1例腹膜透析相关感染合并继发性甲状旁腺功能亢进患者的药学监护  

Pharmaceutical care on a patient with peritoneal dialysis-associated infection and secondary hyperparathyroidism

作　　者：代瑞甫 蔡乐[1] 朱曼[1] 张艳秀[1] 陈勤[1] DAI Rui-fu;CAI Le;ZHU Man;ZHANG Yan-xiu;CHEN Qin(Pharmaceutical Department of PLA General Hospital,Beijing 100853,China;Department of Pharmacy,the 928th Hospital of the Joint Logistic Support Force,Haikou 570100,China)

机构地区：[1]解放军总医院药学部,北京100853 [2]联勤保障部队第九二八医院药剂科,海南海口570100

出　　处：《中国药物应用与监测》2019年第6期347-350,共4页Chinese Journal of Drug Application and Monitoring

基　　金：解放军总医院科技创新苗圃基金项目(17KMM44)

摘　　要：1例30岁女性慢性肾功能不全(CKD 5期)患者,因"腹膜透析6年余,反复发生腹膜炎,皮肤多发钙化斑2年余"入院。入院后给予慢性肾衰一体化治疗,患者在治疗期间出现腹膜炎,给予头孢呋辛钠、左氧氟沙星抗感染,之后根据细菌培养和药敏结果,将头孢呋辛钠调整为万古霉素;给予西那卡塞、司维拉姆、碳酸钙综合治疗继发性甲状旁腺功能亢进。临床药师结合患者病情、抗菌药物药动学及治疗药物监测,在抗菌药物的品种选择、给药途径、给药剂量等方面对患者进行全程的药学监护,协助医生制定万古霉素个体化用药方案。同时,针对继发性甲状旁腺功能亢进治疗进行监护,密切监测全段甲状旁腺激素、血钙、血磷等指标,在患者增加西那卡塞剂量出现血钙降低时,及时建议增加钙剂,为临床优化治疗方案提出合理化建议。最终患者病情好转出院。A 30-year-old female patient with chronic kidney disease(stage 5 CKD)was admitted to the hospital due to peritoneal dialysis for more than 6 years,recurrent peritonitis,multiple calcified spots on the skin for more than 2 years.After admission,the patient was treated with integrated therapy for chronic renal failure.Cefuroxime sodium and levofloxacin were given to the patient for peritoneal dialysis-associated infection and then cefuroxime sodium was adjusted to vancomycin according to the results of bacterial culture and drug sensitivity.Cinacalcet,sevelamer and calcium carbonate were given to the patient for the secondary hyperparathyroidism.Clinical pharmacists carried out the overall pharmaceutical care during the treatment focusing on antibiotics including category,administration route,dose and the individualized therapeutic regimen of vancomycin according to the patient’s condition,pharmacokinetic literature and results of therapeutic drug monitoring.Meanwhile clinical pharmacists monitored the levels of serum intact parathyroid hormone,calcium and phosphorus,and recommended physicians to increase the dose of calcium when the serum calcium decreased after increasing the dose of cinacalcet.The patient was discharged with a better condition.

关 键 词：腹膜透析 感染 继发性甲状旁腺功能亢进 万古霉素 西那卡塞 

分 类 号：R969.4[医药卫生—药理学]