对1例重症肺炎伴肾功能衰竭患者的药学监护

1例87a男性患者,因重症肺炎伴呼吸衰竭、休克、肾功能衰竭入ICU,先后予以莫西沙星、头孢哌酮舒巴坦联合万古霉素和卡泊芬净抗感染,多巴胺升压、氢化可的松抗休克以及肠外营养等治疗。该患者有糖尿病史,在肠外营养支持过程中,对患者血糖情况进行监测;根据患者肝肾功能情况,及时调整抗菌药物剂量,并对莫西沙星致神经系统不良反应进行监测。治疗期间,临床药师在药物剂量调整,营养状况评估,潜在的药物不良反应,生命体征监测特别是肝肾功能情况等方面提供了全面及时的药学服务。

Pharmaceutical care on a patient with severe pneumonia and renal failure

An 87-year-old male patient with severe pneumonia accompanied with respiratory failure,shock and renal failure was hospitalized in ICU.The patient was treated with combination use of moxifloxacin,cefoperazone and sulbactam,vancomycin and caspofungin for anti-infection,dopamine for boosting pressure,hydrocortisone for septic shock and parenteral nutrition therapy.The patient had the history of diabetes,the blood sugar levels were monitored during the therapy of nutritional support;the dose of antibacterials were adjusted timely according to liver and kidney function;the nervous system adverse reaction caused by moxifloxacin was monitored.During the treatment,clinical pharmacist timely assessed the drug therapy,and provided the pharmaceutical care on the dose adjustment,nutritional status assessment,monitoring potential adverse drug reactions and the vital signs especially for liver and kidney function.