临床药师参与1例肺癌并发肺部耐甲氧西林金黄色葡萄球菌及烟曲霉菌重症感染患者的药学监护  

Pharmaceutical care for a lung cancer patient with severe pulmonary MRSA and aspergillosis infection

作　　者：宋立莹 石卫峰[1] 王金丽[3] 曹利娟[4] 刘世坤[2] 徐红冰[1] SONG Li-ying;SHI Wei-feng;WANG Jin-li;CAO Li-juan;LIU Shi-kun;XU Hong-bing(Department of Clinical Pharmacy, the First People＇s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200080;Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013;Department of Pharmacy, Affiliated Hospital of Nantong University, Nantong Jiangsu 226001, 4. Department of Pharmacy, The People＇s Hospital of Liuzhou, Liuzhou Guangxi 545006)

机构地区：[1]上海交通大学附属第一人民医院临床药学科,上海200080 [2]中南大学湘雅三医院药学部,长沙410013 [3]南通大学附属医院药剂科,江苏南通226001 [4]柳州市人民医院药剂科,广西柳州545006

出　　处：《中南药学》2018年第5期704-708,共5页Central South Pharmacy

摘　　要：目的探讨临床药师参与1例肺癌并发肺部耐甲氧西林金黄色葡萄球菌(MRSA)及曲霉菌重症感染患者诊治的药学服务模式,通过药动学、药效学及血药浓度监测等知识并查阅相关文献总结此类疾病的诊治及药学监护策略。方法以1例肺癌并发肺部MRSA及曲霉菌重症感染患者的诊治过程为例,从抗感染方案的制定、血药浓度监测、药物不良反应处理及药品配伍、剂量及疗程等方面讨论肺癌并发肺部MRSA及曲霉菌重症感染患者的药学监护工作。结果通过临床实践,临床药师对患者整个诊治过程实施个体化监护,根据病原菌分布特点、药敏实验结果、血药浓度监测及患者的具体病生理变化情况与医师讨论共同探讨优化治疗方案,使抗感染从经验治疗到目标治疗再到最优治疗方案,并对产生的不良反应及时处理,患者感染得到控制并获得安全、有效药物治疗。结论临床药师作为多学科团队(MDT)重要成员之一,结合自己专业特长,协助医师优化治疗方案,减少耐药菌的产生及不良反应的发生,促进临床合理用药。Objective To determine the role of clinical pharmacists in the therapy for a lung cancer patient with severe pulmonary MRSA and aspergillosis infection, and summarize the diagnosis and treatment. Methods Clinical pharmacists participated in the treatment of a lung cancer patient with severe pulmonary MRSA and aspergillosis infection, assisted doctors to monitor the blood concentration of vancomycin and voriconazole, optimized antibiotics treatment plan, and handled adverse reaction events promptly. Results For tumor patients with severe infections, clinical pharmacists assisted doctors to optimize the anti-infection treatment from experience therapy to target therapy and optimize treatment strategies to avoid serious adverse reactions in the entire pharmaceutical care, based on pathogenic bacteria distribution, drug susceptibility experiment and physiological changes of patients. Patients got access to safe and effective treatment. Conclusion Clinical pharmacists as an important part of a multidisciplinary team can assist doctors to optimize therapy plan according to pharmacokinetics and pharmacodynamics, minimize the drug resistance and adverse drug reaction, and guaratee the satety and effectivenes of clinical treatment.

关 键 词：临床药师 药学监护 肺癌 耐甲氧西林金黄色葡萄球菌 曲霉感染 

分 类 号：R656[医药卫生—外科学]