1例肝脓肿术后高钠血症并发脱髓鞘病变患者的药学监护

摘 要 目的：分析临床药师参与典型疑难危重患者的诊治过程，总结药学监护中临床药师应具备的临床及药学思维，以便更好地服务临床工作。方法: 通过临床药师参与1例肝脓肿术后高钠血症患者并发脱髓鞘病变案例的诊疗过程，结合患者实验室检验指标、影像学检查结果和药物治疗方案，判断分析患者病情变化的根本原因和可采取的治疗措施，提出合理的用药建议。结果: 临床药师密切关注患者用药史和病情变化，及时评估患者的治疗效果，与临床医师积极沟通和讨论，为患者制定个体化治疗方案，取得了良好的治疗效果。结论:临床药师抓主要矛盾，注重细节，在危重症患者的救治过程中可以发挥重要的作用。

Pharmaceutical Care for One Patient with Hypernatronemia Complicated with Demyelination after Hepatic Abscess Drainage

ABSTRACT Objective: To analyze the participation of clinical pharmacist in the process of diagnose and treatment of typical critical patients and summarize the clinical and pharmaceutical thoughts of clinical pharmacist in pharmaceutical care in order to provide better service for clinics. Methods:Through the participation of clinical pharmacist in the process of diagnose and treatment of one patient with hypernatronemia complicated with demyelination after liver abscess drainage, and combined with the results of laboratory tests and imaging examination and drug treatment regimen, clinical pharmacists analyzed the radical causes of apostasies and feasible therapeutic measures, and then provided the reasonable suggestions for the medication. Results:Clinical pharmacist paid close attention to the medication history and disease evolution of the patient, assessed the therapeutic efficacy timely, communicated and discussed with clinical doctors actively, and then made out individualized treatment schedule for the patient, which obtained promising effects. Conclusion: Clinical pharmacist should grasp the principal contradictions and pay attention to details, which can play an important role in the treatment course of severe patients.