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临床药师对1例儿童难治性肺炎支原体肺炎并发脑梗死的药学监护
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| 篇名： | 临床药师对1例儿童难治性肺炎支原体肺炎并发脑梗死的药学监护 |
| TITLE： | |
| 摘要： | 目的：介绍临床药师对儿童难治性肺炎支原体肺炎并发脑梗死的药学监护，以提高临床对肺炎支原体导致脑梗死的认识和临床药师对该病治疗药物的管理水平。方法：临床药师对2018年10月复旦大学附属儿科医院收治的1例难治性肺炎支原体肺炎并发脑梗死的儿童病例进行治疗全程药学监护，主要对治疗过程中抗感染、抗炎、治疗脑梗死等方面的用药情况和可能出现的药物相互作用及疑似不良反应进行分析。结果：该患儿因肺炎支原体肺炎来院治疗，治疗期间出现脑梗死症状，先后予以注射用阿奇霉素抗感染、注射用甲泼尼龙琥珀酸钠抗炎、那屈肝素钙注射液抗凝、甘露醇注射液降颅压、右旋糖酐40葡萄糖注射液抗血栓、复方甘草酸苷注射液保肝、铝碳酸镁片护胃、静脉用丙种球蛋白对症支持治疗等一系列治疗。治疗期间，由于该患儿注射用阿奇霉素治疗效果不佳，考虑其脑梗死可能是难治性肺炎支原体感染导致的，故将注射用阿奇霉素更换为盐酸左氧氟沙星注射液抗感染，患儿预后良好；对于治疗期间患儿出现的肝酶升高，临床药师建议给予抗感染联合保肝治疗后肝酶恢复正常。在整个治疗过程中，临床药师主要监护抗凝药、糖皮质激素、保肝药、降颅压药物、解热镇痛药之间相互作用及可能叠加的不良反应，同时对患儿家属做好用药宣教，告知其需注意的药品不良反应和护胃药、糖皮质激素等药物的服用注意事项。结论：儿童难治性肺炎支原体导致的脑梗死是由肺炎支原体直接或间接介导的免疫反应过强引起的，治疗原则为抑制炎症反应、解决原发病、对症支持治疗，治疗过程中需要多药联用，因此更需要临床药师全程参与和药物精细化监护管理，以保障用药安全。 |
| ABSTRACT： | OBJECTIVE： To introduce the pharmaceutical care for refractory mycoplasma pneumoniae （MP） pneumonia combined with cerebral infarction in child by clinical pharmacist， and to improve further understanding of MP-induced cerebral infarction and the management level of the clinical pharmacist. METHODS： Clinical pharmacist provided whole course pharmaceutical care for a child case of refractory PM pneumonia complicated with cerebral infarction admitted to the Children’s Hospital of Fudan University in Oct. 2018. The drug use in anti-infection， anti-inflammatory， treatment of cerebral infarction， possible drug interactions and suspected ADR were analyzed during treatment. RESULTS： The child admitted to the hospital for treatment due to MP pneumonia. During the treatment， the child suffered from cerebral infarction symptoms. The child was given a series of treatment programs， such as Azithromycin for injection for anti-infection， Methylprednisolone sodium succinate for injection for anti-inflammation， Nadroparin calcium injection for anticoagulation， Mannitol injection for reducing intracranial pressure， Dextran 40 glucose injection anti-thrombosis， Compound glycyrrhizin injection for protecting liver function， Hydrotalcite tablets for protecting gastric mucosa， intravenous immunoglobulin symptomatic supportive treatment. During the treatment， due to the poor therapeutic effect of Azithromycin for injection， it was considered that the patient may have cerebral infarction caused by refractory MP infection， so the patient’s prognosis was good when Azithromycin injection was replaced with Levofloxacin hydrochloride injection for anti-infection. For the increase of liver enzyme during the treatment， clinical pharmacist suggested that anti-infection combined with liver protection was provided for the child and then the liver enzyme returned to normal. During the treatment， clinical pharmacist mainly monitored the interaction and possible adverse reactions among anticoagulants， glucocorticoids， liver protecting drugs， drugs for reducing cranial pressure， antipyretic and analgesic drugs， and at the same time， made medication publicity and education for the family members of the child， and inform them of the adverse reactions of drugs to be paid attention to and the precautions for taking stomach protecting drugs， glucocorticoids and other drugs. CONCLUSIONS： Cerebral infarction caused by refractory MP pneumonia in children is because of excessive immune response directly or indirectly mediated by MP. The principle of treatment is to inhibit the inflammatory response， to solve the primary disease， and symptomatic supportive treatment. Multi-drug combination is needed in the course of treatment， so it is more necessary for the clinical pharmacist to participate in the whole process and to manage the drug refinement and ensure the safety of drug use. |
| 期刊： | 2019年第30卷第23期 |
| 作者： | 海莉丽，朱琳，朱逸清，李智平，马姝丽 |
| AUTHORS： | HAI Lili，ZHU Lin，ZHU Yiqing，LI Zhiping，MA Shuli |
| 关键字： | 儿童；难治性肺炎支原体肺炎；脑梗死；药学监护 |
| KEYWORDS： | Children； Refractory Mycoplasma pneumoniae pneumonia； Cerebral infarction； Pharmaceutical care |
| 阅读数： | 454 次 |
| 本月下载数： | 8 次 |
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