临床药师对化脓性心包积液患者的药学监护

目的：通过对化脓性心包积液患者的药学监护，探讨开展药学监护的方法。方法：临床药师对1例化脓性心包积液患者在抗感染药物的选择、药物浓度测定、药物不良反应观察、药源性疾病诊断和预防等方面实行药学监护。结果：在常规抗感染治疗中，临床药师针对患者的耐药情况及药物抗菌谱特点，建议将抗感染药物左氧氟沙星、头孢吡肟调整为万古霉素、奥硝唑；并对万古霉素使用期间所致的药物热、白细胞降低等不良反应进行监测。医生采纳临床药师建议后，患者相关症状得到缓解。结论：临床药师应与临床医师密切合作，积极开展药学监护，协同临床优化给药方案。

Pharmaceutical Care on the Patient with Purulent Pericarditis

Objective： To explore how to develop the method of pharmaceutical service according to the pharmaceutical care on the patient with purulent pericarditis. Methods： The pharmaceutical care on a patient with purulent pericarditis was implemented in respect of the selection of anti-infective drugs, determination of drug concentration, observation of adverse drug reaction, diagnosis and prevention of drug-induced diseases and so on. Results： In the treatment of anti-infection, clinical pharmacist suggested adjusting the antibiotics of vancomycin and ornidazole instead of levofloxacin and cefepime according to the drug resistance and the antibacterial spectrum, and the adverse drug reactions of leucopenia and drug fever induced by vancomycin were monitored. The doctors adopted the suggestions and the related symptoms of the patient were remitted. Conclusion： Clinical pharmacist should cooperate with clinical doctor, provide active pharmaceutical care and optimize drug scheme.