1例胃癌术后重症腹腔感染患者的药学监护

1例56岁女性患者,因反复胃痛加重、纳差、乏力入院。既往有甲亢病史,曾行胆囊摘除术,入院诊断为胃体印戒细胞癌,在抑酸、保护胃黏膜及对症治疗后行胃癌根治性切除术、胃空肠吻合术。术后抑制胰酶、肠液分泌和静脉营养支持,腹腔引流液送病原学检查和药敏试验。临床药师参与抗感染治疗方案的评估,结合细菌培养结果和药敏试验结果,先后采用降阶梯抗细菌治疗和抗真菌治疗。鉴于用药过程中患者病情变化,参考实验室检验指标和院内感染耐药菌监测结果选择抗菌药物,调整用药剂量,对应激性血糖升高给予监测和控制,加强肠外营养,观察用药中潜在不良反应,治疗一个月后,患者病情稳定出院。

Pharmaceutical care on a patient with severe intra-abdominal infections after the surgery of gastric cancer

One 56-year-old female patient with a history of hyperthyreosis and gallbladder enucleation was hospitalized for repeated stomach pain, anorexia and hypodynamia. She was diagnosed with gastric signet ring cell cancer, and received radical gastrectomy and gastronesteostomy after the treatments of restrain acid and gastricmucosa protection. The treatments of controlling the secretion of pancreatin and intestinal juice and nutrition support were given after the surgery. The major pathogens and drug sensitive test were performed using the drainage fluid of peritoneal cavity. Clinical pharmacists participated in the evaluation of the antibacterial therapy. According to the results of bacterial culture and drug sensitive test, deescalation therapy was used to treat bacterial and fungal infection. Considering the change of condition during the treatment and the monitoring results of drug resistance bacteria in our hospital, clinical pharmacists formulated the treatment plan with the doctors, adjusted the drug dosage, monitored and controlled stress hyperglycemia, provided parenteral nutrition support and observed potential ADRs in therapy. The patient discharged from hospital a month later.