临床药师参与1例肾移植术后并发肺部感染患者的药学监护

摘 要 目的： 为肾移植术后肺部感染患者实施药学监护提供思路。方法: 临床药师全程参与1例肾移植术后并发肺部感染患者的诊疗经过，通过查阅文献，结合患者病情，充分考虑患者病史、临床症状和实验室检查，对该患者药物治疗过程进行分析，并总结其治疗过程中的药学监护重点。结果: 对该例肾移植术后肺部感染患者监护重点包括发病早期和病情好转时免疫抑制药剂量调整；多种抗感染药物与免疫抑制药合用时的药物相互作用；根据患者肾功能对患者用药剂量进行调整；药物不良反应监测等方面，为患者制定个体化用药方案。结论:临床药师通过全面的药学监护，能协助医师及时、有效地制定用药方案，为患者提供专业、有效的药学服务。

Pharmaceutical Care for One Case of Renal Transplantation Recipient with Pulmonary Infection

ABSTRACT Objective: To provide some thoughts for pharmaceutical treatment and care for the patients with pulmonary infection after renal transplantation.Methods: Clinical pharmacists participated the whole treatment process of one case of pulmonary infection after renal transplantation. According to the literatures combined with medical history, clinical symptoms and lab results, the drug treatment process of the patient was analyzed, and the key points of the optimized pharmaceutical care were summarized. Results: The pharmaceutical care included the dose adjustment of immunosuppressants at the early phase of the disease and after the improvement of clinical symptoms, attention paid to the interactions between multiple anti infective drugs and immunosuppressive agents, dosage adjustment based on the renal function of the patient, monitoring adverse drug reactions and drawing up personalized regimen. Conclusion:Through comprehensive medication monitoring, clinical pharmacists can help physicians develop timely and effective treatment programs and provide professional and effective pharmaceutical care for patients.