摘要
目的:通过参与1例食管癌术后吻合口瘘合并混合感染重症患者使用氟康唑后出现肝性脑病的临床实践过程,探讨临床药师参与药品不良反应处理和开展药学监护的方法。方法:对患者病史、用药史及当前用药进行全面系统回顾,分析肝损伤与药物间的关系并评估用药方案,认为患者肝性脑病系氟康唑不良反应所致,协助医师制订抗感染(亚胺培南/西司他丁钠+替考拉宁)、降血氨(门冬氨酸鸟氨酸、异甘草酸镁)、保肝(还原性谷胱甘肽+多烯磷脂酰胆碱)等诊疗方案。结果:通过实施药学监护发现药源性肝性脑病,及时停用氟康唑并对症治疗,7 d后患者肝性脑病症状改善,肝功能恢复至正常。结论:临床药师应结合患者实际情况提供药学监护,及时发现不良反应,为保证合理有效用药起到积极的作用。
OBJECTIVE： To explore the methods of clinical pharmacist participating in disposition of ADR and developing pharmaceutical care by participating in pharmaceutical care for fluconazol-induced hepatic encephalopathy in a patient with anasto- mosis fistula complicating with mixed infection after esophageal carcinoma surgery. METHODS： The medical history, medication history and current medication were reviewed systematically, and the relationship of hepatic injury with drugs was analyzed and medication scheme was evaluated to believe that hepatic encephalopathy was induced by fluconazol. Clinical pharmacists assisted physicians to formulate anti-infection treatment （imipenern/cilastatin sodium＋teicoplanin）, ammonia reducing （ornithine aspartate, magnesium isoglycyrrhizinate） and liver protection scheme （reduced glutathione ＋ polyene phosphatidyl choline）. RESULTS： Drug-induced hepatic encephalopathy was found through the implementation of pharmaceutical care. Fluconazol administration was stopped timely and supported symptomatic treatment was adopted. A week later, hepatic encephalopathy of the patient was improved, and liver function returned to normal. CONCLUSIONS： Clinical pharmacists should provide pharmaceutical care based on the actual situation of patients, and find out ADR timely to ensure the rational and effective use of drugs.
出处
《中国药房》
CAS
CSCD
2014年第26期2493-2496,共4页
China Pharmacy
关键词
氟康唑
肝性脑病
混合感染
吻合口瘘
药学监护
Fluconazol
Hepatic encephalopathy
Mixed infections
Anastomosis fistula
Pharmaceutical care
