急性肾衰竭患者药物中毒监护实例谈TDM工作模式改进  

Improvement on the operating mode of therapeutic drug monitoring by combined with pharmaceutical care from a renal failure case of multiple antibiotics overdose poisoning

作　　者：恽芸蕾[1] 黄立峰[1] 缪海均[1] 陈万生[1] YUN Yun-lei;HUANG Li-feng;MIAO Hai-jun;CHEN Wan-sheng(Department of Pharmacy, Shanghai Changzheng Hospital,Shanghai 200003, China)

机构地区：[1]上海长征医院药学部,上海200003

出　　处：《中国药物应用与监测》2017年第4期247-250,共4页Chinese Journal of Drug Application and Monitoring

基　　金：上海医院药学科研基金资助项目(2014-YY-02-10)

摘　　要：目的:通过实例分析多种抗生素过量引发精神症状的移植肾衰竭病例的诊治过程及药学监护,探讨治疗药物监测工作如何与药学监护相结合才更具临床价值。方法:分析实例中不良事件发生的原因、环节的疏漏及药学监护的缺位等问题,查找药师原有工作模式的不足,及时改进模式并实施。根据新模式要求,临床药师实时监测重点药品的临床应用,并积极沟通临床进行血药浓度监测;发现异常数据,药师研习病史,床边会诊,向主治医师提出药师建议;对危重、疑难病例实施药学监护,直至病情转归。结果:该危重患者在规律血透下,血肌酐基本稳定;肺部感染痊愈;精神症状有所减轻。结论:TDM与药学监护的有效结合使临床药学工作更为主动、更具时效,临床药师应发挥专业优势,提供差异化服务,确保用药安全有效。Objective:To explore how to combine therapeutic drug monitoring with pharmaceutical care for improvingclinical value,by elaborating the medical process of one case of mental poisoning symptom caused by multiple antibiotics overdosein a transplant kidney failure patient.Methods:We analyzed the reason of adverse events,the omission of medical process and theabsence of pharmaceutical care,and then introspected the deficiency of original working pattern and improved it in time.Accordingto new pattern,clinical pharmacists timely monitored the clinical application of some key drugs,and actively communicated theresults of blood concentration monitoring with doctors.If the results were out of the therapeutic range,pharmacists should learnthe medical history,make a consultation,and then provide advice to the attending physician.The pharmaceutical care would notfinish until the outcome of critically ill patients went well.Results:Under hemodialysis,the serum creatinine of the patient becamebasically stable.The pulmonary infection had been healed,and the psychiatric symptoms alleviated.Conclusion:A good workof clinical pharmacy can be carried actively and timely by combining TDM and pharmaceutical care,the pharmacists should takeadvantage of professional superiority and provide differentiated services in order to ensure the safety of drug use.

关 键 词：万古霉素 药物中毒 精神症状 治疗药物监测 药学监护 

分 类 号：R692.5[医药卫生—泌尿科学]