1例颅内动脉瘤术后发热患者的抗感染治疗分析  

Case analysis of anti-infection treatment for fever after intracranial aneurysm operation

作　　者：程淑琴[1] 吕露[1] 王伟[1] CHENG Shuqin;LYU Lu;WANG Wei(Department of Pharmacy,Ezhou Central Hospital,Ezhou 436000,Hubei Province,China)

机构地区：[1]鄂州市中心医院药学部,湖北鄂州436000

出　　处：《药物流行病学杂志》2024年第3期355-360,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：本文报道临床药师参与1例颅内动脉瘤患者术后发热的抗感染治疗经过。患者初期为蛛网膜下腔出血导致的发热,属于非感染性发热。之后出现颅内感染,根据临床相关指南及抗菌药物血脑屏障通透性,优化万古霉素及美罗培南静脉给药方案。后期脑脊液培养提示大肠埃希菌,降阶梯使用头孢他啶,患者颅内感染治愈。住院期间患者出现脱髓鞘性脊髓炎不良事件,考虑与庆大霉素鞘内给药单次剂量过大有关,及时停用鞘内给药方案,最终患者肌力恢复良好。治疗过程中,临床药师协助医师制定并优化个体化治疗方案,为患者安全、有效使用抗菌药物提供参考。This article reported that clinical pharmacists participated in the antiinfection treatment process of a patient with fever after intracranial aneurysm operation.The initial fever in the patient caused by arachnoid hemorrhage was non-infectious fever.Then followed by intracranial infections,the intravenous regimen of vancomycin and meropenem was optimized according to clinically relevant guidelines and the blood-brain barrier permeability of antimicrobials.Later,Escherichia coli was reported via the cerebrospinal fluid culture,and the patient with intracranial infection was cured by step-down therapy with ce?tazidime.During hospitalization,the patient experienced an adverse event of demyelinating myelitis,which was considered to be related to the excessive single dose of intrathecal gentamicin.■e intrathecal administration was promptly discontinued,and eventually the patient recovered well in muscle power.Throughout the entire treatment process,clinical pharmacists assisted physicians in providing patient with an individualized treatment plan and provided reference for the safe,effective,and rational use of antibiotics.

关 键 词：颅脑手术 颅内感染 大肠埃希菌 庆大霉素鞘内注射 脱髓鞘性脊髓炎 

分 类 号：R651.12[医药卫生—外科学] R969.3[医药卫生—临床医学]