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临床药师对1例骨肉瘤患者术后假体周围感染的药学监护
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| 篇名： | 临床药师对1例骨肉瘤患者术后假体周围感染的药学监护 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在骨肉瘤患者术后假体周围感染（PJI）个体化治疗中的作用。方法：我院收治了1例骨肉瘤患者，术后出现PJI，临床药师根据患者病原学和药敏结果对其初始抗感染方案进行调整并进行药学监护，根据抗菌药物药动学-药效学（PK-PD）原理，结合治疗药物监测（TDM）进行抗菌药物剂量调整。当患者出现药品不良反应时，临床药师再次调整用药方案。结果：该患者明确PJI诊断后首先给予头孢替安进行经验性治疗；在获得病原学和药敏结果后，临床药师建议换用对耐苯唑西林表皮葡萄球菌敏感的万古霉素进行针对性抗感染治疗，根据稳态谷浓度调整给药剂量后，患者出现轻度肝功能损伤，同时伴有胸闷气促等症状，临床药师分析后考虑为万古霉素相关药物不良反应，再次建议换用替考拉宁进行治疗。医师采纳临床药师建议更换治疗方案后，患者PJI得到有效控制，且不良反应症状消失，最终痊愈出院。治疗期间，临床药师还针对患者所用药品进行用药教育。结论：临床药师需熟练掌握抗菌药物PK-PD原理，积极运用TDM技术手段对抗感染药物的临床疗效和安全性进行动态评估，从而为骨肉瘤术后PJI患者制订个体化抗感染药物治疗方案，提高临床治疗效果，保障用药安全。 |
| ABSTRACT： | OBJECTIVE： To explore the role of clinical pharmacist in individualized treatment for osteosarcoma patients with periprosthetic joint infection （PJI）. METHODS： An osteosarcoma patient was admitted to our hospital and then suffered from PJI after operation. Clinical pharmacist adjusted the initial anti-infection plan and carried out pharmaceutical care according to the results of patients’ etiology and drug sensitivity. According to the PK-PD principle， combined with the therapeutic drug monitoring （TDM）， the dose of antibiotics was adjusted. With the occurrence of ADR， the antibiotic therapeutic regimen was adjusted again. RESULTS： The patient was administrated cefotiam for empiric therapy initially after the diagnosis of PJI. After obtaining the results of etiology and drug sensitivity， the clinical pharmacist suggested that vancomycin sensitive to penicillin-resistant Staphylococcus epidermidis should be used for targeted anti-infection treatment. After adjusting the dosage according to the steady-state valley concentration， the patient had slight liver function damage， accompanied with chest tightness and shortness of breath. After analysis， the clinical pharmacist considered the adverse drug reactions related to vancomycin， and again suggested that the patient should be treated with teicoplanin. After the doctor adopted the treatment plan recommended by the clinical pharmacist， PJI of the patient was effectively controlled， and the adverse reaction symptoms disappeared. The patient was effectively cured for PJI and discharged eventually. During the treatment period， the clinical pharmacist also carried out medication education for the drugs used by the patient. CONCLUSIONS： Clinical pharmacist should master the principle of antibiotic drug PK-PD theory and evaluate the clinical efficacy and safety of anti-infective drugs dynamically based on the guidance of TDM， so as to develop individualized anti-infection therapeutic regimen for osteosarcoma patient with PJI， improve the effect of clinical treatment and guarantee the safety of drug use. |
| 期刊： | 2019年第30卷第23期 |
| 作者： | 黄芃，岳慧杰，黄晓晖，樊根涛，曹莉莉，张晏洁 |
| AUTHORS： | HUANG Peng，YUE Huijie，HUANG Xiaohui，FAN Gentao，CAO Lili，ZHANG Yanjie |
| 关键字： | 临床药师；骨肉瘤；假体周围感染；抗感染；药学监护 |
| KEYWORDS： | Clinical pharmacist； Osteosarcoma； Periprosthetic joint infection； Anti-infection； Pharmaceutical care |
| 阅读数： | 364 次 |
| 本月下载数： | 3 次 |
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