肾内科临床药师参与1例腹膜透析相关性腹膜炎患者的药学监护

目的：探讨临床药师参与抗感染个体化治疗和开展药学监护的方法。方法：通过参与1例腹膜透析相关性腹膜炎患者的药物治疗实践,临床药师参与临床治疗团队,根据患者病情及药敏试验,提供合理性建议;对患者抽搐等不良反应进行药学监护;对患者血液滤过治疗实时调整药物剂量,提供个体化治疗方案。结果：患者腹膜透析相关性腹膜炎得到有效控制,不良反应症状消失,好转出院。结论：临床药师深入临床直接面向患者提供药学服务,在制订个体化治疗方案及药学监护中发挥了重要作用。

Clinical Pharmacist Participating in Pharmaceutical Care for a CAPD-related Peritonitis Patient in Ne- phrology Department

OBJECTIVE： To investigate the methods of providing individualized therapy and pharmaceutical care by clinical phar macists. METHODS： By participating in drug therapy for a case of CAPD-related peritonitis, clinical pharmacists joined in clinical treatment team and provided reasonable opinions according to disease condition and the results of drug sensitive test; special pharmaceutical cares were offered for adverse effect such as hyperspasmia; drug dosage was adjusted in time according to the condition of hemofiltration in order to provide individualized therapy. RESULTS： The CAPD-related peritonitis was controlled effectively and ADR disappeared, and then the patient was discharged from hospital. CONCLUSIONS： Clinical pharmacist providing pharmaceutical care for patients directly in clinic plays an important role in developing individualized treatment and pharmaceutical care.