯血入院,诊断为肺腺癌,肺栓塞。针对肺栓塞选用低分子肝素、华法林重叠抗凝治疗,患者入院12 d出现了肺部感染,给予静脉注射莫西沙星抗感染治疗3 d后调整为万古霉素,万古霉素单药治疗3 d后联合亚胺培南/西司他丁抗感染治疗一周,患者病情好转。入院18 d开始化疗,方案为:培美曲塞二钠联合卡铂。该患者在治疗上存在双重治疗矛盾,即抗凝与咯血,化疗与感染。临床药师在主要治疗矛盾的确定、抗感染药物的调整、化疗方案的评估等方面进行了药学监护。患者住院期间顺利完成第一周期化疗,状态好转出院。One 44-year-old female patient was admitted to the hospital due to hemoptysis. The diagnosis was lung adenocarcinoma and pulmonary embolism. The pulmonary embolism was treated with low molecular weight heparin and warfarin. On the 12 th day after admission, the patient developed pulmonary infection. Moxifloxacin was given to the patient and transferred to vancomycin 3 days later. After 3 days, imipenem/cilastatin was added. The patient improved a week later. Simultaneous chemotherapy with pemetrexed disodium and carboplatin was given to the patient on the 18 th day after admission. Anticoagulant therapy and hemoptysis as well as chemotherapy and infection were contradictory during the treatment. Pharmacists assisted physicians in determining the main therapeutic contradiction, adjusting anti-infective drugs, assessing chemotherapy schedule and so on. The patient underwent the first cycle of chemotherapy successfully and was discharged with the improved condition.

关 键 词：药学监护 临床药师 肺腺癌 肺栓塞 肺部感染 

分 类 号：R734.2[医药卫生—肿瘤] R563.5[医药卫生—临床医学]