1例脑胶质瘤切除术后肺部感染患者的药学监护

摘 要 目的：研究ICU重症感染患者的药学监护重点。方法: 通过参与1例脑胶质瘤切除术后肺部感染患者的药物治疗，结合患者病史、临床症状和实验室检查，协助医师制订用药方案并针对抗感染治疗、镇静镇痛、抗血小板治疗以及用药过程中的药物相互作用、注意事项以及药品不良反应进行全程药学监护。结果: 通过全程药学监护提高了患者药物治疗的安全性和有效性，患者各项生命体征平稳，抗感染治疗有效，顺利转出ICU继续巩固治疗。结论:临床药师在参与临床药物治疗过程中，应根据患者具体情况协助医师制订合理有效的个体化用药方案，为患者提供专业、有效、优质的药学服务。

Pharmaceutical Care Performed by Clinical Pharmacists for One Patient with Pulmonary Infection after Glioma Resection

ABSTRACT Objective: To study the pharmaceutical care for patients with severe infection in ICU performed by clinical pharmacists. Methods: Clinical pharmacists participated in the medication treatment process of one case of patient with pulmonary infection after glioma resection. According to the medical history, clinical symptoms and lab results, the pharmaceutical care was given in the respects of anti infection therapy, analgesia/sedation, anti platelet therapy, drug interactions, drug precautions and adverse drug reactions. Results: The compliance, therapeutic effect and medication safety of the patient were all improved by giving clinical pharmaceutical care. The vital signs of the patient were stable, the anti infection therapy achieved satisfactory therapeutic effects, and then the patient transferred from ICU and continued to be treated with rehabilitation therapy. Conclusion:Clinical pharmacists in medical team can assist physicians on the basis of the status of patients with reasonable and effective individualized medication and provide professional and efficient pharmaceutical care with high quality.