临床药师构建肺诺卡菌病会诊思维导图的临床药学实践  

Clinical pharmaceutical practice of constructing mind map by clinical pharmacists for the consultation ofpulmonary nocardiosis

作　　者：邓体瑛[1] 胡志敏[2] 徐清[3] 张韶辉[1] 李璐璐[1] 郭珩[1] 胡磊[1] 陈凡[1] DENG Tiying;HU Zhimin;XU Qing;ZHANG Shaohui;LI Lulu;GUO Heng;HU Lei;CHEN Fan(Clinical Pharmacy Support,Pharmacy Department,Wuhan Municipal First Hospital,Wuhan 430022,China;Microbiology Lab,Clinical Laboratory Department,Wuhan Municipal First Hospital,Wuhan 430022,China;Dept.of Respiratory Medicine,Wuhan Municipal First Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院药学部临床药学室,武汉430022 [2]武汉市第一医院检验科微生物室,武汉430022 [3]武汉市第一医院呼吸内科,武汉430022

出　　处：《中国药房》2023年第15期1899-1903,共5页China Pharmacy

基　　金：国家中医药管理局“十二五”中医重点专科协作项目(No.国中医办医政函[2012]123号);湖北省三级医院临床药学重点专科项目(No.鄂卫通[2019]125号);武汉市卫生健康委医学科研项目(No.WH21C21)。

摘　　要：目的 探讨临床药师构建肺诺卡菌病会诊思维导图并应用于临床实践,为促进临床正确遴选诺卡菌病治疗用药并保障药物安全性及疗效提供参考。方法 收集2017年1月-2022年4月我院肺诺卡菌感染患者7例,依据循证医学证据,针对诺卡菌菌种不同药敏性差异大和一线药物复方磺胺甲噁唑不良反应多的难点,构建会诊思维导图(主要包括了解病史、确定感染菌、明确危险因素、制定治疗方案、治疗评估等),制定7例肺诺卡菌感染患者的治疗方案,并进行全程药学监护。结果 结合思维导图,根据诺卡菌菌种的不同、有无药敏结果、患者的过敏史等予以不同的抗菌药物联合方案,其中4例均联合了亚胺培南西司他丁治疗,对长期使用复方磺胺甲噁唑、利奈唑胺的患者进行全程药学监护,并及时处理了药物不良反应。结论 临床药师将肺诺卡菌病会诊思维导图运用到住院患者治疗过程中,利用药学专业优势,参与临床药物治疗,在临床治疗团队中发挥了积极作用,促进了患者合理用药。OBJECTIVE To explore the construction of mind map by clinical pharmacists for the consultation of pulmonary nocardiosis and its application in clinical practice,and to provide reference for promoting the correct selection of nocardiosis treatment drugs in clinical practice and ensuring drug safety and efficacy.METHODS A total of 7 patients with Nocardia pulmonary infection from January 2017 to April 2022 in our hospital were collected.Based on evidence-based medicine,a consultation mind map(mainly including understanding the medical history,identifying infectious bacteria,identifying risk factors,developing treatment plans,and conducting evaluations)was constructed to address the difficulties of large differences in drug sensitivity among different strains of Nocardia and numerous adverse reactions of Compound sulfamethoxazole as a first-line drug.The treatment plan was developed for 7 patients with pulmonary nocardiosis,and whole-process pharmaceutical care was provided.RESULTS Combined with the mind map,different antibiotic combination regimens were given according to the drug sensitivity results of Nocardia,the different species of Nocardia,and the patient’s allergy history.Among them,4 cases were treated with imipenem cilastatin,the patients receiving Compound sulfamethoxazole and linezolid for a long time were given full pharmaceutical care,and the adverse drug reactions were timely treated.CONCLUSIONS Clinical pharmacists apply the consultation mind map of pulmonary nocardiosis to the treatment of inpatients,take advantage of pharmacy,participate in clinical drug therapy,and really play a role in the clinical treatment team so as to promote rational drug use.

关 键 词：肺诺卡菌病 临床药师 思维导图 药学实践 会诊 

分 类 号：R95[医药卫生—药学] R978