1例食管穿孔伴纵膈感染患者临床治疗的药学监护  

Pharmaceutical Care in Clinical Treatment of One Patient with Esophageal Perforation Complicated with Mediastinal Infection

作　　者：贾荣娣[1] 徐凤兰[1] 汪华君[1] JIA Rong-di;XU Feng-lan;WANG Hua-jun(Affiliated Hospital of Jiangsu University,Zhenjiang Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院,江苏镇江212001

出　　处：《抗感染药学》2023年第1期14-17,71,共5页Anti-infection Pharmacy

基　　金：江苏省药学会药学服务专项科研资助项目资助(编号:H202019)。

摘　　要：目的:分析食管穿孔伴纵膈感染患者临床治疗的药学监护过程和要点,为该类患者药学监护的实施提供参考。方法与结果:临床药师在开展临床工作中,遇一患者因异物入食管,引发食管穿孔伴感染,遂予抗感染、抑酸护胃、补液支持等常规治疗,但亚胺培南-西司他丁钠的抗感染治疗效果始终不佳;临床药师多次建议取脓性引流液行微生物培养检查,医生最终接受了建议,结果检出嗜麦芽窄食单胞菌,遂立即根据培养结果和药敏试验结果调整抗感染治疗方案,患者的感染症状和指标较前明显改善。结论:临床药师在对食管穿孔伴纵膈感染患者尤其是病情复杂患者开展药学监护时,应当积极开展个体化分析,协助医生找到病原所在,以制定出有针对性的治疗方案,促进患者的快速康复。Objective:To analyze the process and key points of pharmaceutical care in the clinical treatment of patients with esophageal perforation complicated with mediastinal infection,and provide reference for the implementation of pharmaceutical care for such patients.Methods and Results:In the clinical work,the clinical pharmacist found one patient with esophageal perforation and infection due to a foreign body entering the esophagus,who was then given conventional treatments such as anti-infection,acid suppression for stomach protection and rehydration support,but the anti-infective treatment effect of imipenem-cilastatin sodium was always not good;the clinical pharmacist repeatedly suggested to take purulent drainage fluid for microbial culture examination,and the physician finally accepted the suggestion,and Stenotrophomonas maltophilia was detected.Then the anti-infection treatment regimen was adjusted immediately according to the culture result and the drug susceptibility test results,finally the patient's infection symptoms and indicators were improved apparently.Conclusion:When clinical pharmacists perform pharmaceutical care for patients with esophageal perforation complicated with mediastinal infection,especially those with complex conditions,individualized analysis should be conducted actively to assist physicians to find the pathogen,and formulate a targeted treatment regimen to promote the rapid recovery of patients.

关 键 词：临床药师 食管穿孔 纵膈感染 药学监护 

分 类 号：R969.3[医药卫生—药理学] R97[医药卫生—药学]