CAJ | 학술논문

1例44岁女性患者,因咯血入院,诊断为肺腺癌,肺栓塞.针对肺栓塞选用低分子肝素、华法林重叠抗凝治疗,患者入院12 d出现了肺部感染,给予静脉注射莫西沙星抗感染治疗3 d后调整为万古霉素,万古霉素单药治疗3 d后联合亚胺培南/西司他丁抗感染治疗一周,患者病情好转.入院18 d开始化疗,方案为:培美曲塞二钠联合卡铂.该患者在治疗上存在双重治疗矛盾,即抗凝与咯血,化疗与感染.临床药师在主要治疗矛盾的确定、抗感染药物的调整、化疗方案的评估等方面进行了药学监护.患者住院期间顺利完成第一周期化疗,状态好转出院.
1례44세녀성환자,인각혈입원,진단위폐선암,폐전새.침대폐전새선용저분자간소、화법림중첩항응치료,환자입원12 d출현료폐부감염,급여정맥주사막서사성항감염치료3 d후조정위만고매소,만고매소단약치료3 d후연합아알배남/서사타정항감염치료일주,환자병정호전.입원18 d개시화료,방안위:배미곡새이납연합잡박.해환자재치료상존재쌍중치료모순,즉항응여각혈,화료여감염.림상약사재주요치료모순적학정、항감염약물적조정、화료방안적평고등방면진행료약학감호.환자주원기간순리완성제일주기화료,상태호전출원.
One 44-year-old female patient was admitted to the hospital due to hemoptysis. The diagnosis was lung adenocarcinoma and pulmonary embolism. The pulmonary embolism was treated with low molecular weight heparin and warfarin. On the 12th day after admission, the patient developed pulmonary infection. Moxilfoxacin was given to the patient and transferred to vancomycin 3 days later. After 3 days, imipenem/cilastatin was added. The patient improved a week later. Simultaneous chemotherapy with pemetrexed disodium and carboplatin was given to the patient on the 18th day after admission. Anticoagulant therapy and hemoptysis as well as chemotherapy and infection were contradictory during the treatment. Pharmacists assisted physicians in determining the main therapeutic contradiction, adjusting anti-infective drugs, assessing chemotherapy schedule and so on. The patient underwent the ifrst cycle of chemotherapy successfully and was discharged with the improved condition.