以案例分析谈临床药师在神经外科的临床药学实践  

Introduction of clinical pharmaceutical practice of pharmacists in neurosurgery department:a case analysis

作　　者：金浩[1] 王川[1] 李忠东[2] 

机构地区：[1]空军总医院药学部,北京100142 [2]北京电力医院药剂科,北京100073

出　　处：《中国新药杂志》2017年第11期1339-1344,共6页Chinese Journal of New Drugs

摘　　要：目的:探讨临床药师在神经外科开展精准药学监护的切入点。方法:临床药师通过参与术后颅内感染的抗感染治疗方案的制定、以基因导向和群体药动学为基础设计苯妥英钠剂量个体化给药方案、分析医嘱找出药物间潜在的不良相互作用等角度开展工作。结果:术后颅内感染的患者,通过临床药师提供精准治疗方案,患者感染常很快得到有效控制;苯妥英钠剂量个体化给药可使其在术后7 d内达到有效治疗浓度;通过分析医嘱避免了苯妥英钠与质子泵抑制剂兰索拉唑、奥美拉唑之间可能存在的不良相互作用。结论:上述3个切入点体现了临床药师开展精准药学监护的内涵,在神经外科治疗团队中发挥了重要作用。Objective： To introduce the breakthrough point for precise pharmaceutical care of pharmacists in neurosurgery department. Methods： Clinical pharmacists participated in the forming of precise anti-infective regimen, designed the individualized drug administration of phenytoin on the basis of population pharmacokinetics, and found the potential adverse interaction by analysizing the dictor＇s advice. Results： Infection was timely controlled by precise treatment regimen provided by clinical physicians and clinical pharmacists. Phenytoin blood drug concentrations can reach the therapeutic range within 7 days after the operation by individualized dose design, and adverse interactions between phenytoin and proton pump inhibitors, such as lansoprazole and omeprazole, were reduced by analyzing the doctor＇s advice. Conclusion： The three breakthrough points may present the internal implication of precise pharmaceutical care carried by clinical pharmacists, which play an important role in neurosurgery treatment teams.

关 键 词：临床药师 临床药学 实践 神经外科 

分 类 号：R96[医药卫生—药理学]