中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
1期
108-112
,共5页
张红梅%孙丽蕊%田旭%郭秋实%孙智辉
張紅梅%孫麗蕊%田旭%郭鞦實%孫智輝
장홍매%손려예%전욱%곽추실%손지휘
临床药师%慢性阻塞性肺疾病%肾功能不全%药学监护
臨床藥師%慢性阻塞性肺疾病%腎功能不全%藥學鑑護
림상약사%만성조새성폐질병%신공능불전%약학감호
Clinical pharmacist%Chronic obstructive pulmonary disease%Renal insufficiency%Pharmaceutical care
本文报道了1例老年慢性阻塞性肺疾病急性加重伴肾功能不全患者进行临床药师药学监护。此患者入院给予注射用哌拉西林舒巴坦等药物治疗。由于指南中未提及肾功能减退患者哌拉西林舒巴坦的剂量调整方法，临床药师考虑哌拉西林舒巴坦与哌拉西林他唑巴坦的半衰期、排泄时间和排泄比率相似，因此用药方案采用哌拉西林他唑巴坦的剂量调整方法；患者入院第3天复查血常规提示白细胞、血小板计数低于正常值范围，临床药师考虑为哌拉西林舒巴坦的不良反应，停药后白细胞、血小板计数升至正常值范围；另外，临床药师根据患者用药情况，对支气管舒张剂的注意事项、氟康唑胶囊与其他药物的相互作用、双歧杆菌四联活菌片与美罗培南应用时间等方面进行药学监护，后患者病情好转出院。临床药师针对慢性阻塞性肺疾病的正规治疗方案对患者进行用药教育及出院注意事项的指导。
本文報道瞭1例老年慢性阻塞性肺疾病急性加重伴腎功能不全患者進行臨床藥師藥學鑑護。此患者入院給予註射用哌拉西林舒巴坦等藥物治療。由于指南中未提及腎功能減退患者哌拉西林舒巴坦的劑量調整方法，臨床藥師攷慮哌拉西林舒巴坦與哌拉西林他唑巴坦的半衰期、排洩時間和排洩比率相似，因此用藥方案採用哌拉西林他唑巴坦的劑量調整方法；患者入院第3天複查血常規提示白細胞、血小闆計數低于正常值範圍，臨床藥師攷慮為哌拉西林舒巴坦的不良反應，停藥後白細胞、血小闆計數升至正常值範圍；另外，臨床藥師根據患者用藥情況，對支氣管舒張劑的註意事項、氟康唑膠囊與其他藥物的相互作用、雙歧桿菌四聯活菌片與美囉培南應用時間等方麵進行藥學鑑護，後患者病情好轉齣院。臨床藥師針對慢性阻塞性肺疾病的正規治療方案對患者進行用藥教育及齣院註意事項的指導。
본문보도료1례노년만성조새성폐질병급성가중반신공능불전환자진행림상약사약학감호。차환자입원급여주사용고랍서림서파탄등약물치료。유우지남중미제급신공능감퇴환자고랍서림서파탄적제량조정방법，림상약사고필고랍서림서파탄여고랍서림타서파탄적반쇠기、배설시간화배설비솔상사，인차용약방안채용고랍서림타서파탄적제량조정방법；환자입원제3천복사혈상규제시백세포、혈소판계수저우정상치범위，림상약사고필위고랍서림서파탄적불량반응，정약후백세포、혈소판계수승지정상치범위；령외，림상약사근거환자용약정황，대지기관서장제적주의사항、불강서효낭여기타약물적상호작용、쌍기간균사련활균편여미라배남응용시간등방면진행약학감호，후환자병정호전출원。림상약사침대만성조새성폐질병적정규치료방안대환자진행용약교육급출원주의사항적지도。
An old male patient with chronic obstructive pulmonary disease and renal insufficiency is reported in this article. Piperacillin/sulbactam injection and other medicine were using to the patient. The guidance does not mention the dose adjustments of piperacillin/sulbactam in patients with renal insufficiency. Considering piperacillin/ sulbactam and piperacillin/tazobactam had similar half-life, excretion duration and excretion rate, clinical pharmacist advises piperacillin/tazobactam adjustments could be used for the therapeutic strategy. According to the blood count of the pa-tient, the leukocyte and platelet were below the normal range after three days hospital treatment. Clinical pharmacist considered the piperacillin/sulbactam adverse reaction caused this transformation. As the doctor withdrawals piperacillin/sulbactam, the leukocyte and platelet rose to the normal range. In addition, according to the situation of the patient, clinical pharmacist made pharmaceutical care on bronchodilator precautions, drug interactions with fluconazole capsules, application time of tetralogy of viable bifidobacterium and meropenem. The condition of patient became better and discharges from the hospital after reasonable treatment. In view of the importance of long-term and regular treat-ment of chronic obstructive pulmonary disease, clinical pharmacist offered medication education and precautions guid-ance for the patient.
