1例军团菌重症肺炎抗感染治疗药学监护及文献分析  

Anti-infective treatment for a severe case of Legionella pneumonia:pharmaceutical care and literature analysis

作　　者：李芳 王宁 金典 龙秀英[2] 曾尚霞[2] 魏京霞[1] LI Fang;WANG Ning;JIN Dian;LONG Xiuying;ZENG Shangxia;WEI Jingxia(Dept.of Pharmacy,Chengdu Sixth People’s Hospital,Chengdu 610051,China;Dept.of Neurology,Chengdu Sixth People’s Hospital,Chengdu 610051,China)

机构地区：[1]成都市第六人民医院药剂科,成都610051 [2]成都市第六人民医院神经内科,成都610051

出　　处：《中国药房》2024年第24期3081-3086,共6页China Pharmacy

基　　金：成都市医学科研课题立项项目(No.2023641)。

摘　　要：目的为军团菌重症肺炎抗感染治疗药学监护提供治疗思路与参考。方法临床药师参与1例军团菌重症肺炎患者治疗全过程,协助临床医师根据患者临床症状、体征、肺部影像学变化等,利用WUH(Winthrop-UniversityHospitalcriteria)评分系统评估感染病原体,利用其药学专业知识,建议哌拉西林钠他唑巴坦钠联合盐酸莫西沙星抗感染,实时监护患者的临床表现;及时发现患者谵妄和脂肪酶、淀粉酶、肝酶异常升高,分析原因后,先后建议调整治疗方案为哌拉西林钠他唑巴坦钠联合多西环素或阿奇霉素抗感染,并配合保肝治疗、肠内营养、肠外营养。此外,临床药师还密切关注患者的用药依从性并对其进行用药教育。结果临床医师采纳临床药师的建议,患者治疗后好转出院,1个月后复查无反复。结论临床药师在协助临床医师治疗军团菌重症肺炎时,不仅需关注患者临床症状、体征的改变,还需密切监测氟喹诺酮类、四环素类以及大环内酯类抗菌药物的不良反应,及时识别不良反应并提供治疗方案调整建议,并为患者提供全程药学监护,保证临床治疗的有效性和安全性。OBJECTIVE To provide certain therapeutic ideas and references for the pharmaceutical care of severe Legionella pneumonia in anti-infection treatment.METHODS Clinical pharmacists participated in the entire treatment process of a patient with severe Legionella pneumonia,and assisted clinical physicians in evaluating the infecting pathogens using the WUH(Winthrop-University Hospital criteria)scoring system,based on the patient’s clinical symptoms,physical signs,and changes in pulmonary imaging.Leveraging their pharmaceutical expertise,clinical pharmacists recommended a combination of piperacillin sodium and tazobactam with moxifloxacin hydrochloride for anti-infection treatment,and closely monitored the patient’s clinical manifestations.They promptly identified delirium and abnormally elevated levels of lipase,amylase and liver enzymes,and successively suggested adjusting the treatment plan to a combination of piperacillin sodium and tazobactam with doxycycline or azithromycin for anti-infection after analyzing the causes,along with liver protection treatment,enteral nutrition,and parenteral nutrition.Additionally,clinical pharmacists closely monitor the patient’s medication adherence and provide her with medication education.RESULTS The clinical physicians accepted the recommendations of the clinical pharmacists,and the patient improved after treatment and was discharged.A follow-up examination one month later showed no recurrence.CONCLUSIONS Clinical pharmacists,when assisting clinicians in treating severe Legionella pneumonia,not only pay attention to changes in the patient’s clinical symptoms and physical signs,but also closely monitor the adverse reactions of fluoroquinolone,tetracycline,and macrolide antibiotics.They should promptly recognize adverse reactions and provide recommendations for adjusting treatment plans,as well as offer comprehensive pharmaceutical care throughout the patient’s treatment,to ensure the effectiveness and safety of clinical therapy.

关 键 词：重症肺炎 军团菌 药学监护 不良反应 临床药师 WUH评分系统 

分 类 号：R969.3[医药卫生—药理学]