肾移植术后肺部感染的药学监护重点  

Pharmaceutical Care of Pulmonary Infection After Renal Transplantation

作　　者：马葵芬[1] 陈泉金[1] 许小鑫 吴寅[2] 卢晓阳[1] 张幸国[1] 

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003 [2]第四军医大学西京医院,陕西西安710032

出　　处：《药品评价》2016年第10期33-35,64,共4页Drug Evaluation

摘　　要：目的:阐述肾移植术后感染的处理原则与用药监护重点,为临床药师参与类似病例的用药监护提供借鉴。方法:分析作者参与的一例肾移植术后肺部感染患者,调整免疫抑制方案时导致了急性排斥反应的病例,重点阐述肾移植术后肺部感染处理原则;抗感染药物及免疫抑制剂用药过程中的药学监护重点,以及出现免疫排斥反应后的处理、注意事项及用药监护。结果与结论:临床药师要积极参与到肾移植术后肺部感染患者的疾病治疗与用药管理中,把握肾移植术后肺部感染患者抗感染的治疗原则,注意感染实验室指标的持续监测,以帮助评估抗感染效果;同时根据感染病情调整免疫抑制方案,严密监测CNIs血药浓度及免疫抑制强度。再者,要严密监测肾功损害情况,注意鉴别是药物不良反应、感染加重或新发排斥反应;肾功能损害时,要根据抗菌药物的药代动力学特点对抗菌药物剂量进行调整,以免产生药物不良反应,影响疾病进程。此外,还要根据相应药物特点,注意药物不良反应及相互作用。Objective To explain the principles of the treatment of infection after kidney transplantation and the key points of drug use, to providereference for clinical pharmacists to participate in similar cases. Methods： One case of pulmonary infection after renal transplantationwas analyzed.In this case, when adjust the immune suppression program, acute rejectionhappened, the treatment is focusedon the pulmonary infection afterkidneytransplantation; Pharmaceutical care was performed in the process of anti infection drugs and immune inhibitors, as well as the treatment ofimmune rejection, attention matters and drug monitoring. Results and Conclusion： Clinical pharmacists should participate actively in the treatmentof patients with the disease and medication management of pulmonary infection after renal transplantation, grasp the kidney transplantation patientswith pulmonary infection after anti infection treatment principle, pay attention to infection continuous monitoring of laboratory parameters, tohelp evaluate the effect of anti infection; At the same time, according to the infection condition adjust the immune suppression program, closelymonitor the CNIs blood concentration and immune suppression intensity. Furthermore, to close monitoring of renal function damage, pay attentionto the differential is adverse drug reaction, infection increase or new rejection; impairment of renal function, according to antimicrobial drugpharmacokinetic characteristics of antibacterial drug doses adjusted, so as to prevent any possible adverse drug reaction influence disease progression.In addition, according to the corresponding drug characteristics, more attentionshouled be paid to adverse drug reactions and interaction.

关 键 词：肾移植术 肺部感染 急性排斥反应 药学监护 

分 类 号：R699.2[医药卫生—泌尿科学]