对一例重症肺炎伴免疫缺陷患者的药学服务  

Pharmaceutical care for a case of severe pneumonia with immunodeficiency

作　　者：杜宁 钱跹 陈尔真[3] 何娟[4] 卞晓岚[4] DU Ning;QIAN Xian;CHEN Erzhen;HE Juan;BIAN Xiaolan(Department of Pharmacy,Qiqihar First Hospital,Heilongjiang Qiqihar 161000,China;Department of Pharmacy, Luodian Hospital of Shanghai Baoshan District,Shanghai 201908,China;Emergency Intensive Care Unit,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Pharmacy,Ruijin Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]齐齐哈尔市第一医院药学部,黑龙江齐齐哈尔161000 [2]上海市宝山区罗店医院药剂科,上海201908 [3]上海交通大学医学院附属瑞金医院急诊重症监护室,上海200025 [4]上海交通大学医学院附属瑞金医院药剂科,上海200025

出　　处：《药学服务与研究》2021年第4期279-283,共5页Pharmaceutical Care and Research

基　　金：国家自然科学基金(81571931,81772107);上海交通大学医学院药学科研基金(JDYX2016QN001)。

摘　　要：目的:讨论1例重症肺炎伴免疫缺陷患者的药物治疗过程,为临床治疗此类免疫缺陷患者提供经验,并为临床药师开展药学服务提供参考。方法:分析1例急性呼吸衰竭、重症社区获得性肺炎伴免疫缺陷患者的治疗过程,探讨抗感染方案的制订,初始经验性治疗失败后抗感染方案的调整及优化,血药浓度的监测,后续药物治疗方案的制订及药学服务。结果:对于重症肺炎伴免疫缺陷的患者,常见菌感染可考虑曲霉菌和耶氏肺孢子虫等条件致病菌。根据患者的免疫功能,制订并优化治疗方案,最终患者病情好转,转入内科病房继续治疗。结论:临床药师协助医师制订个体化治疗方案,并对患者进行全程化药学服务,可以提高疗效,降低药物的毒副作用,从而体现出临床药师在多学科诊疗团队中的重要价值。Objective:To discuss the drug treatment process of a patient with severe pneumonia plus immunodeficiency,so as to offer clinical experience for the treatment of such patients and provide reference for pharmaceutical care by clinical pharmacists.Methods:An analysis was made regarding the treatment process of a patient with acute respiratory failure and severe community-acquired pneumonia plus immunodeficiency.Then,the development of anti-infective regimens was discussed,and the adjustment and optimization of anti-infective regimens were also made,following failure of initial empirical treatment.Finally,the detection of serum drug concentration and the development of subsequent drug treatment regimens and pharmaceutical care were discussed in the process.Results:For the patients combined with severe pneumonia plus immunodeficiency,common bacterial infection in most cases might be caused by such conditional pathogens as Aspergillus and Pneumocystis jiroveci.In accordance with the immune function of patients,physicians,with the help of pharmacists,could develop and optimize treatment regimens,and when condition eventually improved,the patient could be transferred to internal medicine ward for further treatment.Conclusion:Clinical pharmacists could assist physicians in formulating individualized treatment regimens and provide integrated pharmaceutical care and help to reduce adverse drug reactions,thus playing an important role in pharmaceutical care as a member of multidisciplinary diagnosis and treatment team.

关 键 词：免疫缺陷 社区获得性肺炎 曲霉菌 耶氏肺孢子虫 

分 类 号：R978[医药卫生—药品] R969.3[医药卫生—药学]