摘要
目的:探讨临床药师在气性坏疽患儿抗感染治疗中的作用。方法:临床药师参与1例气性坏疽患儿的抗感染治疗过程,根据患儿临床症状及各科室会诊意见,建议使用注射用哌拉西林钠他唑巴坦钠初始抗感染治疗;患儿经左下肢清创引流、坏死组织清除术后,临床药师根据气性坏疽的病原学特点及相关指南,建议停用注射用哌拉西林钠他唑巴坦钠,改用注射用青霉素钠+注射用亚胺培南西司他丁钠联合抗感染;根据患儿伤口分泌物细菌培养及药敏试验结果,建议加用盐酸克林霉素氯化钠注射液0.6g,q8 h,ivgtt抑制产气荚膜梭菌生长;根据患儿体征及病原学结果的改变,先后提出停用盐酸克林霉素氯化钠注射液、改用注射用盐酸万古霉素等建议。结果:医师采纳临床药师建议。患儿经外科手术及抗感染治疗后,病情好转,生命体征平稳,转入骨科普通病房继续治疗。结论:临床药师参与气性坏疽患儿的治疗过程,结合相关指南以及患儿的临床症状、病原学检查结果、各科室会诊意见,协助医师制订和调整抗感染治疗方案,保证了患儿用药的安全、有效。
OBJECTIVE： To investigate the role of clinical pharmacists in the anti-infection treatment for gas gangrene chil- dren. METHODS ： Clinical pharmacists participated in the anti-infection treatment of a child with gas gangrene; according to clini- cal symptoms and consultation opinions of different departments, it was suggested to use Piperacillin sodium and tazobactam sodi- um for injection for initial anti-infection treatment. After debridement and drainage of left lower limb, removal of necrotic tissue, clinical pharmacists suggested to stop giving Piperacillin sodium and tazobactam sodium for injection and use Benzylpenicillin sodi- um for injection combined with Imipenem and cilastatin sodium for injection instead for anti-infection treatment according to etiolog- ical characteristic of gas gangrene and related guidelines. According to the results of bacterial culture of wound secretion and drug sensitivity test, clinical pharmacists additionally suggested to use Clindamycin hydrochloride and sodium chloride injection 0.6 g, q8 h, ivgtt to inhibit the generation of Clostridium perfringens. According to the changes of patient＇ s signs and etiological results, it was suggested to stop taking Clindamycin hydrochloride and sodium chloride injection, use Vancomycin hydrochloride for injection successively. RESULTS： The physicians adopted the suggestions of clinical pharmacists. After surgical treatment and anti-infec- tion treatment, the patient＇s condition was improved, the vital signs were stable, and the patient was transferred to the general ward of orthopedics department for further treatment. CONCLUSIONS： Clinical pharmacists participate in the treatment of gas gan- grene child, and assist physicians to formulate and adjust anti-infection treatment plan according to related guidelines, clinical symp- toms, etiological examination results and consultation opinions, so as to guarantee safe and effective drug use.
作者
徐中良
沈正泽
董其勇
向萍
金梅
XU Zhongliang SHEN Zhengze DONG Qiyong XIANG Ping JIN Mei(Dept. of Pharmacy, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China)
出处
《中国药房》
CAS
北大核心
2017年第29期4154-4157,共4页
China Pharmacy
基金
重庆医科大学附属永川医院院内科研课题资助项目(No.YJQN201431)
关键词
气性坏疽
抗感染治疗
用药分析
临床药师
Gas gangrene
Anti-infection treatment
Analysis of drug use
Clinical pharmacists
