1例骨折术后并发脂肪栓塞综合征的药学服务  

Pharmaceutical service in a case of fat embolism syndrome following postoperative fracture

作　　者：张磊姣 王平平 闫琴琴 黄海渝 黄国玺 吴雪 ZHANG Leijiao;WANG Pingping;YAN Qinqin;HUANG Haiyu;HUANG Guoxi;WU Xue(Dept.of Pharmacy,No.924 Hospital of PLA Joint Logistic Support Force,Guangxi Guilin 541002,China)

机构地区：[1]中国人民解放军联勤保障部队第九二四医院药剂科,广西桂林541002

出　　处：《中国药房》2024年第22期2822-2827,共6页China Pharmacy

基　　金：广西壮族自治区卫生健康委自筹经费科研课题(No.Z-C20231114)。

摘　　要：目的分析1例骨折术后并发脂肪栓塞综合征(FES)患者的药学服务过程,为类似患者的临床治疗和药学服务提供参考。方法临床药师参与1例骨折术后并发FES患者治疗的全过程,根据患者的临床表现、检验结果等情况,查阅文献,协助临床医师制定糖皮质激素的用药方案;针对患者治疗过程中出现的肾功能损害、血小板计数减少的药品不良反应,分析可疑药物并进行处置。结果临床药师建议使用注射用氢化可的松琥珀酸钠(100 mg,q8 h,ivgtt,连续使用约1周后逐渐减少剂量)治疗FES。该病例使用的注射用盐酸万古霉素与肾功能损害、血小板计数减少的药品不良反应关联性评价为“很可能”。临床医师采纳药师的用药建议,患者经过治疗后病情稳定,不良反应好转后出院。结论糖皮质激素治疗FES有明确疗效,临床药师应根据患者的病理状态个体化制定用药方案,并注意与术后脓毒血症加以区分,同时需要密切关注药物引起的肾脏、血液系统等不良反应。OBJECTIVE To analyze the pharmaceutical service process in a fracture patient complicated by fat embolism syndrome(FES)following postoperative fracture,aiming to provide a reference for clinical treatment and pharmaceutical service for similar patients.METHODS Clinical pharmacist participated in the entire treatment process of a patient with FES following postoperative fracture.Based on the patient’s clinical manifestations and test results,literature was reviewed to assist clinical physicians in formulating the therapeutic regimen of glucocorticoids.For the drug-related adverse reactions of renal function impairment and reduced platelet count that occurred during the treatment,suspicious drugs were analyzed and disposed of accordingly.RESULTS The clinical pharmacist recommended Hydrocortisone sodium succinate for injection(100 mg,q8 h,ivgtt,for about one week followed by a gradual dose reduction)for treating FES.The Vancomycin hydrochloride for injection used in this case was assessed as“very probably”associated with the adverse drug reactions of renal function impairment and thrombocytopenia.The clinical physician adopted the pharmacist’s medication recommendations,and the patient’s condition stabilized after treatment,with improvement in adverse reactions,and was discharged from the hospital.CONCLUSIONS The use of glucocorticoids in treating FES has a definite therapeutic efficacy.Clinical pharmacists should individualize the medication plan based on the patient’s pathological state and distinguish it from postoperative sepsis.Meanwhile,drug-induced adverse reactions in the kidney and blood system should be closely monitored.

关 键 词：脂肪栓塞综合征 药学服务 骨折术后 糖皮质激素 肾功能损害 血小板减少 

分 类 号：R969.3[医药卫生—药理学] R977.1[医药卫生—药学]