临床药师参与1例发热性中性粒细胞缺乏患者抗感染治疗的药学监护

目的:探讨临床药师在发热性中性粒细胞缺乏患者抗感染治疗过程中所发挥的作用。方法:临床药师参与了1例骨髓增生异常综合征患者使用地西他滨治疗后发生发热性中性粒细胞缺乏的抗感染治疗过程。该患者用药过程顺利,但在用药后出现了Ⅳ度骨髓抑制,并发了严重感染,临床医师给予积极抗感染治疗及支持治疗,根据文献数据及药物特性,结合患者基本情况,权衡提出了抗感染的治疗方案调整。结果:取得了良好的治疗效果,患者好转出院。结论:对于粒细胞缺乏患者的感染,由于监测病原菌阳性率较低,需根据病史及病情变化过程经验性用药,尤其需要考虑合并感染的用药,这是临床药师面对这类患者的用药监护点。

Pharmaceutical Care for Anti-infective Therapy in a Patient with Febrile Neutropenia by Clinical Pharmacists

OBJECTIVE： To investigate the role of clinical pharmacists during anti-infective therapy for a patient with febrile neutropenia. METHODS： Clinical pharmacists participated in treatment process for febrile neutropenia in a patient with myelodysplastic syndrome after decitabine therapy; there were no problems during treatment, but the patient suffered from IV degree arrest of bone marrow and serious infection; clinical physicians provided anti-infective treatment and support treatment. The adjustment of anti-infective plan had been formulated according to literature data, the characteristics of drugs and general situation of patient. RESULTS： Good therapeutic effect had been obtained, and the patient was discharged from the hospital. CONCLUSIONS： Due to low positive rate of monitored pathogenic bacteria, based on medical history and the change of disease condition, empirical medication and therapy for combined infection should be considered for neutropenia patient, which are the points of pharmaceutical care for such patients.