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目的:探讨临床药师在慢性肾功能不全合并肺部重症感染患者救治团队中的作用。方法:临床药师参与1例腹膜透析患者的抗感染治疗方案讨论、制定与调整,并为患者提供个体化全程药学监护。结果:在治疗过程中,临床药师建议加用利奈唑胺抗革兰阳性菌治疗,同时考虑长疗程使用广谱抗菌药物可增加二重感染风险,与医师共同为患者制定了头孢哌酮/舒巴坦作为降阶梯治疗方案,并为患者确定了具体的给药间隔,患者病情得到有效控制后好转出院。结论:全程药学监护有助于提高临床用药的合理性、安全性及有效性。
Objective: To investigate the role of clinical pharmacists in the treatment of patients with chronic renal failure and severe pulmonary infection. Methods: Clinical pharmacists involved in 1 case of peritoneal dialysis patients with anti-infective treatment program to discuss, develop and adjust, and provide patients with personalized full-time pharmacy care. Results: During the course of treatment, clinical pharmacists recommended adding linezolid to Gram-positive bacteria while considering the long-term use of broad-spectrum antimicrobial drugs to increase the risk of double infection. Together with the physicians, they formulated cefoperazone / Bartan as a step-down treatment program, and for patients to determine the specific dosing interval, the patient’s condition was effectively controlled and discharged after better. Conclusion: The whole pharmacy monitoring helps to improve the rationality, safety and effectiveness of clinical medication.