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中国医药导刊 ›› 2021, Vol. 23 ›› Issue (10): 764-767.

• 案例分析 • 上一篇    下一篇

1例术后感染伴肾功能亢进患者的药学治疗实践

 李璐璐1,周鹏2*   

  1. 1.阜外华中心血管病医院药学部,河南 郑州 450000; 2.河南中医药大学第一附属医院药学部,河南 郑州 450000
  • 收稿日期:2021-10-26 修回日期:2021-10-28 出版日期:2021-10-28 发布日期:2021-10-28

Pharmaceutical Practice in the Treatment of a Patient with Postoperative Infection and Kidney Hyperfunction

  1. 1.Department of Pharmacy,Fuwai Central China Cardiovascular Hospital,Henan Zhengzhou 450000,China; 2.Department of Pharmacy,the First Affiliated Hospital of Henan University of Chinese Medicine,Henan Zhengzhou 450000,China
  • Received:2021-10-26 Revised:2021-10-28 Online:2021-10-28 Published:2021-10-28

摘要: 目的:以临床药师参与的1例术后感染伴肾功能亢进(ARC)患者个体化抗感染治疗过程为例,为临床肾功能亢进患者使用β-内酰胺类药物治疗方案的制定提供参考。方法:临床药师通过会诊1例亚胺培南西司他丁钠治疗纵膈肿瘤切除术后出现肺部感染的病例,根据患者临床情况及相关检查结果,并结合国内外文献,从药代动力学/药效学(PK/PD)角度对亚胺培南西司他丁钠治疗失败的原因进行分析,调整治疗方案。结果:治疗方案调整后,患者体温和炎症指标均下降,感染得到有效控制;肌酐清除率(CCr)由208.47 mL·min-1逐步降至95.30 mL·min-1,肾功能亢进得到改善。结论:当发生抗感染治疗效果不佳时,应多方面考虑原因,尤其对年轻的术后患者应考虑是否存在肾功能亢进;临床药师应协助临床及时调整给药方案,保障用药安全、有效、合理。

关键词: font-size:medium, ">肾功能亢进;亚胺培南西司他丁钠;临床药师;PK/PD

Abstract: Objective:Take a case of patient with postoperative infection accompanied by hyperrenal function that the clinical pharmacist is involved as an example,to provide reference for the formulation of β-lactam drug therapy in patients with clinical hyperrenal function.Methods:Clinical pharmacists participated in the treatment of a case of pulmonary infection after resection of mediastinal tumor treating withimipenem and cilastatn sodium.Based on the patient′s clinical conditions and relevant examination results, combined with domestic and foreign literatures,the causes for the failure of imipenem and cilastatnsodium treatment were analyzed from the perspective of PK/PD,and the alternative treatment regimen was proposed.Results:After the adjustment of the treatment regimen, the patient's body temperature and inflammatory indicators dropped, and the infection was effectively controlled. The creatinine clearance rate gradually decreased from 208.47 mL·min-1 to 95.30 mL·min-1, and kidney hyperfunction was improved.Conclusion:Many aspects should be considered when the anti-infection treatment is not effective.especially for young and postoperative patients, the presence of kidney hyperfunction should be considered. Clinical pharmacists should assist clinicians to adjust the dosage regimen in time,and ensure the safety, effectiveness and rationality of medication.

Key words: font-size:medium, ">Kidney hyperfunction;Imipenem and cilastatnsodium;Clinical pharmacist;PK/PD

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