急性脑梗死合并肺部感染患者的病例分析  

Case analysis of the therapy of acute cerebral infarction combined with pulmonary infection

作　　者：贺春晖[1] 李霞[1] 赵懿清[1] 高秋芳[1] 葛重宇[1] 

机构地区：[1]无锡市第三人民医院药学部,江苏无锡214041

出　　处：《中国药物应用与监测》2016年第3期186-188,共3页Chinese Journal of Drug Application and Monitoring

摘　　要：1例74岁男性患者,因急性脑梗死、高血压、肺部感染入院,给予抗血小板、抗感染、调脂和营养神经治疗。入院当天患者体温升至39.2℃,先后给予哌拉西林他唑巴坦(2.5 g,bid,ivgtt)、头孢吡肟(2.0 g,bid,ivgtt)抗感染治疗,效果不佳,临床药师建议更换为万古霉素(1.0 g,q 12 h,ivgtt)后患者体温恢复正常,但仍有咳嗽,痰量增多,联合使用头孢哌酮舒巴坦(3.0 g,q 8 h,ivgtt),患者病情逐渐好转。治疗期间,患者转氨酶(ALT和AST)持续升高,考虑为瑞舒伐他汀引起的肝功能异常,当即停用瑞舒伐他汀,给予还原型谷胱甘肽(2.4 g,qd,ivgtt)保肝降酶,5 d后患者肝功能恢复正常。最终患者病情稳定准予出院。A 74-year-old man was hospitalized because of acute cerebral infarction, hypertension and pulmonary infection. The patient was administrated with antiplatelet drugs, anti-infective drugs, lipid-regulating drugs and neurotrophic therapy. After admission, the body temperature of the patient increased to 39.2 ℃. Piperacillin/tazobactam(2.5 g, bid, ivgtt) and cefepime(2.0 g, bid, ivgtt) were prescribed respectively against infection. Due to the poor effect of anti-infection, the patient was administrated with vancomycin(1.0 g, q 12 h, ivgtt). Four days later, the patient's body temperature returned to normal while cough and increased sputum production continued. Cefoperazone/sulbactam(3.0 g, q 8 h, ivgtt) was combined use for anti-infection treatment suggested by clinical pharmacist. And then the situation of patient improved gradually. During the treatment, the patient's aminopherase(ALT and AST) continued to rise. The abnormal liver function was considered to be induced by rosuvastatin. So rosuvastatin was stopped and reduced glutathione(2.4 g, qd, ivgtt) was given to the patient. Five days later, the aminopherase decreased and then returned to the normal level. Finally, the patient was in a stable condition and discharged.

关 键 词：肺部感染 肝功能异常 病例分析 临床药师 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R563.1[医药卫生—临床医学]